6(B)(ii). Plzeň Hospital Psychiatric Department

Hospital staff said that one “restrictive bed” (meaning cage bed) was used for “aggressive patients”. MDAC monitors were formally refused access to the room in which the bed was located. However, because there was someone in the cage bed at the time of the visit, a monitoring team member managed to look into the room. The frame construction of the bed was similar to those seen elsewhere, but had a thick wire mesh instead of a cotton net, similar to a strong garden fence. The whole construction was painted yellow. The front of the bed was closed. Inside the room, a doctor was discussing something with the patient in the cage bed. A psychiatrist told MDAC that, “when a patient is placed in the restrictive bed and we give them medication, then the doctor can talk to him”.

In another room there were three cage beds. Staff said that sometimes they were occupied at the same time. The monitoring team saw three sets of straps in this room, which were used to tie the patients’ wrists and ankles to the beds. If a patient was “very aggressive”, nurses said, they would strap a sheet over the patient’s body and tuck it into the sides of the bed.

Another room contained one cage bed and two ordinary beds. Staff said that the cage bed was sometimes used as a normal bed with the net open. It was in a corner of the room, and could not be observed from the corridor. If all cage beds were occupied, staff use straps, they said. There were no formal criteria for the use of any of these restraints. A patient could be caged for “five to ten hours”, said staff, explaining that two hours was “too short” to see how the person reacted to medication. Cage beds were used at night only for “aggressive patients”, staff explained.

The director of this hospital referred to cage beds as “therapeutic beds”. He told MDAC that there had been a poll among 400 psychiatrists at a conference four years ago. The attending psychiatrists were asked to vote which restraint they would prefer to be placed in themselves. The choices given were a “therapeutic bed”, an isolation room, a “therapeutic jacket” (straightjacket) or strapping. He said that “ninety nine percent chose the therapeutic bed”, because the psychiatrists thought it was “good for them”.

The director reassured MDAC monitors that although cage beds “might look like medieval torture”, they were more comfortable than straps and the patient could have eye contact with staff, something which was not possible in a seclusion room. During the conversation, a psychiatrist concurred: “I really prefer using net beds. In my opinion it is the best type of restraint.”