2(B). Methodology


This report seeks to answer the question: “What forms of torture or ill-treatment exist in Czech inpatient psychiatry, and what can be done to reform the system?”

At the end of 2012, MDAC submitted official freedom of information requests to 45 inpatient psychiatric facilities in the country, requesting information on the use of cage beds. 17 institutions said that they still use a total of 120 cage beds. Eight institutions failed to respond. Kosmonosy Psychiatric Hospital reported the highest number of cage beds in use in the country, 27 in total 1. A detailed breakdown of responses to the freedom of information request can be found in Annex 1.

In conjunction with its NGO partner the League of Human Rights in the Czech Republic, MDAC contacted the directors of 25 psychiatric facilities identified as still using cage beds or other coercive practices in early 2013 to request permission to conduct monitoring visits. Of those contacted, 12 failed to respond, and eight agreed to the proposed visit.

The institutions visited were:

1. Kosmonosy Psychiatric Hospital, with 600 beds and 15 wards including geronto-psychiatric, male and female acute and chronic, detox, rehabilitation and forensic facilities.

2. Plzeň Hospital Psychiatric Department, situated in a large general hospital, which has 76 beds for men, women and children and providing general psychiatric facilities.

3. Dobřany Psychiatric Hospital, a large institution in a rural setting with 1,250 beds including male and female acute, chronic, detox, geronto-psychatric and forensic facilities. Some beds of the hospital have been designated ‘social care’ beds and are used for people with intellectual disabilities.

4. Opařany Children’s Psychiatric Hospital, which has 150 beds and separate wards for boys and girls with mental health issues, and another ward for children with intellectual disabilities.

5. Opava Psychiatric Hospital, a large institution with 863 beds and numerous wards including adult male and female geronto-psychiatric, acute, chronic, detox and forensic facilities, including wards for children from the age of 5 years.

6. Prague Bohnice Psychiatric Hospital, the largest psychiatric facility in the country based in the capital, with 1,300 beds including adult male and female geronto-psychiatric, acute, chronic, forensic and rehabilitation facilities, and child psychiatric wards.

7. Klatovy Hospital Psychiatric Department, situated in a large general hospital, with 25 beds for men and women and providing general psychiatric facilities.

8. Lnáře Psychiatric Hospital, a rural facility with 70 beds and predominantly providing geronto-psychiatric facilities to men and women

One further institution, Brno Černovice Psychiatric Hospital, was visited by the monitoring team but the director refused to grant access to them. Instead they met with patients in a café run by an NGO at the institution, and the institution ended the use of cage beds many years previously. The director of Kosmonosy Psychiatric Hospital allowed access to the monitoring team on a number of occasions but refused access to wards containing cage beds. A list of all institutions contacted and visited is provided in Annex 2.

Monitoring took part in early February 2013 and late March 2013. Monitoring teams comprised of a senior clinical psychiatrist and ex-member of the European Committee for the Prevention of Torture, a health care inspection professional from the Care Quality Commission in the UK, two Czech lawyers, a representative of a Czech mental health NGO, a disability studies researcher, interpreters and interns. Monitors spoke with patients, staff and directors of all institutions visited. Two interviews were held with people who have used cage beds, who were not in psychiatric hospitals at the time of being interviewed. To protect the identities of patient-informants, their personal identities have not been used in the report beyond descriptions of age and gender.

Although the director of the institution reported that 29 were in use when interviewed in person by the MDAC monitoring team – see Chapter 6.

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