This is the last in the series of articles on the work of the Mental Disability Advocacy Centre (MDAC), an international organisation based in Budapest, which fights for the human rights of people with mental disabilities. People with psycho-social and intellectual disabilities are especially vulnerable to abuse and neglect, and this article will attempt to draw attention to some of the heinous mistreatment suffered in the recent years.

The Problem:

Picture this:  strapped to a bed, subjected to treatment without your consent, you are sedated and electrocuted. Or imagine, isolated and alone, you are kept in cold, dirty and degrading facilities, with no-one to turn to.

Sounds like a scene straight out of “One Flew Over the Cuckoo’s Nest”? Sadly, these horrors are still a reality for many people with psycho-social and intellectual disabilities. For a long time, placing people with mental disabilities in grotty, isolated institutions has been deeply etched into the public psyche. However, this treatment does not meet international requirements enshrined in the European Convention on Human Rights (ECHR), and UN Convention on the Rights of People with Disabilities (UN CRPD), which are aimed at providing protection for individuals from precisely such heinous abuses.

The Legislation:

The absolute prohibition on torture, inhuman and degrading treatment in Article 3 of ECHR is re-iterated amongst the provisions of the UN CRPD. For example, Art 17 protects the physical and mental integrity of persons with disabilities, while Art 15 protects against torture, cruel, inhuman or degrading treatment or punishment, including consent to scientific and medical experimentation. Furthermore, Art 25 provides that healthcare treatment can be given to a person only on the basis of that person’s consent, a point made in a 2008 report of the UN Special Rapporteur. Finally, the right to be free from sexual, physical and mental abuse is covered by Art 16, which also protects against exploitation and violence.

The Incidents:

Despite the numerous pieces of international legislation and global outcry on the subject of mistreatment, incidents of abuse are still coming to light.  In June of this year, MDAC launched a report, in response to the exposition of ill-treatment in Czech Republic psychiatric hospitals dating back 10 years. After 10 years, MDAC had returned to investigate the situation to find that very little had changed; cages are still used in many institutions, and in others cages have been substituted with the use of leather straps, chemical sedation and solitary confinement. These techniques are often used as a method of management due to a lack of staff, or as means of punishment.  Despite the Czech Republic ratifying the UN CRPD in 2009, such abuses are still prevalent.

A victim of a ‘cage bed’ told MDAC: “It is a feeling like you were closed, as if you were an animal. As if you weren’t human. They treat you as someone even lower than an animal.”

This problem is not limited to the Czech Republic. The UN has expressed concerns about the abuse of women in psychiatric hospitals in Moldova, where MDAC has conducted monitoring visits and training. Furthermore in May 2013, a TV programme broadcasted disgusting conditions in Romania, showing residents of facilities there tied to their beds, suffering from physical and verbal abuse, undergoing force-feeding, and being kept in the dark conditions around the clock. Sadly this abuse was not isolated, and the abuse highlighted in the programme represents part of a bigger problem relating to the segregation of people with disabilities in Romania.

Although MDAC’s activities are centred on Europe, incidents of ill-treatment are occurring across the globe. For example, hundreds of people in India are electrocuted without consent every day, often while they are fully awake. Indeed, often this electrocution includes the use of unmodified ECT (without anaesthesia or muscle relaxants). Despite widespread debate and doubt surrounding the efficacy of ECT, the Indian Psychiatric Society and the World Psychiatric Association support the view that this practice is acceptable.

Call for change:

Ill-treatment of people with mental disabilities, both inside and outside of facilities, is a part of a broader societal problem that MDAC is strives to combat. This problem arises partially from the social stigmas and attitudes that surround mental disabilities. Therefore, MDAC promotes wider understanding of recommended treatment, noting that respect for consent and refusal is necessary, particularly when considering forced psychiatric treatment. MDAC campaigns against the use of physical and chemical restraints, and seclusion – arguing that such methods are inhumane and degrading, and that their use is often left unregulated and unmonitored.

MDAC is also asking for regular independent monitoring of services, alongside investigation into allegations of ill-treatment and death, to prevent future abuse and ensure that institutions are protecting their patients.

It is time that States, who have declared to protect the vulnerable in their ratification of international agreements, made good on their promises.

Support MDAC’s campaign to end cage beds: petition to the Czech Prime Minister here: and follow twitter updates: #EndCageBeds.