6(C)(ii). Cage beds are used to deal with aggression

MDAC’s 2003 cage bed report laid out staff views on aggressive behaviour. Overall they said it was rare. This is not a finding which was repeated in 2013; on the contrary, MDAC monitors found that staff frequently spoke about their difficulties in dealing with situations which they perceived as “dangerous”. Staff in several hospitals told MDAC that cage beds were used for patients who they judged to be “aggressive”, although staff rarely defined what this actually meant, and how it differed from “anger”, a perfectly natural response to being detained and injected with medication against one’s will, and without much legal remedy.

A doctor in one hospital shared her observation that in recent years intoxication had resulted in more aggression, and cage beds, “are the best way to help the patient, not isolation,” adding that “there is this public pressure to ban net beds and we are planning to build an isolation room but this is not a good idea.” Staff in many hospitals told MDAC they used cage beds to constrain patients they considered “dangerous”. In other places it seemed that cage beds were used as a way for a predominantly female workforce to contain patients: it was difficult to recruit men, especially in psychiatry, MDAC was told, because of pay and status.

The length of time a person was placed in a cage bed seemed to depend on their perceived level of aggression at the time of placement. A psychiatrist told MDAC that in cases where patients “are in delirium or more aggressive” they were placed in a cage bed for three days.

A female patient in one hospital had worked at the hospital previously, so she was used to seeing the cage beds and was not shocked when she saw them upon arrival as a patient. This person had become accustomed to their use for agitated patients, describing one person’s placement into a cage bed simply “because she was moving too much”. This patient explained that, “we cannot have dangerous objects such as [phone] chargers, because we could hang ourselves.” Her perception of dangerousness included pre-empting any outward signs of aggression. A belief in the inevitability of cage bed use was held by a majority of patients with whom MDAC spoke, and was likely held because these patients (like the majority of people in the Czech Republic) had not had access to more humane alternatives.

The mother of a young patient told MDAC that cage beds were used because staff lacked skills to protect patients from violence. Her son had been given new medication that made him distressed. He had been screaming for three days which in turn caused other patients to become agitated and they beat him up, so the staff “isolated him in a net bed to protect him”.