Reassessing the High Proportion of Involuntary Psychiatric Hospital Admissions in South Korea

Abstract

The 2007 WHO-AIMS report on the mental health system of South Korea documented progress towards a national mental health plan, protection of human rights, and growth of community based services. Yet concern was expressed that the high proportion of involuntary to total psychiatric hospitalizations (92%) may indicate an excessively coercive system. Involuntary hospitalization in Korea rose from 117 to 132 (per 100,000) between 2000 and 2006. In 2000, the median rate in the European Union (EU) was 74 per 100,000 (Range: 6-218). While Korea's involuntary hospitalization rate is within the EU range, its proportion of involuntary hospitalizations is three times that of the highest EU country (30%, Sweden). Underdevelopment of voluntary psychiatric services and culturally mandated family referrals resulting in involuntary hospitalization are apparent reasons for the high proportion of involuntary hospitalizations. Population-based rates per 100,000 more accurately describe involuntary hospitalization than the proportion (ratio) measure used in the WHO-AIMS reports.

The Low Proportion and Associated Factors of Involuntary Admission in the Psychiatric Emergency Service in Taiwan

“…This could lead to a lower percentage of involuntary admission in this study. However, in South Korea culturally mandated family referrals can override the patients’ wishes to initiate compulsory admissions, which may account for its high percentage of involuntary admission [ 9 ].…”

“…In 2000, the proportion of involuntary to total psychiatric hospitalizations, termed the involuntary admission quota, ranged from 3.2% to 26.4%, whereas the involuntary admission rate ranged from 6 to 218 with a median of 74 per 100,000 inhabitants across the EU [ 1 , 7 , 8 ]. However, only one study has been reported from the Asian country in South Korea where a high involuntary admission quota of 92% was noted in 2007 [ 9 ]. There remains a lack of studies about involuntary admissions in non-Western developed countries.…”

“…These can be categorized into socio-demographic, clinical, psychiatric service utilization, social support, and ecological factors. Relevant studies have been reviewed by the EU [ 1 , 7 , 9 ], and carried out in Asian countries [ 9 , 12 ] and the USA [ 13 ]. Overall, these patients were characterized as younger or male gender, with more severe psychopathology, dangerous behaviors, poor insight or low motivation for treatment, and poor functioning or poor supportive system.…”

Human Rights Violations and Mental Illness

“…This has created concern regarding forcible admission; however, it is suggested that these numbers must be viewed through a cultural lens. Bola, Park, and Kim (2011) indicate that these numbers can be attributed to the fact that stigma prevents individuals from voluntarily accessing treatment; also, these services may not be adequately supported financially for individuals.…”

Outcomes of involuntary psychiatric commitment: An integrative review

“…[5] Methods in implementing psychiatric commitment include consideration of individual's autonomy, and decision-making powers or referrals which may follow mandates that place the power to decide to non-medical authorities such as judges, courts, government officials, or social workers as well as family or significant others and decisions of the mental health professionals according to legal provisions. [6] Bola and col-leagues' study [7] in South Korea revealed that more than half (66%-77%) of involuntary admissions were referred primarily by the family while Rotvold and Wynn [8] accounted 25% in their study. Family involvement in the involuntary admission of the patient may pose long-term consequences in terms of relationship with the patient.…”