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Mind games

A celebrity visit reignites a mental health controversy

By Kimberly Ashton
Staff Writer, The Prague Post
June 13th, 2007 issue

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Three years ago, when Harry Potter author J.K. Rowling called the use of caged beds in the Czech Republic inhumane, the government took notice and banned them.
Psychiatrists hoped they could seize the opportunity to highlight other problems in the practice of psychiatry, mainly its lack of funding.
Now, in the wake of Rowling’s surprise return in May, the debate over the outcome from the 2004 scandal has revived. Given paltry funds and a tarnished public image, some medical experts say the row might have actually damaged the country’s psychiatry.
Since caged beds grabbed world headlines, little else has been done for psychiatry, which remains chronically underfunded here.
“After Slovakia, we are the second worse-off in Europe,” said Dr. Zdeněk Bašný, the former head of Bohnice Psychiatric Hospital in Prague 8.
About 3 percent of the national healthcare budget is allotted to psychiatry, he said. The World Health Organization recommends that a country spend 15 percent of its healthcare budget on mental health.
Furthermore, the majority of this amount, Bašný said, goes to inpatient psychiatric facilities, leaving little money for less-contentious outpatient community clinics.
“So there is less and less for the actual development” of psychiatry beyond its base in hospitals, he said.
Rather than helping psychiatry, the caged-beds debate hurt it, in Bašný’s view.
“All that remained is a sort of smear on our psychiatry, because it made it look worse than it is,” he said, adding that the use of caged beds was never widespread in psychiatry.
Caged beds kept a small number of psychiatric patients enclosed in metal bars welded to a bed about 8 feet (2.5 meters) long, 3 feet wide and 4 feet high. The Mental Disability Advocacy Center, based in Budapest, called their use an abuse of human rights, no doubt in part because of the danger they could pose to patients. In one case, a 14-year-old girl died after the top of her cage collapsed and fractured her skull, according to a TimesOnline report.
The Center has also documented the mental impact caged beds have on patients, likening their use to a form of dehumanization and torture.
Though few dispute the need to phase caged beds out of practice, Bašný says widespread publicity of these beds, which were used in exceptional cases, may have turned potential patients in need away from hospitals that could help them. “The number of people with mental disorders is on the rise,” Bašný said, “and that situation only incited fear in people who might have problems and should seek help.”
Tomáš Cikrt, spokesman for the Health Ministry, agrees that Rowling’s criticism simply wasn’t fair. He says beds that restrain patients in some way are still needed in cases where patients may be dangerous to themselves or others.
“It is not possible not to use some [physical] restrictions, because some patients can suffer from aggression, hallucinations, or they might have suicidal attempts and they can hurt themselves or somebody else,” he argues.
For these reasons, the limited use of netted beds — and not caged beds — has continued for two groups of patients.
“The first group is patients who have irregular aggression seizures, so that they would not have to be under very strong medication all the time, and the second group is made up of gerontopsychiatric patients — it is quite efficient in preventing falls from beds,” Bašný said.
Cyril Höschl, director of Prague Psychiatric Centre, said that after the ministerial ban on caged beds, “some family members asked for reimposition of them in social service institutions for security reasons.”
In an official poll of psychiatrists, most said they themselves would prefer net bedding as a form of restriction were they agitated in delirium or suffering from severe dementia, according to Höschl.
But Höschl does not think psychiatry’s reputation was harmed by the scandal if only because “for historical reasons, all over the world, the reputation of psychiatry does not match that of other medical disciplines.”
Continued advocacy
As for Rowling, she is not giving up her involvement with child welfare, and stands by her 2004 campaign. Her public relations agent Nicola Dodd called May’s visit “a private fact-finding trip to learn more about child welfare in the Czech Republic.”
During the visit, she met with Džamila Stehlíková, minister without portfolio who handles human rights and minority issues. Stehlíková was unavailable for comment before press time.
Contrary to some Czech media reports, Rowling does not regret her campaign against caged beds, Dodd says. Now, Rowling is in preliminary talks to open a branch of her children’s advocacy organization, Children’s High Level Group, in Prague.
Two other outlets of the London-based charity, which works toward ensuring minimum United Nations standards of welfare for children, already exist in Romania and Moldova.
— Hela Balínová and Naďa Černá contributed to this report.

Kimberly Ashton can be reached at kashton@praguepost.com


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