How can a change in the operating system of the mental health review board promote the discharge of long-term hospitalized psychiatric patients? A case study of Seoul city

Abstract

BackgroundOne of the most typical and chronic problem in Korean mental health system is the prolonged length of hospital stay. In contrast to there are many components which leads to long length of stay of psychiatric patients in Korean situation such as low and fixed medical fee for psychiatric inpatient treatment, shortage of community resources, lack of care-givers’ awareness and so on, there are just few mechanisms to handle this issue such as Mental Health Review Board (MHRB) which is based on Mental Health Act since 1995. However, the discharge order rate was very low and there community care system after discharge order is still very weak.Case descriptionThe Korean government has revised the Mental Health Act in 2008 and changed the operating principals of the MHRB from a regional level to a local level to strengthen the function of MHRB. However, the discharge order rate versus the whole evaluation requests still remains at a very low level or less than 5%. And it is still very difficult to execute a discharge order against a patient whose symptoms and conditions become psychiatrically stabilized enough for discharge, due to a shortage of community care facilities and a lack of social support system. These results are exactly same with former studies.DiscussionAny policies to promote psychiatric discharge including MHRB are needed to take the comprehensive factors into consideration, such as payment program, community infrastructure, increasing care-givers’ acceptance and so on.ConclusionDespite of the political trial of Korean government to reduce length of stay of chronic psychiatric patients, it was not successful. Still it had failed to propose a detailed policy measure in terms of the above-mentioned prerequisites. Therefore, new system and program developments including reform of payment system which reflect prior studies’ recommendations are essential.

Are mental health tribunals operating in accordance with international human rights standards? A systematic review of the international literature

“…A study on the early implementation of the Mental Health (Care and Treatment) (Scotland) Act 2003 found that half of the informants felt that the outcome of their tribunal hearing was a ‘foregone conclusion’ and that tribunal outcomes that deviated from individuals' preferences undermined valuable mechanisms – such as advance statements, the named person provision and independent advocacy – which were designed to enhance participation (Ridley & Hunter, ). The inability of individuals to shape tribunal outcomes was also evident in a survey with mental health review board members in South Korea, where individuals and carers' wishes were not factored into the tribunal's decision‐making deliberations (Lee, Lim, Kim, & Lee, ).…”

“…Individuals are thus perceived as being unnecessarily held in hospital in several jurisdictions. For instance, in a South Korean study, 93% of respondents stated that it would be difficult to discharge somebody whose mental health had stabilised but who lacked appropriate supports in the community (Lee et al, ). Similarly, slightly under a quarter of probate judges in South Caroline indicated that a lack of alternatives would increase the chances of granting an order (Ferlauto & Frierson, ).…”

Design and Methodology of the Korean Early Psychosis Cohort Study

“…In Korea, mental health services are typically characterized by low accessibility to psychiatric treatment, high caseloads, and a relatively large incidence of inpatient care 11. The duration of untreated psychosis (DUP), which is related to a poor prognosis for patients with schizophrenia,1213 is comparatively long in Korea relative to that of Western countries14 and may be attributed to the high level of stigma associated with psychosis and psychiatric treatment 15.…”