9. Conclusion
Before they could get him back in, he ate another patient’s slippers.
MDAC first called for the prohibition of cage beds in Czech psychiatric hospitals in 2003. Despite continuing international attention, the response of the government and the Czech psychiatric community has been insufficient. The retention of netted cage beds and supplementing them with straps, restraints and seclusion is indicative of the failure to reduce overall levels of coercion in Czech psychiatry, despite the removal of metal cage beds. All of these practices constitute ill-treatment prohibited by international law.
The outdated and indefensible practices observed by MDAC monitors overwhelmingly reflect the archaic institutional nature of psychiatric service provision in the country, predominantly provided at large and dilapidated institutions where coercive practices are literally built into the fabric of the buildings. Without doubt, this points to a failure to invest in community-based mental health services, as well as a broader attitudinal problem whereby decision-makers and service providers continue to revert to a medicalised model of disability rather than engaging with a human rights approach which places dignity, autonomy and consent at the centre.
As has been highlighted in this report, not only is it possible to drastically reduce coercive practices inside institutions, but this is now a requirement under international law. However, reducing coercion cannot be an end in itself. The UN Convention on the Rights of Persons with Disabilities requires that institutions which segregate people with disabilities from society are eventually closed, with investment instead being focused in the communities where we all belong. Whilst social prejudices and discrimination may make such a transformation difficult to imagine it has been shown to be possible where there is strong leadership and a reallocation of resources.
MDAC hopes that the Czech government will now show this leadership, proving to people with mental health issues and the international community that they will take real, concrete steps to bring Czech psychiatry into the twenty-first century. An obvious first step would be to immediately ban cage beds – something that could have been achieved a decade ago. It is also hoped that new generations of medical professionals operating in the field will contribute to the broader changes required, supporting the autonomy and dignity of the people that they have committed to serve.
The fundamental changes required mean that the voices of people placed in psychiatric institutions should now take centre stage. MDAC will continue to monitor the human rights of people with mental disabilities in the Czech Republic and elsewhere. It is hoped that the recommendations provided in this report will contribute to the push to ensure that all people with mental disabilities are included and supported to be equal members of our societies.