6(B)(v). Opava Psychiatric Hospital
At the time of the visit, Opava Psychiatric Hospital had 22 cage beds. The management reported their desire to have more, but they lacked the space. Staff told the monitoring team that cage beds were sometimes used as regular beds: the bars were pulled down and staff expected the patient to ignore the netting around the bed. From the perspective of staff this may seem like an ordinary bed, but any occupant is likely to see things differently: at any moment staff could pull up the side of the bed and encage the person. Staff showed the monitoring team a room containing three cage beds. Each had a metal frame and a sliding bar that could be raised upwards and locked, enclosing a patient inside a net consisting of cord approximately 5mm thick. The monitoring team were told that one or two of these cage beds were in use at any one time. When questioned about the sparseness of the rooms, and whether patients had anywhere to store their possessions, staff said, “such patients hardly have anything” but they could store their possessions elsewhere on the ward. In this hospital, cage beds were mainly used at night to prevent people with dementia or delirium from getting out of bed, but were used at other times in response to behaviour that staff perceived to be “dangerous” (for these people straps were also used). A nurse told MDAC that a person can be in a cage bed from one to twelve hours, and a cage is usually used for people with delirium, people who self-harm or are “aggressive”. Staff reported that before they place someone into a cage bed, they try to calm the person down, or use medication.
A side room had three beds, one of which was a cage bed, empty at the time of MDAC’s visit. The monitoring team tracked down a patient who had slept in this cage bed. She reported feeling degraded by the experience and did not understand the reason she had to sleep there. A nurse said that patients who are confused and mobile could stand on their beds, or climb over horizontal bedrails and fall badly. Cage beds were, therefore, “effective”. The monitoring team suggested having lower beds to shorten a potential fall distance, but the nurse dismissed this suggestion.
At the time of the visit, there were two doctors for 830 patients in the hospital. Cage beds were particularly used, said staff, for “confused patients that have a tendency to get up and leave during the night.” The doctors tried to reduce the amount of medication to patients but they believed the use of cage beds was “more humane.” Getting rid of cage beds would result in increasing the dose of medication, which can lead to the death of older patients, said one doctor.
A person in a cage bed was observed every three hours, staff told MDAC. One nurse explained that “patients are not able to ask for their needs,” implying that cage beds were best for them. Patients in cage beds wore adult nappies, and the team was told that this was the case for most patients anyway.
MDAC monitors went into a further two rooms with three cage beds in each. In the first room, one of the beds was painted yellow, with a vertical bar mechanism that closed the structure by being slid shut from left to right. In the second room, there were three beds that closed by sliding a bar from the bottom of the bed to the top. There was no material difference in the different designs. All of these cage beds could be locked shut with an Allen key. None of the rooms had curtains or other coverings on the windows: all had two wall lights (at least one of which was suitable to be left on at night) and an overhead bulb. Lights were controlled from outside the room. The rooms were bare except for the beds. In a women’s room there were three beds, of which one was a cage bed. Staff told the monitoring team that if a person was restrained in this cage bed, the other two beds may continue to be used for other patients if the hospital was at full capacity.
Some cage beds in the elderly ward had clean nappies on top of them, prepared for new entrants. At the time of the visit, the room smelled of urine and disinfectant. The nurses told MDAC that caring for these patients is “like caring for 25 children, it is impossible to maintain all of them” (“je to jako 25 dětí, není možné je udržet”). Again likening patients to children, another nurse said that cage beds were “like cots for infants”, explaining that she might put an agitated person into a cage bed for one or two hours, sometimes after giving medication. Some of the nurses presented cage beds in part as alternatives to medication.