8(B). Eating slippers and other risks

Many psychiatrists were adamant that cage beds represented an indispensable part of their clinical practice. Explaining their position, they often invoked the horrors of other forms of physical restraint. A psychiatrist at Plzeň Hospital Psychiatric Department told monitors that patients calmed down quicker in a cage bed than in straps. She regretted plans to remove cage beds: according to her, this would result in patients being strapped for longer periods. “We cannot survive without restraints”, she said, because “there are only two nurses and one doctor [at night]. Patients are even brought in by six police officers.” Another doctor in the same hospital predicted that people would look back and realise that cage beds were “the most helpful [means of restraint] for the patients”. She conceded that there was growing public pressure to stop cage beds. Her response to this? “We are planning to build a seclusion room.”

Another psychiatrist at Plzeň Hospital Psychiatric Department explained that the public looked at cage beds as if they are medieval torture instruments. His view was that a patient in a cage bed could be given lower doses of medication, and that caging someone was better than placing them in an seclusion room as staff could observe them. He said that patients had told him that in a cage bed they can itch a scratch, but in straps they couldn’t. “That must be torture,” he argued.

In Kosmonosy Psychiatric Hospital a doctor explained that cage beds existed for “historic and architectural reasons.” If they had to go, he suggested that on the elderly ward they be replaced with “belly straps”. A doctor at Klatovy Hospital Psychiatric Department was of the view that the demand for cage beds would decrease only if more staff were recruited. This was unlikely, he continued, as staff numbers had already been reduced and a minimum staffing level had now become the norm. A doctor in the same hospital thought it would be “stupid” to get rid of cage beds, adding that he could not imagine what he would do with “geriatric patients”. Thanks to cage beds, he said, patients did not need to be chemically restrained. Furthermore, cage beds had prevented broken limbs as they constrained patients who might otherwise have slipped on the floor. He said that there had been no leg fractures for 14 years in his hospital (a statement which the monitoring team were unable to verify). The correlation between the use of cage beds and the lack of leg fractures had, according to him, become a simple matter of cause and effect. Without cage beds, “we would have to use straps”, pointing out that in England there are no cage beds but that staff “lie on patients” there. Monitors asked where he had heard this, to which he replied, “probably on the internet”.

At Plzeň Hospital Psychiatric Department, a psychiatrist seemed rather relieved that he did not have to treat elderly patients, as he did not know “what to do with patients with dementia when the therapeutic beds are outlawed”. At Kosmonosy Psychiatric Hospital staff explained that increased staffing levels would enable the hospital to reduce the prevalence of strapping and the length of time a person is strapped, but more staff would not diminish the use of cage beds. In the same hospital, another doctor explained that a new seclusion room would replace the cage bed on her unit. The seclusion room would have straps: “It would be dangerous for staff to enter so there will always be need for straps,” she said, noting that the staff were planning to use more strapping if cage beds are removed.

Dobřany Psychiatric Hospital had removed cage beds following a death of a patient in 2012. The monitoring team were particularly alarmed at the perspectives of staff. A senior psychiatrist expressed some frustration when asked about the removal of the cage beds, complaining that he had been asked the question numerous times previously. According to him there had been no benefit in removing cage beds, meaning that patients were placed in two new seclusion rooms instead. The hospital director told monitors that removing cage beds was a bad idea. The European Committee for the Prevention of Torture (CPT) had visited the hospital in 2006 and asked the director to release a male patient from a cage bed. The director told MDAC monitors that when staff complied with the request, “before they could get him back in, he ate another patient’s slippers.”