5(C). Mental health services and inspection in the Czech Republic
The Czech Republic is one of few countries of the European Union (EU) which does not have a mental health policy.21 As a result of a directionless mental health service, there is an abundance of institutional confinement and very little community mental health care.
According to official data, in 2012, there were 2,834,000 community mental healthcare examinations and 578,413 patients were treated. There were 790 psychiatrists working in outpatient facilities, funded primarily through public health insurance via payments for medical procedures.22
The numbers of beds in inpatient psychiatry were:
- 8,847 beds in 18 adult psychiatric hospitals (including 188 beds for children);
- 250 beds in three child psychiatric hospitals; and
- 1,260 beds in psychiatric wards of general hospitals.
This amounts to a total of 10,357 psychiatric beds.
Budgetary expenditure on psychiatric service provision constitutes 2.91% of the total healthcare budget, which equates to just 0.26% GDP (the average in the EU is 2% GDP).23 Approximately 80% of all resources for inpatient psychiatric care are allocated to psychiatric hospitals, the other 20% being allocated to psychiatric facilities housed within general hospitals. A third of the capacity of psychiatric hospitals are acute care and two thirds chronic beds. Approximately half of beds in psychiatric hospitals relate to geronto-psychiatric care, child and juvenile psychiatric care, forensic care and addictions.
Psychiatric hospitals are financially dependent upon the number of beds which are occupied at any one time. The vast majority of involuntary hospitalisations are to psychiatric hospitals as opposed to psychiatric wards in general hospitals. In 2012, 39,615 adults and 1,040 children were hospitalised as inpatients. The average percentage of beds in use at any one time in adult psychiatric hospitals in the Czech Republic in 2012 was 93.3% for adult psychiatric settings, and 87.7% in respect of children’s psychiatric hospitals.24 Psychiatric wards in general hospitals offered a total of 1,260 beds in 2012, however several of these wards do not provide care for patients with more severe mental health issues due to a lack of professional and technical capacities.
In October 2013 the Ministry of Health adopted a ‘Strategy for Reform of Psychiatric Care’ for the period 2014-2020. The strategy recognised that the provision of institutional psychiatric care is insufficient and committed to developing community care. It proposed the establishment of ‘Centres of Mental Health’ as a new form of psychiatric care and ‘humanisation’25 of psychiatric hospitals.26
Coercion is associated with managing chronic patients, especially elderly patients. Lack of alternatives to hospitalisation, outdated hospital infrastructure and a lack of financial resources are all factors which explain the commonplace nature of restraints and seclusion within Czech psychiatry. A typical example is the use of cage beds for elderly patients with Alzheimer’s disease or other forms of dementia.
21 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), at p. 2.
22 Ibid. at p. 17.
23 Petr Winkler (ed.), Reforma systému psychiatrické péče: mezinárodní politika, zkušenost a doporučení (Czech), (Prague: Psychiatrické centrum Praha, 2013), at p. 29.
24 Supra note 21 at p. 23.
25 It is notable that this term is avoided by policy-makers in the context of social care institutions in the country, due to the awareness that this could sound like making ‘golden cages’ rather than focusing on an overall goal of deinstitutionalisation. Source: conversation with MDAC Legal Monitor in the Czech Republic.
26 Czech Ministry of Health, Strategie reformy psychitrické péče (Czech), (Prague: Ministry of Health, 2013), available online at: http://www.reformapsychiatrie.cz/wp- content/uploads/2013/10/SRPP_publikace_web_9-10-2013.pdf (last accessed: 15.06.2014).