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Central Europe: Use Of 'Cage Beds' An Affront To Rights Of Mentally Ill

An international advocacy group for the mentally ill says some psychiatric institutions in Central Europe continue to use an archaic and cruel device called the "cage bed." The Mental Disability Advocacy Center made public its findings today after study missions in Slovakia, the Czech Republic, Hungary, and Slovenia. The group's lead researcher told RFE/RL that use of cage beds persists, even though hardly anyone supports or defends the practice.

Prague, 17 June 2003 (RFE/RL) -- A young mother in Slovakia slips into a manic episode shortly after giving birth. She is heavily sedated after being incarcerated in a mental institution. When she awakes, confused, she slips out of bed and goes to the hospital's lobby. She is unclear as to what she wants.

Attendants try to administer sleeping pills. She refuses. They inject her with a sedative. When she awakes, she finds herself behind bars like a monkey in a zoo. What amounts to her cell is a bed with a wire cage built on top -- known in the profession as a "cage bed."

She needs to use the toilet and calls out to be released. Nobody comes. She loses control, but attendants refuse to release her or even to clean her mattress.

The Budapest-based Mental Disability Advocacy Center (MDAC) made public today a report of its findings about the use of cage beds by institutions in the Czech Republic, Hungary, Slovakia, and Slovenia. It says the practice -- though outmoded, inhuman, and degrading -- is widespread among institutions its researchers visited.

The case just described is an actual one. MDAC's lead researcher on the project, Susan Treadwell, said she has seen people incarcerated in cage beds in conditions she has difficulty describing. "It is easier for me to use the words of people who I spoke with who described their feeling of being like an animal in a zoo. And, you know, there are photos that we've taken where we've seen people in cage beds. And it really does look like we are visitors at a zoo and looking at something that is caged," she said.

The MDAC report mentions no names and throws no stones. It relies on what has been called "one-rat-in-the-barn" logic. That is, when a farmer sees one rat in his barn, he knows the chances are good he has an infestation of rats.

Treadwell said her organization hopes to make a point larger than the idea that some institutions are engaged in unnecessarily abusive behavior. She said MDAC's intent is to publicize a problem that is systematic in the four countries visited and, undoubtedly, in numerous others.

"Oftentimes, when there are critical reports, and there are a limited number of institutions that are named, states often just take stopgap measures to remedy the situation in only these particular institutions. This problem is systematic. It goes across all of these institutions, social-care homes and psychiatric hospitals within the countries. And our intent was to force the governments to address the issue, to find out on their own which institutions may be the most abusive," Treadwell said.

MDAC was formed three years ago to promote and protect the human rights of people with mental disabilities in 28 countries of Central and Eastern Europe, the former Soviet Union, and Mongolia. It says its goal is to improve the quality of life of what it calls "users of psychiatric services" by advocating public policies that respect human rights.

The Open Society Institute of financier-philanthropist George Soros funded MDAC's cage-bed study. Lead by Treadwell, who holds a master's degree in human rights from Essex University in the U.K., researchers spent four months visiting more than 20 psychiatric institutions -- both hospitals and social-care homes -- and found the use of cage beds to be endemic.

MDAC says it hopes its report will result in careful monitoring of psychiatric practices so that comprehensive data can be developed about the methods used to deal with patients. It urges that effective laws and regulations be adopted that would forbid cage beds and other practices believed to be abusive. And it seeks effective monitoring to enforce such rules.

"Well, we hope that the states, the four countries concerned, will prohibit the use of cage beds through legislation, mental-health legislation, or any legislative means that they can take, and provide some mechanism for monitoring and inspecting to make sure that cage beds are, in fact, removed and that the human rights of people in institutions are protected," Treadwell said.

The researchers found few institutions -- even those regularly using cage beds -- that said the devices are desirable. The MDAC report says that all of the psychiatric staff members interviewed told the researchers that they used cage beds only rarely.

The MDAC workers concluded, however, that the practice is commonplace and that any use of cage beds is countertherapeutic and a violation of international norms. "Most of the professionals that we have spoken with admit that cage beds are not a good thing. They wouldn't defend them openly. But given the circumstances under which they're apt to work, with understaffing, lack of resources, inappropriate facilities, they think that this is their only alternative," Treadwell said.

Treadwell counters by noting that institutions that have forbidden the use of cage beds report little change in their staffing needs and few problems resulting from the new policies.

"Many of the institutions we visited in Hungary and one in the Czech Republic, they have stopped using cage beds. They don't have, you know, greatly different numbers of staff than institutions that do use cage beds. The greatest difference is in policy and institutional culture. If a director of an institution says we are going to stop using cage beds, they are often able to accomplish that without very many changes or adding greatly to the staff," Treadwell said.

MDAC notes that all four of the countries it covered are signatories to various human rights treaties and declarations. And all are soon to be accepted into the European Union. This, MDAC says, is all the more reason that Slovakia, Slovenia, Hungary, and the Czech Republic should overhaul their oversight of psychiatric institutions.