5. Psychiatric hospitals   Preliminary comments on systemic problems of forensic treatment ―― There is no governmental concept of forensic treatment and there are thus differing opinions among physicians, experts and judges as to the purpose of the protective treatment and the time when the patient should be released. ―― The laws and regulations do not provide a list of patient’s rights and obligations, and there are no recommended psychiatric and sexological procedures for a number of aspects of care – the situation in individual hospitals therefore unreasonably differs. ―― Many hospitals are overburdened and there is no plan how to satisfy capacity requirements for protective treatment in the Czech Republic. ―― Some of the departments are unsafe and there is a habit of prolonged use of restraints. The reason lies especially in insufficient staffing, unadapted environment and combination of patients with various problems. In addition, we examined the use of ECT and means of restraint: ―― Our experts studied individual cases with a view to verifying whether the patients’ rights were respected. ―― In one hospital, electroconvulsive therapy is applied to patients in spite of their protests, solely on the basis of consent granted by the patient’s guardian. Such cases must be referred to the courts, as required by the Civil Code. ―― The physicians mostly do not debrief the patients on cases where means of restraint were employed, and they do not consider administration of tranquillizers to control the patient’s behaviour in spite of his/her resistance to be a restraining measure. ―― In two psychiatric hospitals, we found long-term use of mechanical restraints. In one hospital, the lack of male personnel is dealt with by frequently calling in the Police. ―― We encouraged the hospitals to take systemic measures to reduce the need for using restraints, especially by modifying the environment and increasing the personnel.   Did you know that means of restraint.... …are subject to new standards? In 2017, the CPT reviewed the standards for use of means of restraint in psychiatric establishments for adults. Its twelve points comprise the main aspects of preventing ill-treatment when using force against the patient. The ultimate goal of experts and governmental authorities should be to avoid the use of means of restraint as far as possible. The 2006 standards in Czech are available at http://bit.ly/2noBknx The revised standards in English are available at http://bit.ly/2BHtTvP 21