Director of Bohnice mental hospital: a bed is not enough

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Sixteen years after the fall of communism, state-run psychiatric care in the Czech Republic still has not managed to completely shake off the stigma of being misused as well as neglected by the regime. Although much has been done in the last years, many critics still say mental hospitals - many of them built a century ago - are still worlds of their own, cut off from normal life. The Bohnice mental hospital in Prague has decided to show the public that despite a difficult financial situation, it offers more than a bed and medication to its clients.

The Bohnice hospital was built at the beginning of the 20th century. It consists of many small houses scattered around a large English-style park, centred around an Art Nouveau church. In one of the houses, fifty-year-old Jaroslav is weaving a rug on an old-fashioned loom. He first learnt the skill four years ago and explains the technology to me as he shuttles a yellow yarn back and forth across the warp. On the ground floor, other men are sandpapering parts of what is going to be a rocking horse.

When the first large mental hospitals were built in the Austro-Hungarian Empire in the mid-19th century, work was an important part of therapy. Between the 1920s and the 1960s, these methods were abandoned in this country. Currently, the Bohnice hospital has a number of sheltered workshops where men and women of all ages make jewellery, pots, candles and wooden and textile toys. Thanks to an EU grant, more people can now join in. Work therapist Veronika Galusova:

"We will enlarge the workshops and add new ones and also equip them with modern tools. The goal is for the clients to maintain their working habits, to be active and take part in their recovery. The skills can help them integrate into society and be able to leave institutions, plus the money they make here can help them cover the costs of housing and living in the future."

The Bohnice hospital also works with NGOs to provide sheltered housing for patients who leave the hospital but still need some assistance. For 15 years now it has been running a 24-hour help line and a crisis centre. The hospital's director, Ivan David, says these activities meet with little understanding from health insurance companies.

Ivan David
"The insurers don't cover the work of psychologists, therapists and social workers - only doctors. In similar establishments in the West, there are around two professionals per one client. Here it is less than one professional per patient. Out of all health care expenditures, only 3.6 percent goes to psychiatry, while the EU average is 7 percent."

Besides that, Dr David says, the hospital receives the same payments from insurance companies for all patients even though the costs of their individual treatment differ significantly. But he says talks are underway with the health ministry about a new system of payments which would allow the hospital to stop its buildings from falling into disrepair and continue providing more than a bed and medicines to its patients.