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I Became a Mental Hospital Patient, Before I Even Knew It

This year, in Korea, the movie Come to See Me was released. This movie plainly shows the reality of compulsory psychiatric hospitalization and the devastated life of the victim. Scenes depicting cruel violence and suspicious administration of drugs toward the main character following her compulsory hospitalization came as especially shocking to the audience. Unfortunately, this is not just a scenario based on fiction, but an absurd reality. Even now, compulsory hospitalization is conducted in our vicinity. The Sungkyun Times (SKT) informs Kingos of the reality of compulsory hospitalization, a recent constitutional nonconformity decision along with the controversy and limitations of the related law, and the tasks that should be tackled in order to improve this situation.

Compulsory Psychiatric Hospitalization; How does it occur in Korea?

Progress and Seriousness

The primary purpose of compulsory psychiatric hospitalization is to support the successful rehabilitation of mental patients into society, and to prevent the unsuspected harm that may occur to others. Compulsory psychiatric hospitalization is conducted according to the Mental Health Act which was legislated to control the medication and prevention of mental disorders. Specifically, Article 24 of the Mental Health Act handles the contents of hospitalization by people with duty of care. The main point of this article is that compulsory psychiatric hospitalization is possible without the agreement of the mental patient if more than two legal guardians and a psychiatrist consent to it. If there is only one legal guardian, a single agreement is also allowed for compulsory psychiatric hospitalization. Therefore, under the current law, the guardian and attending physician may conspire and conduct compulsory hospitalization with no difficulty. What is worse is that there is no intervention by a third party that could check if it is a conspiracy or a legitimate diagnosis in Korea. In contrast, in the United Kingdom (UK), psychiatrists from other hospitals need to be involved in the diagnostic process to prevent a conspiracy between family and their physician. The average time of hospitalization is also extremely high in Korea. While the average time of hospitalization in Germany and England is at maximum one month, and two to three days in Italy, Korea’s average hospitalization time is 262 days at a psychiatric hospital and 3,655 days at a mental health care facility. According to the statistics from the Ministry of Health and Welfare, as of 2014, the number of patients who were in psychiatric hospitals was seven million. Among them, approximately five million people were hospitalized by force. Those who were forcibly hospitalized comprise 70% of patients in psychiatric hospitals, which is an abnormally high figure. The compulsory hospitalization rate worldwide is estimated to be 10-30%. The criticism toward human rights abuse owing to compulsory hospitalization has been continuously brought up because there is no clear standard to diagnose whether a person has serious mental disorders that may cause harm to themselves and others. Furthermore, the absence of clear mental disorder hospitalization criteria is also a serious problem.

From the Movie Come to See Me / newshankuk.com

Actual Cases

Recently, the phenomenon of the “revolving door of hospital readmissions” is radically increasing. It means that psychiatric hospitals temporarily allow patients to leave the hospital according to the medical instructions, and force the patients to be instantly hospitalized again. Additionally, there are some vicious psychiatric hospitals which do not allow patients to leave the hospital to receive medical care benefits.

Case 1

In 2013, a 50-year-old woman was preparing for remarriage. At the time, she was taking steps for accusation against her ex-husband concerning the division of assets. Then, the urgent voice of her son, whom she could not meet for five years, reached her ears. Astonished, she instantly opened the door and there stood two strangers waiting. They came into the woman’s house and hauled her to a psychiatric hospital, where she was confined without knowing the reason behind her hospitalization. Later, she discovered that she had been forcibly hospitalized by her son who was afraid of the deprivation of his property rights. Her son abused the Mental Health Act for monetary reasons.

Case 2

Person A had difficulties marrying Person B in 2015 because A’s parents disallowed it. Even though the bride and groom had already went on their honeymoon, A’s parents persistently called A, pressuring her to return to Korea, and did not accept B as their son-in-law. In the same year, the couple fought over a minor problem and A temporarily stayed at her parents’ house. By chance, A’s parents decided to separate the couple by sending their sane daughter to a psychiatric hospital, under the claim that she was clinically depressed. At night, when A fell asleep, the parents took her to the hospital and she was confined there for two months. The hospital rejected visits from all people, including B, as A’s parents had requested. This case also shows the abuse of Article 24 of the Mental Health Act.

According to the National Human Rights Commission of Korea, the percentage of petitions related to human rights in confined institutions was the highest, accounting for 32%. Moreover, the number of cases related to confinement problems that the Korea Legal Aid Corporation has dealt with is radically increasing as shown below.

Increase of Confinement Problems / hankook.ilbo.com

The staff of Korea Legal Aid Corporation pointed out that “Even a suspect of a crime cannot be arrested if there is no warrant. It is too easy to hospitalize people by force because there are no particular qualifications that are needed. Therefore, with conflict situations among family members, Article 24 of the Mental Health Act can be easily abused.”

Constitutional Nonconformity of Compulsory Psychiatric Hospitalization

Legal Protection of Compulsory Hospitalization / chosun.com

In May 2016, as the side effects of the Mental Health Act became controversial, the Ministry of Health and Welfare proposed an amendment, later passed by the National Assembly, which changed the problematic articles. The new amendment includes the following: The period of judging whether a patient can leave a psychiatric hospital is shortened from six months to three months. Secondly, patients can be hospitalized by force only if they have a possibility of self-harming or causing damage to others. Finally, compulsory hospitalization is only allowed if the opinion of other hospitals’ psychiatrists is in accordance with the hospital where a patient is expected to be hospitalized. This amendment will be implemented in May 2017. Nevertheless, as resistant voices of various human rights groups became louder, the Constitutional Court of Korea decided to take constitutional nonconformity action. This action was adopted under the unanimity of all judges, concerning the invasion of personal freedom and abuse.

Constitutional Nonconformity of Compulsory Psychiatric Hospitalization

In May 2016, as the side effects of the Mental Health Act became controversial, the Ministry of Health and Welfare proposed an amendment, later passed by the National Assembly, which changed the problematic articles. The new amendment includes the following: The period of judging whether a patient can leave a psychiatric hospital is shortened from six months to three months. Secondly, patients can be hospitalized by force only if they have a possibility of self-harming or causing damage to others. Finally, compulsory hospitalization is only allowed if the opinion of other hospitals’ psychiatrists is in accordance with the hospital where a patient is expected to be hospitalized. This amendment will be implemented in May 2017. Nevertheless, as resistant voices of various human rights groups became louder, the Constitutional Court of Korea decided to take constitutional nonconformity action. This action was adopted under the unanimity of all judges, concerning the invasion of personal freedom and abuse.

Limitation and Continuously Arising Controversy

Limitation of the New Amendment

Although the new amendment of the Mental Health Act passed, problems still exist. First of all, there are concerns that the retrial will be stopped at the level of conventional procedures because the scale of judges is small. While more than 100 patients are hospitalized daily, there are only five national psychiatric hospitals in Korea. Therefore, it is almost impossible to take care and judge all of the patients specifically. The Habeas Corpus Act is a system which was made to help people who were confined in institutions like psychiatric hospitals and prisons by unreasonable causes or unconstitutional administrative measures. Although the requirement of patients towards the Habeas Corpus Act is becoming higher, the percentage of cases that are accepted and solved does not reach ten percent. Rather, the guardians abuse this act to take patients out of the hospital and hospitalize them again, because readmission is always possible if the family members agree.

Opposition Against New Amendment / ablenews.co.kr

Concerns of Physicians: What about mental patients at serious levels?

Psychiatrics and physicians are insisting that it should take more time for mental patients to return to society. Furthermore, physicians point out that it is an irony that they cannot compel patients to receive treatment before they harm themselves or threaten others. Experts say that the problem of responsibility is going to occur. In other words, if compulsory psychiatric hospitalization by the agreement of family members is unconstitutional, who should take responsibility for the serious mental patients who continuously reject the remedy? A neuropsychiatry professor of Asan Medical Center said, “Although the consent of patients is also crucial, it is not acceptable to simply respect their opinions because they may not be able to make a judgement on what might be beneficial for themselves. Meanwhile, some patients who rejected the remedy in past regretted their behaviors after recovering.”

What needs to be done?

Effective Systems Overseas

In other countries, systems for compulsory hospitalization are well-kept and more reasonable. For example, in Germany, judges meet the patient directly and examine whether the patient should be hospitalized or not while the Federal Constitutional Court mediates the whole procedure of compulsory hospitalization. In addition, the World Health Organization (WHO) recommends all nations to conduct a test on whether the patient is suitable for hospitalization. Some countries guarantee patients the right to appoint a lawyer or a social worker as their spokesperson. In the United States, the government provides a “group home” where patients are supported continuously to successfully return to society in a house-like environment.

What should Korea aim for?

To make this situation better, the system of regularly checking the psychiatric hospitals should be improved. Specifically, the safety device which prevents local mental care institutions from abusing the Mental Health Act as means of earning money should be established. Furthermore, skilled personnel other than family members and physicians are required to take care of patients to reduce the rate of hospitalization. Strong punishment for family members and psychiatrists who abuse the Mental Health Act should be also established.

Korea has tried hard to improve the situation of compulsory psychiatric hospitalization by revising the current law and taking unconstitutional nonconformity. With the decision of the Constitutional Court, the harmful consequences that occurred due to guardians and physicians abusing the defects of the law are expected to decrease. Even after adopting the amendment, however, voices of concern still exist. Although we should wait and see how effective the new amendment may be starting from May, 2017, an alternative will be needed to prevent chaos for a while, and related organizations should promote the settlement of complete law.

강가은  ge0923@skku.edu

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