The Prague Post Online: News: Local experts react to caged-bed fallout

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July 7th, 2008

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Local experts react to caged-bed fallout

The issue may be distracting attention from the big picture

January 23rd, 2008 issue

By Kimberly Hiss

Staff Writer

Since news broke last week that a team of BBC journalists posing as charity workers had visited multiple “social care” homes in the Czech Republic and filmed the now-familiar caged bed footage, an investigation of the concerned institutions has been announced by the Labor and Social Affairs Ministry. Beyond such concrete measures, the report has caused concerns about a more nebulous fallout.

“[It’s led to] a bad perception of the Czech healthcare system and human rights status that is not justified, and the further stigmatization of mentally ill people and mental health care,” said Dr. Cyril Höschl, director of the Prague Psychiatric Center and president of the Association of European Psychiatrists.

The use of so-called caged beds was banned in the Czech Republic in 2004, a development associated with the much-publicized advocacy of British author J.K. Rowling. In 2007, a new law reinforced that ban. The Jan. 15 BBC report claimed the enclosures shown in its footage suggested the law had been violated. But such a charge is a matter of dispute.

Upon viewing the footage, Labor and Social Affairs Ministry officials were unable to immediately determine whether or not the law was breached. However, spokesman Jiří Sezemský released a statement saying, “Nevertheless, it can be ruled out that traditional caged beds would be used in these cases. Children’s beds with movable railings and beds for adults with adequately high railings can be used in exceptional cases.”

Although ministry officials did not respond to requests for comment as of press time, Höschl’s opinion supports their stated view. He is clear that the BBC footage showed “beds with heightened sides,” as opposed to caged beds with tops. According to Höschl, such enclosures (including net beds, which polls indicate most psychiatrists prefer) are sometimes necessary.

“Some sort of constraint is needed in cases of huge restlessness, agitation, aggression, fits, etc., where such a measure can prevent the harm of the patient and/or of others,” he said. “Of course, it must be properly indicated and limited in duration. ... Sometimes, patients themselves and/or relatives ask for preventive placement into net beds to avoid injury, e.g., in delirium.”

Höschl also pointed out that such beds are a preferable alternative to some practices used in other European countries, like physical restraint by staff members, isolation in a designated room, “calming” injections, or the lashing of a patient to a bed.

Beyond matters of law and definition, Höschl worries that the caged bed firestorm acts as a distraction from other mental health issues in the Czech Republic. The psychiatric field requires “serious discussion about the specific needs of mental health care,” he said. Such necessities include “funding, education — of staff, of patients, of relatives, of the public — and prevention.”

As an example of a positive psychiatry initiative deserving of such attention, Höschl cited the development of Information Technology Aided Relapse Prevention in Schizophrenia, a small Czech program that involves psychiatrists in the long term follow-up of patients with psychotic disorders in order to spot warning signs of relapse. According to Höschl, the program has “so far decreased the hospitalization rate in participating schizophrenic patients by 70 percent, and in those who fully collaborate even by 100 percent.”

But Höschl worries that the public rarely hears about such mental health success stories.

“Paradoxically,” he said, “nobody writes about it, nobody takes care about it, and the state does not contribute to it financially at all.”

— Hela Balínová and Naďa Černá contributed to this report.

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