[Problems in protective psychiatric care in institutionalized patients at the Psychiatric Sanatorium in Havlíckův...

The authors analyzed a group of 52 case-sheets from hospitalized patients with the objective to provide protective in-patient treatment in the sanatorium in Havlíckův Brod. Hospitalizations terminated during the two-year period from July 1, 1988 to June 30, 1990 were involved. The stimulus for this work was the dissatisfaction of the authors with the practice of protective treatment provided in the region. From the results of the analysis three spheres of problems emerged: expert opinions, hospitalization in the sanatorium, activities of the legal authorities. Serious shortcomings were found in all spheres. In some expert opinions there were also mistakes as regards lay-out and contents. Treatment was recommended in 27 instances to persons without mental diseases in the strict sense of the word, incl. 17 cases where their condition was not treatable under the conditions of the sanatorium and in-patient treatment was abolished by court on recommendation of the sanatorium or else changed to ambulatory treatment. In almost half the recommendations of the sanatorium regarding a change of in-patient treatment or its abolition submitted to court untrue statements were found. The courts proceeded in the majority of patients very slowly; time intervals between the submission of the recommendation and the decision of the court were unacceptably long. The authors consider controversial from the medical aspect a concurrent decision on a prison sentence and provision of protective psychiatric in-patient treatment which sometimes was started after several years of imprisonment. The authors discuss some of the most serious problems and suggest possible solutions.