Chronicle “To the small care”
In a report made public on Tuesday, the general controller of places of deprivation of freedoms reports on the inhuman situation experienced by patients in a mental health center in Lens.
Sometimes, psychiatric services are the scene of frightening slippages, even worse than those recently denounced in retirement homes. And fortunately sometimes, the comptroller general of the places of deprivation of liberty is worried about it during impromptu visits. This is what has just happened with the Jean-Baptiste-Pussin mental health center in Lens (Pas-de-Calais), where, following a check-up carried out last month, Dominique Simonnot decided to take legal action and make the report public on March 1, “as we have seen a significant number of serious malfunctions affecting the dignity of patients and their fundamental rights”.
This report is all the more disheartening as this situation is not new. She has already been denounced by the county mental health council, but nothing seems to be happening despite the seriousness of the accusations. Patients are thus locked up, tied up, while they are in free hospitalization. “Their rights, which are as little known to patients as to staff, are all the more rarely implemented as the judges do not move around the establishment and put up with the repeated absences of patients from their hearings”. And this is not an isolated case: in this place, it concerns “all the units of the establishment, resulting from a lack of overall management”.
Reading this report resembles a sad list of grievances à la Prévert. Everything is going wrong. On the first day of control, 56 patients out of 71 were in free hospitalization. All, however, were locked up in closed places. “The building is closed most of the time, with the exception of cafeteria opening hours from 1:30 p.m. to 4:30 p.m., during which patients can access an outdoor area adjacent to the entrance car park, without to be able to cross the gates of the enclosure. Within each unit, people can be locked in their room without decision or medical control, sometimes even against medical advice”, notes the report.
No privacy, poor sanitary conditions
And it continues. “Patients cannot lock their room or their sanitary area including toilets, sink and shower. They have no privacy when they wash or go to the toilet, they have no peace, day or night, while some have been hospitalized for weeks, months or even years. Several hospitalized people, including a young woman and a minor, have filed a complaint for acts of harassment and assault in the room, day or night. Or : “Patients cannot call for help since, according to professionals, the in-room call device has been voluntarily deactivated in all units due to excessive use by patients. And this twists in all areas: “Due to poor workmanship, the heating is very unevenly distributed and the rooms at the ends of the building are particularly cold, so that several blankets have to be distributed and one patient reported sleeping with a cap. Domestic hot water is lukewarm at most.”
superfluous consent
Let’s move on to access to care. It is systematically failing, according to the report. “Patients cared for in the emergency room of the hospital center are sometimes restrained on stretchers… Within the units, the care plan is not defined, the patients are not associated with it, nor the people of confidence whose designation is not always valid due to the vagueness of the procedures observed. Incidentally, the patient’s consent seems superfluous to say the least. “Review of medical records shows that consent to patient care is not documented. The examination of pharmacological treatments reveals the persistence of the prescription “if necessary”… The administration of a treatment can therefore be carried out without prior psychiatric medical examination and involve the use of force, as has been the case on several occasions. times in the presence of the controllers, and without the doctors present being called or even notified.
These illegal practices affect all patients, including minors. “Adults and minors are subject to arbitrary isolation and restraint measures, implemented in appalling conditions.” And the report details: “There are officially two isolation rooms, each located in a sector of the floor, positioned at the end of the corridor, particularly poorly heated, having no clock allowing to locate oneself in time nor any device of call accessible in a situation of contention. The confined patient cannot see the outside through the windows, which are opaque and cannot be opened. His privacy and the confidentiality of his care are not respected since he is exposed to everyone’s view through the peephole of the door, or the screens of the surveillance cameras located in the nursing station and visible from the corridor.
More amazing, “isolation and restraint are not only practiced in isolation rooms but without distinction in hotel rooms, so that we can consider that the center does not have two isolation rooms but eighty rooms in ‘potential isolation’. Thereby, “Examination of the isolation and restraint paper registers kept in each unit shows that isolation is practiced in all the rooms for periods very frequently exceeding the legal deadlines and without respecting the renewal procedures, with sometimes associated restraints during a whole day and which may concern people in free care”.
Court decisions not always enforced
Dantesque situation, which continues. “Despite the recommendations made for years by the Departmental Commission for Psychiatric Care, no decision has been taken to remedy the situation. In the last report of June 1, 2021, the members of the commission say they are “scandalized to see that patients in free care were placed in an isolation room as soon as they arrived”. As for management, “not content with not taking any measure to remedy the multiple dysfunctions thus denounced, it trivializes them and even seems to validate them, since the documents given to the controllers and supposed to clarify the practices are in perfect contradiction with various legislative and regulatory provisions”.
Last point: the control of the judge of freedoms and detention is ineffective. The patient rarely has access to his judge. “The controllers even noted the existence of medical certificates attesting to the incompatibility of the condition of certain patients with an appearance before the judge, because of a risk of running away. However, such a reason cannot be regarded as a medical reason. Finally, the judge does not always have a complete file on the day of the hearing. And when he makes a decision, it is not always applied.
In the end, the report concludes, “the Jean-Baptiste-Pussin mental health center in Lens must be the subject of urgent measures”. We can hope so, but how to understand the silence of the doctors, like that of the management, and more generally the indifference of the supervisory authorities and the Regional Health Agency?