Several COE Member States are continuing to ‘deinstitutionalise’, in the sense of various policies and practices designed to close down large-scale institutions in which persons with mental health conditions and psychosocial disabilities, and other disabilities, are placed and detained. Efforts to reduce coercion in mental health services in these countries cannot be neatly distinguished from the broader aims of deinstitutionalisation.
The Czech Republic has initiated such a project in the form of a 2013 mental health policy that was boosted in 2017 with European Investment and Structural Funds (Submission 18). The subsequent National Action Plan for Mental Health Care includes selected measures to address, ‘inter alia, the rights of people with mental illness, support for the quality of psychiatric care and services in mental health and prevention of involuntary hospitalisations’ (Submission 18).
The Strategy for the Reform of Psychiatric Care aims to avoid simply shifting people from institutions to hospitals, or ejecting people from psychiatric institutions and hospitals without the provision of follow-up support and resources. Instead, the aim is to create a range of services so that ‘inpatient care does not replace other care in the social environmental system in order to meet health and social needs’ (Submission 18). 17 psychiatric hospitals are participating in the reform process.
The Ministry of Health required the directors of individual hospitals to change the structure of care provided so that services are provided in service user’s own social environment (e.g. the establishment of community mental health centres). Effort is also underway to assist individuals who have been detained in hospitals for periods longer than six months to transition back to living outside of the institutional environment. From 1 January 2019 to 31 May 2019, 736 long-term hospitalised patients were released (Submission 18). 43% of long-term hospitalised patients have nowhere to live.
Another feature of reform has been a largescale survey of mental health service users and their family members, comprising of more than 700 respondents from across the Czech Republic (research which is underway at the time of writing) (Submission 18).
The overall Strategy is closely linked to the WHO QualityRights project (see above p.17). In 2018, in cooperation with the WHO, a mapping of the quality of care was carried out in a total of 17 psychiatric hospitals. The output of this quality of care mapping, which was based on WHO QualityRights standards (following the CRPD), was evaluation reports for psychiatric hospitals and a summary evaluation report. The evaluation team consisted of a doctor, a person with experience of a mental health condition and psychosocial disability, a social worker, and a lawyer.
hospital was provided with a consultation process and educational program for workers (doctors, nurses, medical orderlies, social workers and other paramedical professions) on selected issues concerning the implementation of the CRPD. These programmes are implemented by quality managers and are always thematically focused on the real need or demand of the psychiatric hospital. The implementation of full-time education and thematic workshops in psychiatric hospitals has been suspended due to the Covid-19 pandemic, and have temporarily occurred via webinars.
For the first half of 2021, online educational programs are being prepared focusing on the following topics for example:
- Human rights;
- Arbitration and the right to decide for oneself;
- Recovery and the right to health;
- Freedom from coercion, violence and abuse;
- Mental health, disability and human rights, and so on.
In addition to these educational programs implemented in individual hospitals, seminars for hospital management were held in cooperation with the Office of the Public Defender of Rights of the Czech Republic. These seminars focused on the legal liability of health professionals, the basics of human rights, the issue of regime measures and the issue of prevention of the use of restraints measures. These seminars also took into account the need to anchor the issue in a managerial and procedural approach of particular psychiatric hospitals (Submission 18).
In cooperation with the WHO, an e-training educational program focused on quality and human rights WHO QualityRights was published in November 2019, which includes a module focused on the prevention of the use of restraints measures. This e-training educational program, which is available on the website https://humanrights-etrain-qualityrights.coorpacademy.com/login is open to all interested stakeholders, is available in the Czech language version and psychiatric hospitals are systematically supported in its implementation into internal education within the organization. As of 1 December 2020, a total of 2,395 people had completed this educational program (Submission 18).
By June 2021, the Ministry of Health is set to publish its Recommended Practices for Psychiatric Hospitals. The forthcoming best practices include:
- Prevention and use of restraints measures in psychiatry;
- Best practice for complaints (including Easy to read version);
- Recommended procedure for the issue of liability of healthcare professionals;
- Recommended procedure evaluation of quality and human rights within the internal processes of a psychiatric hospital;
- Guardianship and other support measures; and
- Hospitalisation and treatment without patient consent, informed consent.
The Government Council for Mental Health has discussed the possibility of establishing a new separate department within the organisational structure of the Ministry of Health in 2022, to promote and protect the rights of persons in healthcare, including reducing rates of involuntary psychiatric initiatives.