Cage beds and coercion in Czech psychiatric w www.mdac.org mentaldisabilityadvocacy @MDACintl institutions Cage beds and coercion in Czech psychiatric institutions 2014 June 2014 ISBN 978-963-89303-6-1 Copyright statement: © Mental Disability Advocacy Center (MDAC), 2014. All rights reserved. Supported [in part] by a grant from the Open Society Foundations. Contents 1. Foreword ................................................................................................................................................................................................... 5 2. This report ................................................................................................................................................................................................. 6 2(A). Mental Disability Advocacy Center (MDAC) ............................................................................................................................... 6 2(B). Methodology ................................................................................................................................................................................... 6 2(C). Acknowledgements ......................................................................................................................................................................... 8 3. Executive Summary ................................................................................................................................................................................ 10 3(A). Exposing abuse in 2003 ................................................................................................................................................................ 10 3(B). Developments in the last decade ................................................................................................................................................... 11 3(C). Findings of this investigation ........................................................................................................................................................... 11 3(D). Reducing coercion .......................................................................................................................................................................... 13 4. Recommendations .................................................................................................................................................................................. 14 4(A). To the Minister of Health ................................................................................................................................................................ 14 4(B). To the Minister of Social Affairs ..................................................................................................................................................... 14 4(C). To the Minister of Justice ................................................................................................................................................................. 15 4(D). To the Minister of Finance ............................................................................................................................................................. 15 4(E). To the Public Defender of Rights (Ombudsperson) ...................................................................................................................... 16 4(F). To directors of psychiatric hospitals and wards ............................................................................................................................ 16 4(G). To providers of health care insurance ........................................................................................................................................... 16 5. Context ..................................................................................................................................................................................................... 18 5(A). Key findings from 2003 .................................................................................................................................................................. 18 3. 5(B). Glossary ........................................................................................................................................................................................... 20 5(C). Mental health services and inspection in the Czech Republic ............................................................................................................ 21 5(D). Developments in the Czech Republic since 2003 ...................................................................................................................... 22 5(E). Developments internationally since 2003 ................................................................................................................................... 23 5(F). International human rights standards ........................................................................................................................................... 24 6. Cage beds ................................................................................................................................................................................................. 28 6(A). Testimonies ....................................................................................................................................................................................... 28 6(B). Observations ................................................................................................................................................................................... 31 6(C). Staff views ....................................................................................................................................................................................... 35 7. Other restraints and seclusion.............................................................................................................................................................. 38 7(A). Chemical restraints ......................................................................................................................................................................... 39 7(B). Leather and fabric straps ................................................................................................................................................................ 40 7(C). Seclusion .......................................................................................................................................................................................... 42 7(D). Dehumanisation and coercion ...................................................................................................................................................... 44 8. Reducing coercion ................................................................................................................................................................................. 46 9. Conclusion ................................................................................................................................................................................................ 53 Annex 1. Numbers of cage beds self-reported by directors of psychiatric facilities ................................................................... 54 Annex 2. List of psychiatric facilities contacted and visited ............................................................................................................... 55 3. Photo: Lnáře Psychiatric Hospital © MDAC 4. 1. Foreword Ill-treatment is a persistent beast. Cage beds are a degrading experience for the user, and considered ill-treatment by many observers. Still, the phenomenon persists in Czech psychiatric institutions and elsewhere. It is defended by those who apply the method, with the argument that the alternatives are worse. The same argument is used by those who defend other forms of coercion in different countries. The argument is flawed. Ill- treatment cannot be justified, legally, clinically or morally. More specifically, the use of any means of mechanical restraint for days on end can have no medical justification and amounts to ill-treatment. Flawed arguments alone cannot explain the persistence of different forms of coercion still prevalent in the Czech Republic and across the region. Whilst the techniques may be different, the common element is their persistence, particularly difficult to understand when they are performed by otherwise well- meaning staff in institutions. Cultural traditions in therapy can be so intractable that they seem to be built into the foundations of hospitals. In these settings, coercive practices are expected by all, even victims. These traditions remain unchanged in spite of legislative amendments, funding, training, academic research arguments above, fundamentally undermines those who argue and public opinion. Often, the only solution is complete in favour of high levels of coercion. The same experience was prohibition, tearing down the walls. This has been the case found in other countries which have successfully managed to with various forms of coercion in psychiatry and social care in reduce their own preferred forms of coercion in psychiatry, often several countries. to the surprise of ardent supporters of coercion. Cage beds are degrading.