Prisons, psychiatric hospitals, administrative detention centers, the General Controller of Places of Deprivation of Liberty (CGLPL) publishes a thematic report on “The words of people deprived of their liberty”. In psychiatry, he denounces a system where the control authorities are sometimes “ghostly” and where the lack of confidentiality of appeals hinders the defense of rights. Between lack of resources and professional resistance, the urgency today is to transform these places of constraint into spaces for real dialogue to restore the dignity of people treated without consent.
The latest report from Dominique Simonnot, the general controller of places of deprivation of liberty (CGLPL) deals with the expression and participation of people deprived of liberty, understood here as all the ways, individual and collective, spontaneous as well as organized by establishments, direct and indirect, allowing them to share opinions, requests or suggestions, to take part in certain decision-making processes or even to alert, including beyond the walls. It questions the coherence between discourse and practices and the opportunities as well as the limits, in law and in fact, in taking into account what these people have to say.
This report highlights in particular that the words of patients hospitalized in psychiatry are often discredited by the institution. Although the right to express grievances is recognized, both orally and in writing, no guarantee of confidentiality is provided for these procedures. The hospitalized person’s charter certainly allows comments on care to be made, but access to information remains precarious. The welcome booklets and the displays concerning user fees are sometimes incomplete or inaccessible in certain units, she further emphasizes. Furthermore, the use of professional interpreting is frequently restricted to medical interviews only, which limits the ability of non-French-speaking patients to express themselves about their daily lives. “Their words (that of people deprived of their liberty), and particularly those of psychiatric patients, remain susceptible to being discredited. Security prisms and injunctions, to which places of confinement are particularly permeable, also tend to reduce those they welcome to troublemakers of public order, more or less asserted dangerousness. notes the report.
Very limited participation and representation of users
Concerning collective representation, the current framework presents significant structural limits. If the participation of user representatives is planned within user commissions, it remains optional at the level of services and hospitalization units.. These representatives often come from family associations rather than patient groups themselves, which creates a gap in the defense of the direct interests of users. The involvement of patients in the development of the establishment project also remains exceptional, even if the development of user-specific projects is progressing in certain places. “In fact, if the participation of user representatives is planned within the User Commissions (CDU), elsewhere it is optional. No representation of users is provided within hospital services and units and nothing allows patients to claim to play a role in this sense.
Spaces for dialogue that are lacking
Furthermore, spaces for dialogue, such as caregiver-patient meetings, are “optional” et “continue to be lacking in many establishments”notes the report. The lack of staff and the intensification of nursing work tend to reduce these exchanges to reframing functions or psychoeducation sessions, thus neglecting dialogue on the conditions of care. “However, for patients, these meetings can constitute an opportunity to express themselves and to feel considered and recognized as interlocutors”. The report observes, however, that discussions on “daily life, material conditions, schedules, activities or even the organization of care (…) make it possible to collectively identify difficulties and solutions”sometimes concretely improving the care “activity offers, layout of premises, room equipment, food…”.
Finally, external control is considered insufficient, particularly through the Departmental Psychiatric Care Commissions which are described as “ghostly” (see box below),“lack of doctors, user representatives, sometimes both”. These bodies struggle to meet regularly due to a lack of members or doctors and rarely respect the obligation to carry out two annual visits per establishment. Many patients, and even certain professionals, are unaware of the existence of these commissions, which makes the right to appeal theoretical. Patients also remain largely excluded from feedback aimed at preventing adverse events or reducing isolation and restraint measures.
« Des commissions départementales des soins psychiatriques fantomatiques »
« Si les commissions départementales des soins psychiatriques (CDSP) comptent parmi les interlocuteurs extérieurs susceptibles d’œuvrer au respect des droits des patients hospitalisés en soins sans consentement, ce point de contact se révèle souvent théorique.
Dans de nombreux départements, ces commissions ne sont pas régulièrement constituées ou réellement opérationnelles, faute de médecins, de représentants des usagers, parfois les deux. Les difficultés récurrentes liées au renouvellement des mandats contribuent au caractère plus qu’intermittent de leur travail et de leur regard sur les établissements.
L’information sur les possibilités de saisir la CDSP peut faire défaut (information ne figurant pas dans le livret d’accueil, livret d’accueil non remis aux patients, information insuffisamment claire). Dans certains établissements, une majorité de patients, et parfois de professionnels, ignore ainsi l’existence et le rôle de ces commissions.
Les opportunités de contacts directs sont également réduites du fait de la faible activité de nombreuses CDSP en matière de visite des unités de psychiatrie. La fréquence minimale de deux visites annuelles est rarement respectée. Si les patients sont en principe informés en amont des éventuelles visites, ce n’est pas toujours le cas en pratique. Les échanges avec les patients sont pourtant essentiels à une réelle appréhension des conditions générales d’hospitalisation. »
Learn more:
The General Controller of places of deprivation of liberty publishes a thematic report on “The words of people deprived of liberty” and a new episode of the podcast “Les Enfermé·es”.
