6(C)(iii). Cage beds are used to deal with restlessness

In most hospitals agitation was the reason staff gave for using cage beds. At Opařany Children’s Psychiatric Hospital where cage beds have been withdrawn, staff said that the cage beds were “never used for children with normal intelligence”, but they were used to constrain children during the night, instead of allowing them to run around. On elderly wards cage beds were purportedly effective in constraining elderly patients who would otherwise fall out of bed. Staff at Kosmonosy Psychiatric Hospital told MDAC that they could not imagine using straps for elderly patients during the night, and side-boards on normal hospital beds were dangerous for the “grandmas,” as they could fall from the bed and hurt themselves.

A psychiatrist in a different hospital said that cage beds are better than seclusion rooms, because there is no danger of the patient falling out of a cage bed. This does not make much sense, since most isolation rooms have at most a mattress on the floor. In another hospital, cage beds were reportedly used primarily for elderly patients who may otherwise fall from ordinary beds at night: staff prefer cage beds over sedatives. Some patients go into a cage bed every night, while others only when staff deem it necessary. If a person has “delirium”, the cage bed is used for three or four hours or the whole night. It seemed that this was the case for women in one particular hospital, while the men who became restless are strapped to the bed and/or chemically restrained.

At Kosmonosy Psychiatric Hospital, a nurse told MDAC about a woman who could not walk and had been in a cage bed for three-and-a-half years. Sometimes the staff took the woman out in a wheelchair, said one staff member, recalling that this had only happened five times during placement in the cage bed. She would visitors in the cage bed, eat in the cage bed, and drink in the cage bed. When she wanted to use the toilet, the nurses would take her out. Apparently, she recovered her walking and when she started to walk again she was finally released.

At Opava Psychiatric Hospital, staff said that they use cage beds for “confused patients”, especially those with dementia, who might hurt themselves. “Sundown syndrome” was used by staff members to describe the phenomena where patients would try to walk around in the late afternoon and evening, and they would fall. These people did not present a danger to others but to themselves. Staff said that some patients would get confused and wander somewhere, then urinate on the floor, and slip on their urine and break a bone. Thus were the justifications for using cage beds to prevent restlessness.