3(B). Developments in the last decade
The government’s instruction to directors of psychiatric and social care facilities in 2004 ended the use of metal cage beds in all institutions. Whilst the 2006 Social Care Act banned all cage beds from social care institutions, the 2011 Medical Services Act (No. 372/2011) continued to allow for netted cage beds to be used in psychiatric hospitals. The distinction the Czech authorities make between the metal and netted variants of cage beds is purely semantic, given that both types deprive a person of their liberty and can constitute ill-treatment.
MDAC decided to conduct a follow-up monitoring mission to psychiatric facilities in 2013, a decade after publishing its initial report on cage beds. The Czech Republic is the only country in the EU without a governmental mental health policy,12 with the majority of mental health provision in the country provided through large, outdated psychiatric institutions. In 2012 there were 18 psychiatric hospitals for adults with 8,847 beds, of which 188 beds were set aside for child patients, and three hospitals exclusively for children with 250 beds. Another 1,260 beds were in psychiatric wards of general hospitals. Although the Ministry of Health adopted a “Strategy for Reform of Psychiatric Care” for the period 2014-2020, it has done little to reduce the high levels of mental health coercion, as documented in this report.
In a positive development, the Czech government ratified the Optional Protocol to the UN Convention against Torture in 2006, designating the Public Defender of Rights (Ombudsperson’s office) as the “National Preventive Mechanism”, the body responsible for visiting all facilities in which people may be deprived of their liberty. The government also ratified the UN Convention on the Rights of Persons with Disabilities in 2009, signalling its commitment to moving towards recognition of the dignity, autonomy and liberty of everyone with disabilities – including those with mental health issues, dementias and intellectual disabilities.
Ratifying these treaties, however, has not substantially reduced overall levels of coercion within psychiatric institutions, a point which has also been reported by the Public Defender of Rights. In a country which spends a mere 0.26% GDP on mental health service provision (the average in the EU is 2%),13 moving to community-based mental health provision remains low on the government’s set of priorities, partly because of a lack of political will, and partly because of a lack of investment into the mental healthcare sector.
12 Jiří Raboch and Barbora Wenigová (eds.), Mapování stavu psychiatrické péče a jejího směřování v souladu se strategickými dokumenty České republiky (a zahraničí) (Czech), (Prague: Česká psychiatrická společnost o.s., 2012).
13 Petr Winkler (ed.), Reforma systému psychiatrické péče: mezinárodní politika, zkušenost a doporučení (Czech), (Prague: Psychiatrické centrum Praha, 2013), at p. 29.