Ban on cage beds premature: Czech officials
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* Dinah Spritzer

*   © 2004 Canadian Medical Association or its licensors

Mental health advocates across Central Europe are celebrating the death of the cage bed, a device used in the Czech Republic, Slovenia and Hungary to restrain patients with mental disabilities. However, a lack of staff and resources to deal with these patients means the ban may be premature.

![Figure1](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/171/6/557/F1.medium.gif)

[Figure1](http://www.cmaj.ca/content/171/6/557/F1)

Figure. **Cage and net beds, like this one at the Bohnice Psychiatric Hospital in Prague, are now banned.** Photo by: Dinah Spritzer

Hungary stopped using the beds in July, while Slovenia, which has only 2 such devices, plans to phase them out. The Czech Republic followed in Hungary's footsteps after *Harry Potter* author J.K. Rowling urged the government to ban the beds. 

Amnesty International, the Council of Europe and others had long pressed for a ban but were told by Czech officials that insufficient money and staff existed to solve the problem. About 750 to 1000 such beds were in use in the Czech Republic until July.

Caged and netted beds were first used in the early 1900s when they were viewed as a more humane way of restraining patients than straitjackets. In the 1960s they were deemed barbaric in Western European countries, but thousands of patients in Europe's Communist bloc continued to be confined — sometimes for years — to a space roughly 2 metres by 1 metre. 

The sudden ban on the beds put a spotlight on the ailing mental health care system in the former Eastern bloc. During the Communist era, mental health patients were hidden from society and patient rights were nonexistent, says Diana Hoover, executive director of the Mental Disability Advocacy Center. 

This Budapest-based organization, which focuses on the former Eastern bloc, applauds the ban, but Hoover now wonders how understaffed mental health facilities will deal with patients deemed dangerous and whether staff will receive the necessary retraining so that sedatives or long-term physical restraints do not replace the use of the beds. 

“Caged beds are wrong, but doctors tell us that banning them could lead to methods that are even worse,” says Jan Jarab, director of the Czech government's Commission for Human Rights.

Cost has long been the key argument for maintaining the beds. Removing them will cost millions, according to the Social Affairs ministry, which is seeking training aid from the European Union.

Hoover has little patience for the ministry's laments. “So lack of money and training means you can abuse people's human rights?” 

Hoover and Jarab agree that the larger problem is that too many people in former Communist countries are warehoused in institutions, when they could be integrated into society. 

“The funding structure, which gives facilities more money when they have more patients, does not provide an incentive to get people back out there into society,” Jarab says.

Another problem is that patients in the former Eastern bloc have almost no legal rights, making the potential for mistreatment quite large, Jarab says.

These unresolved issues mean that a ban on caged and netted beds is premature, says Pavel Dzodla, director of the Samuel Blum Psychiatric Clinic in Plesivec, Slovakia. “Should we strap the patients in so they can't even move? And what about an old man who suffers from mental illness and would die if he fell out of bed? A cage bed prevents this.”

“Better would be modern medical units with sufficient number of doctors and nurses but the Slovak health care system has no money for this,” says Dzodla.

Zdenek Basny, director of Prague's Bohnice Psychiatric Hospital, says he is “not in favour of these beds [but] there is no better alternative for patients with serious mental defects and long lasting periods of aggressive behavior. Banning them is a political solution, but it doesn't solve the problem that we lack the personnel to look after these patients.” — *Dinah Spritzer*, Prague, Czech Republic