• The Korean Society of Law and Medicine
• /
• v.25 no.1
• /
• pp.149-192
• /
• 2024

People with mental illness are generally either unaware of their illness or unwilling to voluntarily seek treatment, which makes treatment difficult and the pain mainly passed on to their families. Accordingly, non-face-to-face treatment, in which the patient is diagnosed by interviews with the family and unannounced medication, in which medication is secretly administered through the family, can be performed, and this has been considered a necessary evil. Even considering realistic aspects such as the special nature of mental health care and families' suffer, not-informed treatment without consent violates not only medical laws, but also human rights of mentally ill patients. Above all, if the patient finds out about this late, the trust between the patient, family, and doctor is completely broken, and a treatment is absolutely refused. Japan's Chiba decision, which presents exceptional conditions for allowance might be a solution. However, it would not be a right solution, considering that it could lead to long-term unannounced medication and completely cut off treatment through therapeutic dialogue. Ultimately, it need to approach this problem and seek alternatives through restoration of therapeutic dialogue.

• Korean Journal of Psychosomatic Medicine
• /
• v.25 no.1
• /
• pp.46-55
• /
• 2017

Objectives : Outpatient treatment orders refer to a mandatory social program in which mentally ill persons are ordered by the court to participate in specified outpatient treatment programs. This study aimed to investigate the factors that affect outpatient treatment orders and adherence to outpatient treatment in mental health patients. Methods : A survey on outpatient treatment orders and adherence to outpatient treatment was conducted on 60 psychiatrists between October and November 2016. The questionnaire items were drafted based on a literature review, and they were then evaluated by 3 psychiatrists and 1 law school professor before being finalized. Answers from the respondents were analyzed using descriptive statistics, and the median, maximum, and minimum values of the effectiveness scores of outpatient treatment orders were calculated. Results : Among the 60 psychiatrists, 45(75.0%) were aware of outpatient treatment orders; however, only 2 out of the 45(4.0%) had actually used the program in the last 12 months. The subjective effectiveness was very low, with only 40 points out of 100. Furthermore, of the readmitted patients, 37.7% had received continued outpatient treatment, whereas 53.1% chose to quit the outpatient treatment programs, meaning that the number of dropouts was higher. Among the discharged patients, approximately two-thirds were receiving continued treatment. With regard to follow-up for dropouts, majority of the responses were either "Not taking any action"(n=27) or "Not following up"(n=15). Only two respondents answered "Contact the community mental health promotion center," meaning that this response was very rare. Meanwhile, when asked about efficient measures to be implemented for dropouts, a vast majority of the respondents(n=30) selected the answer "Work with the community mental health promotion center." Conclusions : The outpatient treatment orders currently being administered were found to be ineffective, and the associated adherence to outpatient treatment was also found to be extremely poor. Hence, the effectiveness of the therapeutic interventions could benefit from institutional as well as administrative improvements. Community mental health promotion centers are expected to have an important role in the future.