The Czech Ministry of Health continually refuses to comply with European standards for the use of constraining methods, either through calming medication or by tying patients to their beds.
No official evidence is kept so it is difficult to check the frequency and purpose of employing such methods; nor is it possible to compare the practice across various hospitals. A recent survey by the Ombudsperson Anna Sabatova suggests that some patients are being constrained unnecessarily, or for excessive periods of time.
An official guidelines paper is now being prepared at the Ministry to regulate carers’ approach. According to the ombudsperson, however, the draft is in some places unclear, while in others it ignores directives of the European Court of Human Rights. Although the Czech government announced a phase-out of caged beds some time ago, the draft guidelines still include their use without any limitation.
“The current situation is difficult both for the patients as well as for the staff,” says the ombudsperson.
Key features missing
Sabatova enumerates five key features missing from the present draft. There is no instruction to keep register of the use of restraining methods, no development of alternative measures, or duty to increase staff numbers where restraining methods are used to solve staffing issues. There is also no mention of gradual phasing out of netted beds, and no guidelines to evaluate the patient’s situation in order to minimise traumatisation of patient and staff after restraint has been applied.
“We have already exhausted all sensible arguments and the Ministry’s reaction is simply not adequate. For example, we explain to the Ministry that we have been internationally criticised for twenty years for the use of netted beds and we ask them to at least incorporate a vision of their phase-out into the guidelines. And the ministry responds that the use of netted beds must be evaluated individually for each case,” says Marie Lukasova, legal counsel from the ombudsperson’s office.
She adds, “mentally challenged patients are especially harshly affected. Due to tying down or the use of netted beds, parents often take the patients home even though the patient should really stay on the psychiatric ward. And nobody talks about it.”
Public attention was drawn to the debate in February when an Alzheimer-stricken man died. According to his widow, the Psychiatric Ward in Brno tied him down which led to bruising and troubled breathing. Yet the Constitutional Court found the widow’s complaint unfounded.