'Caged beds' banned in psychiatric wards, but system remains under strain

Caged bed

For years advocates for the rights of the mentally ill and disabled have been campaigning for Czech hospitals and other institutions to prohibit the use of so-called "caged beds" to restrain patients. This week, the author of the Harry Potter children's books, J.K. Rowling, very publicly lent her voice to the campaign; on Tuesday, the Czech Health Minister ordered psychiatric institutions to immediately stop using the caged beds. Brian Kenety spoke with the director of Prague's Centre for Mental Health Care Development, psychiatrist Dr Jan Pfeiffer, about the use of cage beds and the state of the psychiatric care system in the Czech Republic.

This week the recently appointed Minister of Health, Jozef Kubinyi announced that the 'caged beds' would be banned, outlawed immediately, and the netted beds, also used to restrain patients, would be phased out within the year. What does this mean, practically, for these institutions?

"Generally, I welcome such a decision, but it is only a small part of the whole problem and if we stay focused only on that, in fact there will be no real change."

So the caged beds make the headlines, but it's only a small part of the problem in the mental health care system.

"Sure, because, together with that you have to give support to the institutions. It must be thought out how they are budgeted, what kind of training the staff receive. How the rights of the clients are advocated and many other things that have to come in the same time as this decision."

How many of these caged beds and netted beds are in use?

"In the psychiatric institutions, the psychiatric hospitals, there are around 100 or 200, there are probably others in health care facilities, but there are a quite large number of them in social care homes, probably one or two thousand, mainly net beds."

What does this decision mean, in practical terms, for these institutions? As we speak, are the caged beds gone? Are they banned? And what will they do now, if there is a patient who is considered a danger to himself or to others?

"Well, I think that in the psychiatric hospitals they are mainly used for elderly people, who are confused, and they are put in the caged beds in the night time. If there is proper control by the nurses, I don't think it will be a really big problem. And for the other type of people - really aggressive or agitated - probably the secluded rooms offer a solution also."

Part of the concern is that a person with a psychiatric problem may end up in one of these caged beds or netted beds and have little recourse to psychiatric therapy or to legal aid?

"Yes. Yes, that's the case because there is an undeveloped advocacy system, or system of independent control, which is not necessarily a negative sign for the institutions, but just to help them see the 'blind spots.' And there are many willing and good people in the institutions but working under difficult conditions; low staff numbers on the night shifts, not enough support in terms of training and supervision. That's the problem."

"Unfortunately, and it's one of the things that have to be developed, there are no standards for use of restraining methods, generally. There is not sufficient control of it and there is no advocacy for the people who are under restraint. And it very much varies from place to place; the decision has to be made by the doctor."

I recently had the opportunity to visit two psychiatric hospitals in Prague, one off Karlovy Namesti, and the other Bohnice, and I've seen the net beds, though not the cage beds, and the general conditions there. And I know that, for example, a patient's family has to bring his or her own supply of toilet paper, or adult diapers in the case of incontinence. So, clearly, it's a problem of the budget, of resources, as well.

"Yes. Sure, sure. These institutions are more poorly funded than most general hospitals and also you see that the conditions are much worse than in general hospitals. Still you can find facilities where more than 10 or 15 people are in one room and there are two or three toilets for 60 people. And the Bohnice hospital is one of the best ones."