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Last Updated: Tuesday, 15 January 2008, 14:09 GMT
Q&A: Cage beds

The BBC's Ten O'Clock News has filmed the use of cage beds in social care institutions in the Czech Republic - despite the fact that this is now illegal under Czech law and may violate international human rights accords.

What is a cage bed?

Child in cage bed, and nurse
Most types of cage bed can be padlocked shut
A cage bed is a bed with a cage placed on top of it to confine a person inside. Cage beds have metal bars or alternatively netting hung around a four poster metal structure. The metal poles are often more than one metre (39 inches) high.

It is normal for the bed to have one side that can be raised or lowered, and locked in position.

When and how are they used?

Cage beds have been used both in psychiatric hospitals and social care institutions in some Central and Eastern European countries to restrain patients, including children.

Sometimes they are used in combination with psycho-pharmacological drugs.

Patients confined in the beds may suffer from learning difficulties, autism, epilepsy, hyperactivity and other more serious mental health issues.

Campaigners say there is evidence they are sometimes also used as a form of punishment.

What is wrong with cage beds?

Campaigners say that restraint and seclusion in cage beds breaches an individual's right to liberty, because it is a form of incarceration.

They argue that the use of cage beds may actually make patients' violence or aggression worse, rather than solving it. There is a risk a patient may injure himself or herself on its metal structure, they add.

My mouth was so dry I even attempted to drink my own urine
Michel Celetka, of his confinement to a cage bed

People who have been confined in cage beds describe it as a humiliating experience. They say they are often ignored and their requests for water or access to toilet facilities denied. They describe being made to feel like an animal.

Doctors say using cage beds in the psychiatric environment reduces the relationship between patient and staff to that of prisoner and guard, creating an atmosphere of control rather than collaboration.

Are they still being used?

They are still permitted in psychiatric institutions in both the Czech Republic and Slovakia, but according to charities who campaign on the issue of cage beds, they are sometimes also used in social care settings, where they have been banned.

Campaigners estimate that there are at least 220 cage beds in psychiatric institutions and social care institutions in the Czech Republic and more than 100 in psychiatric institutions in Slovakia.

The Czech Republic has the second highest percentage of children in care in Europe, according to one non-governmental organisation, the Children's High Level Group. It says some 22,000 children are institutionalised in care homes in the country and that only 6% of them are actually orphans.

Is the use of cage beds illegal?

Campaigners say they amount to a violation of Article Five of the Universal Declaration of Human Rights - "No-one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment."

Lobbying has led to cage beds being phased out or banned in many Eastern and Central European countries. Hungary outlawed the use of cage beds for patients with mental disabilities in 2003 and, by 2004, they were no longer in use in Slovenia.

Cage beds were banned in social care institutions in Slovakia and the Czech Republic, in 2004 and 2007 respectively.

Why do some countries still use them?

Some doctors and staff in mental health hospitals where they are in use say there is simply no other way of managing violent or aggressive behaviour.

They say they often lack resources, staff and training and that wards are just too overcrowded.

What are the alternatives?

Alternative options include chemical restraint, such as sedatives, and physical restraints such as the use of straps and patient seclusion.

Why has the use of these beds become a political issue?

International bodies such as the United Nations and the European Union and numerous human rights organisations have condemned the use of cage beds.

Campaigners say the use of the beds violates obligations that the Czech Republic and Slovakia gave when they joined the European Union in 2004.

Both countries have ratified a number of international treaties prohibiting inhuman and degrading treatment.

Campaigners say the use of cage beds reveals a deeper problem of attitude to mental illness where children who suffer from mental disabilities are treated as shameful and hidden away, rather than helped.

Graphic showing cage bed



SEE ALSO
Czech man's week in a cage
07 Jul 04 |  Crossing Continents
Out of sight, out of mind
03 Jul 04 |  Crossing Continents
Country profile: Czech Republic
28 Jun 04 |  Country profiles

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