Contemplation of Legal Criteria of Psychiatric Compulsory Admission : Including an Introduction of US Case Which Can be Referred to the Assessment of the Appropriateness of Hospitalization in Korea

Hyesoo Kim; Yongmin Ahn; Jong-Ik Park

doi:10.4306/jknpa.2018.57.1.43

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Kim, Ahn, and Park: Contemplation of Legal Criteria of Psychiatric Compulsory Admission : Including an Introduction of US Case Which Can be Referred to the Assessment of the Appropriateness of Hospitalization in Korea

Review Article

J Korean Neuropsychiatr Assoc 2018;57(1):43-51.

Published online: 17 January 2018

DOI: https://doi.org/10.4306/jknpa.2018.57.1.43

Contemplation of Legal Criteria of Psychiatric Compulsory Admission : Including an Introduction of US Case Which Can be Referred to the Assessment of the Appropriateness of Hospitalization in Korea

Hyesoo Kim, MD¹, Yongmin Ahn, MD, PhD^2,³, Jong-Ik Park, MD, PhD, LLM⁴

¹Department of Medicine, Seoul National University College of Medicine, Seoul, Korea

²Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea

³ Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, Korea

⁴Department of Psychiatry, Kangwon National University School of Medicine, Chuncheon, Korea

Jong-Ik Park, MD, PhD, LLM Department of Psychiatry, Kangwon National University School of Medicine, 156 Baengnyeong-ro, Chuncheon 24289, Korea Tel +82-33-258-9171 Fax +82-33-254-1376 E-mail lugar@kangwon.ac.kr

Revised 24 October 201718 December 2017 Accepted 25 December 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The Korean Mental Health Act has been radically reformed recently in order to improve psychiatric patients’ human rights by regulating the compulsory admission process. However, the expert group brought up questions about difficulties in practice and incoherence in its philosophy before the Act was implemented. There are already discussions concerning the next revision of the Act. In such a situation, lessons can be learned from the experiences of other countries. Articles on psychiatric compulsory admission were comprehensively reviewed with the focus on legal criteria, and found that current trends worldwide include a move towards broad diagnostic criteria, use of capacity and treatability test, and treatment in the interest of health rather than safety. In addition, we introduce the Whittington scale, an assessment tool for the appropriateness of hospitalization used in the Connecticut Mental Health Center, US, as a reference for the similar procedure being implemented soon in Korea.

Keywords: Compulsory admission, Legal criteria, Psychiatric diagnosis, Dangerousness, Need for treatment, Decision-making capacity, Appropriateness of hospitalization, The Whittington scale

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Table 1.

Criteria for hospitalization

Criteria for Hospitalization
Instructions to reviewers
(1) Rate patient on each criterion as : none=0, slight=1, moderate=2, extensive=3. Multiply the rates by the weight shown and enter the score on each criterion. Then sum scores of each criterion for total score. (2) Ratings are to be based on the patient's condition in the 7 days preceding evaluation for hospitalization. (3) In applying the criteria, an item of reported behavior should be employed to arrive at a rating on the first criterion on the list to which it applies : Do not use the same item of behavior to score a criterion that falls later in the list (e.g., suicidal behavior should not be used in rating Criteria 4 and 5).
	W	S
1. Is there evidence of active suicidal preoccupation in fantasy or thoughts of patient?	2
2. Have there been suicidal attempts or active preparations to harm self (i.e., buying a gun, etc.)?	4
3. Has the patient threatened to hurt someone else physically? (limit to verbal threats)	2
4. Have aggressive outbursts occurred toward people?	4
5. Have aggressive outbursts occurred toward animals or objects?	2
6. Has antisocial behavior occurred?	1
7. Are there evidences of impairment of such functions as reality assessment, judgment, logical thinking, and planning?	1
8. Does the patient's condition seem to be deteriorating rapidly or failing to improve despite supportive measures?	1
9. Are there physical or neurological conditions or a psychotic, disorganized state which require(s) hospitalization to initiate the treatment process?	2
10. Does a pathological or noxious situation exist among patient's family or associates that makes initiation of treatment without hospitalization impossible? Or does the patient's disordered state create such difficulties for family or associates that he has to be removed and hospitalized for their sake?	1
11. Are emotional contacts of the patient so severely limited or the habitual patterns of behavior so pathologically ingrained that the “push” of a structured hospital program may be helpful? (This criterion should not be applied to acute patients, but only to those who are so limited as to be unable to establish and maintain emotional contacts.)	1
12. Does evaluation of the patient's condition require the 24-hour observation and special evaluation that a hospital provides (including stabilization or reevaluation of medication)? Or is patient referred for treatment of drug or alcohol dependency?	4
Total score :

Adapted from Henisz et al. Behav Res Methods Instr 1981;13:629-636, with permission of Springer.

³²⁾ W : Weight, S : Score

Table 2.

Proposed revision of the hospitalization checklist used at the Connecticut Mental Health Center criteria for hospitalization

Proposed revision of the hospitalization checklist used at the Connecticut Mental Health Center criteria for hospitalization Instructions to reviewers
(1) Rate patient on each criterion as: none=0, slight=1, moderate=2, extensive=3. Multiply the rates by the weight shown and enter the score on each criterion. Then sum scores of each criterion for total score. (2) Ratings are to be based on the patient's condition in the 7 days preceding evaluation for hospitalization. (3) In applying the criteria, an item of reported behavior should be employed to arrive at a rating on the first criterion on the list to which it applies: Do not use the same item of behavior to score a criterion that falls later in the list (e.g., suicidal behavior should not be used in rating Criteria 4 and 5).
	W	S
1. Have there been suicidal attempts or active preparations to harm self (i.e., buying a gun, etc.)?	4
2. Is there evidence of active suicidal preoccupation in fantasy or thoughts of patient?	2
3. Have aggressive outbursts occurred toward people?	4
4. Have aggressive outbursts occurred toward animals or objects?	2
5. Has the patient threatened to hurt someone else physically? (limit to verbal threats)	2
6. Has antisocial behavior occurred?	1
7. Are there evidences of impairment of such functions as reality assessment, judgment, logical thinking, and planning?	1
8. Does the patient's condition seem to be deteriorating rapidly or failing to improve despite supportive measures?	1
9. Are there physical or neurological conditions or a psychotic, disorganized state which require(s) hospitalization to initiate the treatment process?	2
10. Does a pathological or noxious situation exist among patient's family or associates that makes initiation of treatment without hospitalization impossible? Or does the patient's disordered state create such difficulties for family or associates that he has to be removed and hospitalized for their sake?	1
11. Are emotional contacts of the patient so severely limited or the habitual patterns of behavior so pathologically ingrained that the “push” of a structured hospital program may be helpful? (This criterion should not be applied to acute patients, but only to those who are so limited as to be unable to establish and maintain emotional contacts.)	1
12. Does evaluation of the patient's condition require the 24-hour observation and special evaluation that a hospital provides (including stabilization or reevaluation of medication)? Or is patient referred for treatment of drug or alcohol dependence?	4
Total score :

Adapted from Henisz et al. Behav Res Methods Instr 1981;13:629-636, with permission of Springer.

³²⁾ W : Weight, S : Score

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