Report of CAT-session on Czech Republic

I have been to Geneva again, on Friday May 11 2012.
I was asked by ENUSP, the European Network of (ex) Users and Survivors of Psychiatry (www.enusp.org) to go to the UN OHCHR and participate in 48th CAT-session, in the private session on Czech Republic.

The Committee Against Torture (CAT) is a body of 10 independent experts that monitors the implementation of the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment by its State parties. States must report every four years, and the CAT-Committee examines each report and addresses its concerns and recommendations to the State party in the form of "concluding observations".

This private CAT session with NGO’s was part of the CAT- review on Czech Republic, which is to see if any human rights violations classified as torture occur in the particular State.

In the private CAT session, amongst others, forced treatments and especially caged beds (net beds) were subject to discussion in the context of torture, and I was asked to step in as an international representative of ENUSP (and WNUSP, the World Network) and as an expert on (banning) forced treatments. Also Michal Caletka, survivor of caging from Czech Republic and ENUSP Deputy Board member was there to give his statement.

I felt very honoured by this invite by ENUSP, and I feel connected to the cause of banning caged beds and all other forced treatments, because of my own experiences with long term solitary confinement (isolation cell) and bed-strapping. I have never been in a caged bed myself, but there are similarities in all these kind of physical restraints, as they are all so utterly degrading, with things like inability to go to toilet, no access to food or human contact, totally depending.

So I went to Geneva. ENUSP funded my trip, and my own organization Mind Rights (www.mindrights.nl) funded the hotel night. I arrived in the late evening of Thursday May 10, 2012, and then stayed at Hotel Admiral for quite a short night. Then the next day, Friday May 11, I left with all my luggage to OHCHR, where I was going to meet Michal Caletka and Victoria Lee from IDA (International Disability Alliance, www.internationaldisabilityalliance.org ) and also Zuzana Durajová from LIGA/MDAC (Mental Disability Advocacy Centre, www.mdac.info / LIGA www.llp.cz )

We were supposed to meet each other at 9 am prior to the CAT session at “Cafetaria Wilson”, to prepare for a joint statement and strategy against net beds and forced treatments in general. Coincidentally both Michal Caletka and I had mistaken the location of the meeting, and were at the big UN complex “Palais des Nations”, downstairs at the cafetaria. (This time I had no trouble getting access to the UN Palais des Nations. The security remembered me and said: “Hey, you have been here before”. That was quite nice)
Michal and I talked and waited until we found out we were at the wrong address, so we took a tram and went to “Palais Wilson”, which is another UN building not very far from the big Palais des Nations. The UN compounds are really confusing, and we even struggled to get out of the building, but we managed to get to Palais Wilson within like half an hour.

Then we met Victoria and Zuzana, and we prepared for the session while we were sitting outside on the sunny terrace. By the time it was 12.00 we were going in for our private 1-hour session with the CAT Committee.

First Victoria Lee (IDA) gave an introduction of who we were and what we were going to present to the CAT Committee. She highlighted some points in advance that are relevant for Czech Republic, such as the obligation of de-institutionalization, based on the right to live in the community and not in a setting, which follows from art. 19 (Living in the community) of the UN Convention on the Rights of Persons with Disabilities.

ENUSP had sent a written submission to contribute to the CAT discussion on Czech Republic, on the forehand of the sessions – which had enabled us delegates to participate at this Private NGO session with CAT Committee. ENUSP pleas for a ban on caged beds and makes a strong point against forced treatments.

The written ENUSP submission had already explained how the abolition of caged beds was a precondition to entering the European Union in 2004. And in 2007 a new law entered into force that prohibits the use of cage beds in social care facilities. Even though it is now officially prohibited to use cage beds in social care facilities, a undercover report of BBC in 2008 shows that net beds still are in use in some of the social care facilities (including in children’s facilities).
Also, the written ENUSP submission mentions that there is no law that prohibits the use of caged beds in psychiatry (mental health care), which is arranged in other laws separately from social care facilities. Very recently, in January 2012, a 51-year old woman hung herself in the net of such a caged bed. This is about the 5th death due to caged beds in recent years. In 2006, a 30-year old woman died in a caged bed, by suffocating while she ate her own faeces. This then caused a public debate throughout the Czech Republic, which lead to camera surveillance for caged beds in psychiatry. In January 2012, the 51-year old lady was able to commit suicide despite camera surveillance, so this proves that the use of cage beds is very unsafe.

Our contributions in the discussion were related and supportive to this ENUSP submission.
Find the ENUSP statement at: http://www.enusp.org/documents/ENUSP_EDF_CAT%20Committee%20submission%2023_04_2012.pdf

Zuzana Durajová (LIGA/MDAC) explained the Czech situation in more detail. She explained that since 2007, there is a National Transformation Centre for the transformation of social services, which includes some social care institutions as a pilot project. The funding of this Transformation Centre is only secured until 2013. Also there is no special strategy regarding children and elderly, and none for psychiatry or Community Based Rehabilitation (CBR) and ambulatory care. The Czech Republic has a long history of institutionalization, and even children as young as the age of 3 years are institutionalized on a large scale. The Transformation Centre needs to be sustained and expanded, and it should focus on transformation of all disability services, including for children and elderly.
Also there is a lack of monitoring. People who are institutionalized are at a big risk of ill treatment and restraints. The complaint procedures are lengthy and not accessible. Also for example, at closed wards sometimes persons are not allowed to send or retrieve letters. Also the SPT doesn’t easily get access to all these places in Czech Republic, so monitoring is another point of concern.

Then Michal Caletka shared his horrible personal experience of being caged in a psychiatric hospital in the Czech Republic. He told about how he became confused, and then he was a long time without rest (drained from energy). At a point he became des-oriented. Then his friends/family took him to a psychiatric hospital. He went there voluntary, as he also wanted help through this hard time in his life. Then, instead of wise words or any advice, some persons came to inject him forcefully, and put him in a caged bed. He was left unconscious. He only woke up to pee, which he had to do through the net. When he was awake, nobody was there. He couldn’t get out to eat or drink something, so he became physically very weak as well. He tried to escape, but he couldn’t. He experienced that he was close to death. Only after 10 days he was allowed out of the cage. He can never forget this horrible experience of almost dying in a caged bed. And that is why he is now active in the Czech user and advocacy movement, and also in the European Network of Users and Survivors of Psychiatry (ENUSP).
Michal also referred to the UN Convention on the Rights of Persons with Disabilities (UN CRPD), and added that in Czech Republic, persons with mental health problems are seen as “incapable” and are totally stripped of legal capacity and all freedoms, which is a violation of almost every article of the UN CRPD.

Then it was my turn for a contribution. I said that the use of caged beds is shocking and horrible, and then I emphasized that substitution of caged beds by other forms of forced treatments should be avoided. All forced treatments are in fact all equally bad. People can die in all of these restraints, as bed-strapping, caging, solitary confinement, and forced drugging. It also causes suicides, and people are damaged for life. Some don’t get out of that circle at all, and it only gets worse. This happens everywhere all over Europe and beyond. I also had 2 years of solitary confinement, and I was strapped on a bed. I have never been in a caged bed, but the experiences are quite similar. It causes trauma, powerlessness and despair. What can be worse than being so horribly abandoned in such a degrading and inhuman position like a caged bed. This has got nothing to do with mental health care. Research on recovery shows that love, hope, perspective, chances and a respectful attitude are keys to recovery.
Often the arguments for using restraints are danger and safety, or for treatment purposes. But both are not right. Restraints cause trauma and resistance, and leads to more psychosocial problems, and therefore restraints lead to more unsafety. Also restraints are no treatment, because it doesn’t lead to wellbeing, which should be the goal of mental health care.
Also I added that forced treatments are said to be a last resort, but often there are not any first resorts at all, so in practice the use of force is often a first step. This on its turn also keeps up the misperceptions towards mental health treatment and the stigmatization of the persons. There are alternatives to forced treatments, which are based on respect and recovery, and these should be implemented.

It was very nice that Mr. Grossman (chair of CAT, coming from Chile) suddenly thanked me in Dutch for my contribution, saying “Dankuwel voor uw bijdrage”. I liked that.
Mr. Wang and Mr. Grossman were the rapporteurs on the Czech Republic for the purpose of this review.

Then some members of the Committee had some further questions, especially on the forced castration of certain sex offenders (paedophiliacs) which happens in Czech Republic as a precondition for returning to the community, and on the forced sterilization of Roma women, that used to happen and the women still aren’t compensated for this. Both of these things are in ongoing discussion in the Czech parliament, so not much can be said about that, only that there is a public debate going on in Czech Republic, and laws might be changed.

Further there were some questions about children in institutions. Zuzana explained that research shows that children in Czech Republic are put in institutions often for social reasons, like inadequate housing, or financial reasons, rather than other reasons, like a disability. Especially Roma children are vulnerable to institutionalization, ill treatment and neglect.

Mr. Grossman, the chair of the CAT Committee then thanked us all and closed the session.
At the end of the session I also handed out my leaflet against forced medication to all the CAT Committee members.

Afterwards the four of us (Zuzana, Victoria, Michal and I) went back to the cafeteria Wilson, where we met Ms. Nora Sveaass, a member of the CAT Committee, coming from Norway. She wanted to speak with us in more detail during lunchtime. She has a background as a psychologist, and she is aware of what happens inside institutions. She supported our statement, and asked us for more information, so she would be able to formulate the right questions to ask to the Czech Government, at the Question-session on Monday, May 14 2012. We had a very interesting conversation about how to translate the ill practices of mental health care into good questions for the legal torture framework, based on the topics we had identified.
All four of us were invited by Ms. Sveaass to send her proposals and suggestions for the Questions she should ask according to us. So during the weekend we (delegates and networks) prepared a list of suggested Questions and sent them to ms. Nora Sveaas.

In the Monday session (May 14, 2012) of Questions to the Czech Government, Ms. Nora Sveaass indeed asked these questions, which she had reformulated in her own words. Unfortunately I missed the live broadcast of this session, but I was very happy to find out that our topics were addressed.

The next day, Tuesday afternoon, May 15 2012, I watched the entire live broadcast of the Answering session, where the Czech government replies to the Questions of the CAT Committee. This was a 3-hour session, and I didn’t find it exciting. Only a few lines were spoken by the Czech government in reply to the answers about cage beds/net beds, saying it was “a possible option to solve the patients situation, which is now further instructed by a new law, which describes a procedure on how and when to use it”.

Both the Question and the Answering CAT-session of Czech Republic will probably be put online soon in the archives at http://www.treatybodywebcast.org/

Now the next step is to wait for the Concluding Observations with concerns and recommendations regarding Czech Republic, which the CAT Committee will publish in about 2 weeks time, at http://www2.ohchr.org/english/bodies/cat/cats48.htm


More information on ENUSP statement on cage beds:

1) ENUSP/EDF Suggestions for disability-relevant recommendations to be included in the Concluding Observations on Czech Republic of the Committee Against Torture 48th session,
http://www.enusp.org/documents/ENUSP_EDF_CAT%20Committee%20submission%2023_04_2012.pdf

2) ENUSP report on recent death of caged woman - http://dl.dropbox.com/u/5351397/ENUSP_PRESS_RELEASE_ENG_FEB%202012%20%281%29.pdf

3) The only English language report on the latest death : http://praguemonitor.com/2012/01/26/pr%C3%A1vo-mental-hospital-patient-strangles-herself-caged-bed

4) BBC (2008, caging of children discovered in social care home despite ban):
http://news.bbc.co.uk/2/hi/europe/7181854.stm

5) The Lancet report (2006- report on legal action against Czech government following death of woman in psychiatric cage) http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(06)68824-7/fulltext

6) BBC(2003- Czech man's week in a cage)-http://news.bbc.co.uk/2/hi/programmes/crossing_continents/3873123.stm