Ending the use of seclusion and restraint in mental health services in Czechia

WHO/Jesus Onn Toi Chew Ambrosio

To promote the human rights of people with psychosocial, intellectual and cognitive disabilities, and in an effort to end the continued and excessive practice of seclusion and restraint in mental health services in Czechia, WHO conducted a 2-day workshop on 13–14 February 2019 in Prague.

The event, hosted by the Czech Ministry of Health, was aimed at staff representatives, including quality managers, from psychiatric hospitals across Czechia to highlight the impact of restrictive practices and propose alternative approaches.

Seclusion and restraint still used in the European Region

Seclusion and restraint are still routinely administered and considered standard procedures in many psychiatric institutions across the WHO European Region. These findings follow WHO’s assessments of 98 facilities as part of the WHO project on adults with psychosocial and intellectual disabilities living in institutions in the Region.

The WHO project targets a highly marginalized, vulnerable group whose quality of life, human rights and inclusion in society are seriously compromised by outdated, often inhumane institutional practices. Its goal is to promote and facilitate deinstitutionalization.

The urgent need to train institution staff and other stakeholders on how to realize rights-based and recovery-oriented mental health care – free from coercion and abuse – was the single most common recommendation made in the 98 assessments.

Offering alternative approaches

The workshop in February aimed to provide an understanding of what constitutes seclusion and restraint, the impact they have on patients, and how their use violates human rights. In the words of one of the participants at the workshop, “I was trained in some psychiatric procedures and attitudes towards patients that I understood as helpful to patients and their recovery, and I have never thought that I might, in fact, be doing something that could elsewhere be considered illegal. This realization was quite shocking to me.”

Using role play and interactive methodology, participants explored alternative approaches that improve recovery outcomes for people who use services, resulting in a safer and more dignified environment for everyone. They built knowledge and skills on the different strategies that can be implemented in mental health and social services in order to end seclusion and restraint.

Reflecting on one of the role plays, a participant commented. “If a patient would throw water at the doctor, that would be the end of the story and the next thing would be restraining the patient. It is very useful to see that the situation can be resolved differently.”

About the WHO QualityRights initiative

WHO QualityRights is reforming mental health services and promoting the human rights of people with psychosocial, intellectual and cognitive disabilities around the world. It offers a new approach to mental health care which is rights-based and recovery-oriented.