Mental health care under spotlight after stabbings

After the incident in Horní Bříza, photo: CTK

Just seven months after a woman suffering from schizophrenia killed a student in a school in Žďár nad Sázavou, a similar attack has claimed another life. A 28-year-old librarian was stabbed to death on Monday in the town of Horní Bříza near Plzeň by a man recently released from a mental hospital.

After the incident in Horní Bříza, photo: CTK
The two cases that occurred within less than a year bear a disturbing resemblance. In both cases, patients suffering from a mental illness were released from institutional to outpatient care and not long after committed a violent crime.

And just like the attacker in Žďár nad Sázavou, who was acquitted by a court on the grounds of temporary insanity, the man responsible for the death of the young librarian may also avoid serving time in prison.

The schizophrenic woman who killed the student in Žďár nad Sázavou had been released from a mental hospital despite being involved in a different stabbing incident in the past. The library attacker was admitted to a mental hospital in Dobřany in January against his will, allegedly suffering from delusions and threatening to kill someone, only to be released a month later.

Ivan David, a former health minister and deputy head of Bohnice mental hospital, points out that the number of patients suffering from delusions is very small and only about one percent of them, that is around 800 people, are really dangerous:

Ivan David, photo: archive of Radio Prague
“In the Czech Republic, as in most other countries around the world, a court cannot order a patient to undergo treatment unless they commit a crime. Only a very small number of people suffering from a mental illness are hospitalised.

"And, as soon as the patient is no longer perceived as dangerous they have to be released. When they are in hospital their situation improves, but when they are released they usually stop taking their medication.”

Once patients are released to outpatient care, it is up to them whether they want to continue seeing a doctor, so there is no way of monitoring their condition.

While Mr David agrees that no measures can provide a 100 percent guarantee that random attacks of this kind will not happen, an effective system should be able to minimize the risks:

"In my opinion, there should be an option, in case of potentially dangerous patients, to force them to take drugs based on a court decision. As far as I know, in some US states, dangerous mental patients can be ordered to undergo so-called forensic treatment, no matter whether they have committed a crime or not.

"This concerns mainly aggressive patients, patients with addictions who refuse to take medication and manifest warning signs, such as delusions, that could lead them to commit a violent crime.”

Dobřany mental hospital, photo: CTK
According to Mr David, security measures such as the ones taken in schools after the attack in Žďár nad Sázavou, are only addressing the consequences. Unless we treat the real cause of the problem, he warns it is only a matter of time before a similar attack takes place again.

While the town of Horní Bříza is still coming to terms with the tragedy, the senior doctor in charge of the patient has resigned and the health minister has dismissed the hospital’s CEO.