The Council of Europe last week released a report criticizing the Czech Republic for the way it treats people with mental disabilities. The criticism targeting the living conditions and rights of this most vulnerable segment of the population is not the first of its kind. The Czech authorities have previously come under fire for using caged beds in mental institutions. On a fact-finding visit to the Czech Republic, Council of Europe Commissioner for Human Rights Nils Muiznieks went further, arguing that many of the patients in mental institutions could be living a more dignified life outside of these walls.
On a four-day visit to the Czech Republic Council of Europe Commissioner for Human Rights Nils Muiznieks visited several psychiatric institutions and talked to both employees and inmates. In a report issued last week he expressed concern regarding the high number of people who are placed in psychiatric institutions - approximately 60,000 – and the fact that more than 30,000 of them have been totally or partially deprived of their legal capacity and placed under guardianship.
“I am concerned that you still have very large psychiatric institutions where people are staying and this is not good. This is not in line with international human rights standards.”
The Czech authorities admit the country has a problem and say steps are being taken to correct the situation. I called the government’s human rights commissioner Monika Šimůnková to find out how she views the report and whether it reflects the present state of affairs.
“Personally, I believe that the commissioner’s description of the situation in the field of mentally disabled people in the Czech Republic is relatively objective. We spoke with Mr. Muiznieks when he visited the Czech Republic last year and we tried to be very honest about the situation. We are fully aware of the problems he points out in the report and we are striving to resolve them. However, these matters cannot be resolved immediately. It is a lengthy process.”
Can you explain why the Czech Republic has so many people in psychiatric institutions?
“Yes, I should confirm that the numbers stated in the Council of Europe report are real. However we must take into account that the problem is largely inherited and reflects the attitudes and practices applied before the fall of communism in 1989. The social services act which went in force in 2007 clearly established the right of option. This means that a person with a disability can chose for themselves whether they want to use field services or institutional facilities.”
“We still have to work on that of course. The Czech Republic is committed to the principle of de-institutionalization. The Ministry of Labour and Social Affairs is taking steps to ensure that people who chose to stay in their home environment for as long as possible can do so. The process of rebuilding large institutional facilities into smaller community-based facilities is also underway.”
What do you lack most at this point – is it finances or experts?
“I cannot speak on behalf of the ministry, but I should say that it is primarily finances. The recession means that the transformation process is going slower than we expected. But I have to say that the number of people in institutional care is decreasing and one should keep in mind that transformation processes of this kind in other countries lasted for more than 20 years. “
The problem does not only concern the high number of people placed in mental institutions. Each year 2,000 people on average are deprived of their legal capacity and placed under guardianship. In some cases the courts reach this decision without actually seeing the person in question, simply on the grounds of medical records presented and the recommendation of specialists. Consequently it happens that people with mild intellectual disabilities and people with severe disabilities are treated alike. Few are in a position to raise their voice in protest.
In 2009 the Constitutional Court first expressed serious concern with regard to the institution and how it was used. According to the court ruling the practice of depriving people of their legal capacity –as it is applied in its present form - is “a constitutionally problematic instrument” and “a relic of the past” incompatible with the principles of democracy and human rights the country has embraced. It dealt with the issue on the grounds of a complaint from a 58-year-old woman who had been under full legal guardianship for 27 years of her life despite being able to carry out daily tasks of a more complex nature. Despite repeated appeals the courts refused to change her legal status. In 2007 a court partially restored her legal capacity but only to the extent that she was able to handle a small amount of money. The case went to the Constitutional Court which in 2009 ruled that the previous court rulings had violated articles 5 and 10 of the Chapter of Fundamental Rights and Basic Freedoms. After 27 years in captivity the woman got an important part of her life back under her control.
In 2010 the Constitutional Court issued another groundbreaking verdict in favour of a man with a mild mental disability who complained that he was not allowed to vote in elections. The court ruled that stripping a person of the right to manage their legal affairs should not automatically imply that they would lose the right to vote. The ruling set an important precedent.
Despite these verdicts courts are sometimes slow in changing adopted practices. Jaroslav Červenka has been under full guardianship for years. He says that although he still lives at home his freedom is severely restricted.
“As a person under guardianship you have no rights whatsoever. I’m allowed to live here in my own flat which is nice but I can’t go to the theatre for instance and although I’d love to go swimming I can’t do that either.“
A new civil code due to go into effect next year should finally effect a radical change in this respect. Monika Šimůnková explains:
“I have to say that from the human rights point the new civil code brings really fundamental changes. When it enters into force on January 1st 2014 it will abolish the institute of full deprivation of legal capacity. Under the new civil code a person could be only partially deprived of their legal capacity by the courts based on an expert opinion. The reformed law will introduce the institute of assisted decision-making which means the provision of assistance and advice to those who are limited in their legal capacity. So the institute of full deprivation of a person’s legal capacity will be abolished and I think that is a very positive move.”
The general public knows little about the twilight world within the walls of psychiatric hospitals. Under communism the subject was taboo and in the past twenty years not much has been written about the problem outside medical journals. Petr Třešnák, a reporter from the weekly Respekt is a rare exception. He entered the gates of the Bohnice psychiatric hospital to bring readers a powerful story of life within – a report on the case of a patient heading for complete isolation and a caregiver who saved his life by realizing in time that the man who was labeled “aggressively anti-social” was in fact desperately craving human contact. The report won the 2012 European Journalist Award in the health category.