Liz Lynne

Harry Potter joins the fight to end Czech "cage bed" use

Amnesty International and Mental Disability Advocacy Center together with Czech non-governmental organizations: The Center for Mental Health Care Development, Czech Helsinki Committee, Fokus - Association for Mental Health Care, Inclusion Czech Republic, User and Ex-user Organization Kolumbus and Sympathea - Czech National Association of Family Members

A group of non-governmental organizations (NGOs) welcome recent steps by the Czech Minister of Health to end the use of "cage beds" within psychiatric institutions.

On 13 July 2004, the Czech Minister of Health Jozef Kubinyi issued a press statement stating that he had instructed directors of all health institutions to immediately cease use of "cage beds", calling for the elimination of "net beds" by end 2004, and advising replacement of these beds with seclusion rooms and increased numbers of staff to improve care for people with mental disabilities. This decision was made days after the authorities received a letter of concern from Harry Potter author JK Rowling.

"Cage beds" - beds which are fitted with a metal-barred construction above the mattress, or a metal frame covered with netting, designed to enclose a person within their confines - are currently endemic within the Czech (and Hungarian and Slovak) psychiatric and social care systems. The Czech and Slovak authorities make a distinction between "cage beds" and "net beds".

The NGOs call on the Czech authorities to extend the ban with immediate effect to the use of "net beds" in psychiatric institutions. The NGOs also advocate for a similar prohibition in institutions for children and adults with mental disabilities under the authority of the Ministry of Labour and Social Affairs. In addition, Czech authorities should allow NGO representatives to monitor the enforcement of these measures in all relevant institutions as there is no such mechanism to oversee this process.

The NGOs are particularly concerned that the Czech President Vaclav Klaus, in statement reported on 14 July 2004, criticized the Minister of Health and stated that the cage bed ban "was an unduly hasty step".

Furthermore, the president's spokesperson stated that "this decision has been a premature reaction to irresponsible and populist attacks against the quality of health care and protection of human dignity in the Czech Republic".

"President Klaus appears to ignore the internationally-recognized position that the use of 'cage beds' is inhuman and degrading and in violation of international human rights law which the Czech Republic has ratified and is bound to uphold. As the highest public official, who is legally bound to protect the rights of all people in the Czech Republic, president Klaus carries particular responsibility to ensure that people with mental disabilities are treated with respect for their human dignity," the NGOs said.

The NGOs are concerned that there are no plans to remove "cage beds" in long-stay social care institutions for children and adults, which are under the responsibility of the Ministry of Labour and Social Affairs. There is no official data on the numbers and use of "cage beds" in social care homes. The Ministry is reportedly working on guidelines for the use of "cage beds" and "net beds" in exceptional circumstances and has emphasised the need of re-training of staff. According to the NGOs this does not go far enough - international law does not allow for the regulation of something which is considered inhuman and degrading.

Currently, there is no legislation regulating the use of seclusion and restraints in the Czech Republic. Even if "cage beds" have been eliminated, there is a risk that, without legal regulations of other harmful restraints (such as bed straps and handcuffs), isolation and increased psychiatric medication will be used.

The NGOs call on the Czech authorities to adopt regulations which would ensure that any method of seclusion and restraint practised in establishments caring for people with mental disabilities are in line with international human rights standards and best professional practice. Such regulations should ensure that measures controlling agitated patients should be non-physical. Restraint or seclusion must always be either expressly ordered by a doctor or immediately brought to the attention of a doctor; must be used for as short a time as possible; and never be applied, or their application prolonged, as a punishment. Staff must receive training in both non-physical and manual control techniques to deal with agitated patients.

"'Cage beds' are only one of the issues that the Czech authorities should consider when embarking on a much needed reform of its mental health care system. In order to provide modern mental health services compliant with human rights standards, the Czech government needs to reform its mental health policy, creating community-based alternatives to psychiatric and social care institutions," the NGOs said.

Amnesty International and the Mental Disability Advocacy Center now call on the government of the Slovak Republic to take decisive action to end the use of "cage beds" in Slovakia.

--- Background Information ---

The Czech government has been aware of the international human rights concern about cage beds since a visit by the European Committee for the Prevention of Torture and Inhuman and Degrading Treatment or Punishment (CPT) in 2002. Subsequently the use of "cage beds" in the Czech Republic has been criticized by the European Parliament and Gunther Verheugen, the European Union Enlargement Commissioner. The belated reaction to calls for the withdrawal of "cage beds" only came this week in response to a letter by Harry Potter author JK Rowling. The Czech measure comes only a week after the Hungarian Minister for Health, Social and Family Affairs issued a legally binding ban of "cage beds".

Responding to the decision of the Minister of Health, Liz Lynne, Member of the European Parliament for the Liberal Democrats, who hosted MDAC's cage bed report launch in the European Parliament last year, said, "We have been calling upon the Czech government to eliminate this barbaric practice for some time, I am pleased that the government has taken the first steps. I hope that they will implement this decision fully. There is no justification for the use of cage beds, and I call upon other countries that are still using them will also take similar action."

John Bowis, Member of the European Parliament and former Minister of Health from the UK, said "Having taken the issue to the Czech Senate and the Czech EU Commissioner Pavel Telicka, I am pleased that the Minister of Health has now decided to remove cage beds from the psychiatric system. However, it important that cage beds not be replaced by other unacceptable forms of restraint, such as bed straps."

In June 2003, the Hungarian-based MDAC launched its report on cage beds in four countries (Czech Republic, Hungary, Slovakia and Slovenia) at the European Parliament in Brussels. "Cage Beds: Inhuman and Degrading Treatment in Four EU Accession Countries", is available in 5 languages on www.mdac.info. In November 2003 the Chairman of the Czech Senate hosted a high-profile event about cage beds. In December 2003 the EU Enlargement Commissioner called on countries to end cage bed use, and in May 2004 cage bed use was highlighted in Amnesty International's Report 2004.

Both the UK Sunday Times (13 June 2004) as well as BBC Radio 4's "Crossing Continents" program (8 July 2004) have run stories on Czech cage beds. Reacting to press coverage, author of the Harry Potter books JK Rowling, sent a letter to the Czech Ambassador in London stating, "I am sure that I am not alone in feeling a deep sense of shock that a fellow member of the European Union like the Czech Republic could permit such abuses." She continued, "The very idea of being locked in a bed-sized cage around the clock is enough to give adults nightmares - far more terrifying than anything Harry Potter has had to encounter."

The European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) visited Opava Psychiatric Hospital and the Ostravice Social Welfare Home in April 2002. The CPT concluded that "net- and cage-beds are not an appropriate means of dealing with patients/residents in a state of agitation. The CPT recommended that "cage-beds be immediately withdrawn from service and that net-beds cease to be used as a tool for managing such persons as soon as possible", adding that "more suitable means than net-beds can also be found to ensure the safety of persons with impaired mobility or nocturnal disorders (e.g. disorientation/sleepwalking)." (Council of Europe document CPT/Inf (2004) 4)

The United Nations Human Rights Committee commented on cage beds for the first time in August 2003 during its examination of Slovakia, stating that "The use of cage beds should immediately cease." (UN document CCPR/CO/78/SVK)

In response to a question asked by John Bowis MEP in the European Parliament on 17 December 2003 Günther Verheugen, the EU Enlargement Commissioner stated, "I think that we are dealing with a phenomenon that gives us some insight into the sometimes terrifying history of psychiatry, and that we should be really shocked by this. I am sure we all agree that such methods have no place in a modern psychiatric service. For this reason the Commission will do all in its power to continue pursuing the matter, and we shall not stop until the last cage bed has disappeared in every single one of these countries."

The European Parliament, in its "Annual Report on Human Rights in the World in 2002", said that the EU Parliament "is particularly concerned about the continued use of cage beds […] in a number of eastern European countries." The report called on the countries concerned "to cease this degrading and inhuman practice without delay" (EU document 2002/2011(INI)).

-- Contact details of the coalition of NGOs --

Amnesty International is a worldwide movement of people who campaign for internationally recognized human rights. www.amnesty.org. Contact Ivan Fiser, Central Europe Researcher, International Secretariat, Amnesty International, 1 Easton Street, London WC1X 0DW, United Kingdom, Tel : +44 (0) 20 7413 5681, Fax: +44 (0) 20 7956 1157. Email: ifiser@amnesty.org

The Mental Disability Advocacy Center (MDAC) is an international non-governmental organization that promotes and protects the human rights of people with mental health problems and intellectual disabilities across central and eastern Europe and central Asia. MDAC works to improve the quality of life for people with mental disabilities through litigation, research and international advocacy. MDAC has participatory status at the Council of Europe and is a cooperating organization of the International Helsinki Federation for Human Rights. MDAC, H-1241 Budapest, PO Box 263, Hungary. Tel: (+361) 413-2730, fax: (+361) 413-2739, email: mdac@mdac.info, web www.mdac.info

The Center for Mental Health Care Development is Centre a "know how" NGO active in the field of reform of mental health care predominantly in the Czech Republic, but also in several other countries. CMHCD, Kamenická 25, 170 00 Praha 7, Czech Republic. Web: www.cmhcd.cz, Tel: +420 233 376 301.

The Czech Helsinki Committee is a national NGO working for the protection of human rights. Ostrovského 253/3, 150 00 Praha 5, Czech Republic. Tel./Fax: ++ 420-257 323 508. Web http://www.helcom.cz, E-mail: jana.chrzova@helcom.cz.

Fokus - Association for Mental Health Care is a civic non-governmental, non-profit organization. It aims to help people with mental health problems in the normal life in the society. Fokus provides community based services for people with mental health problems in 7 regions in the Czech Republic. Web: http://www.fokus-praha.cz

Inclusion Czech Republic (Sdružení pro pomoc mentálně postižením) is a non-profit organisation which campaigns for the rights and interests of people with intellectual disability and their families throughout the country. Karlínské nám. 12 - 186 03 Praha 8 - Czech Republic e-mail: ivykydal@psp.cz.

User and Ex-user Organization Kolumbus is an organization that associates users and ex-users of psychiatric care. Kolumbus seeks to protect the rights and improve the life of mental health service users. Web: http://kolumbus.wz.cz

Sympathea - is the Czech National Association of Family Members.

John Bowis OBE is a Conservative Member of the European Parliament from the UK and a spokesman on Health, Environment and Consumer Policy in the European Parliament. He is a former UK Minister of Health and can be contacted on jbowis@europeal.eu.int.

Liz Lynne is Liberal Democrat Member of the European Parliament from the UK, and was rapporteur for the European Year of People with Disabilities 2003, and wrote the report for the European Parliament calling for a UN Convention on the rights of people with disabilities. She can be contacted on elynne@europarl.eu.int.