top of page
Search
  • Writer's pictureJiah Hwang

Review of "[Analysis of involuntary admissions in Korea through the admission information system]"

Author’s Note

With the recent “mujima” (“don’t ask”) stabbings occurring at various subway stations all over South Korea, people have been pointing towards mental illnesses as the problem, which stigmatizes them even further. In the Korean legal system, criminals could have a lighter sentence if it is brought to light that they are mentally unstable or not of sober mind when committing the crime. However, these accusatory fingers pointing towards mental illnesses do not explain why more than three stabbing (or close to stabbing) incidents have occurred over the course of barely a month. Through reviewing this research article that covers the revision of The Mental Health Promotion and Welfare Act in 2016, I hope to uncover some of the effects it could have had on the accessibility of resources for mental illnesses.


Summary

According to the Korean Mental Health Act enacted in 1995, admission into hospitalization by legal guardians “does not guarantee the rights to self-determination and procedural rights of people with mental illness.” Yet, this act was deemed a violation of human rights, and the Constitutional Court ruled the constitutional inconsistency of the Mental Health Act in September 2016. The Mental Health Promotion and Welfare Act was enacted on May 30, 2017, to provide a narrower definition of mental illness as “[someone who is limited in independent living due to delusion, hallucination, thought and mood disorder, etc.]”


This act also categorized hospitalizations into voluntary admission, consented admission, emergency admission, and two types of involuntary admission: by legal guardians, which requires the consent of two guardians and a diagnosis from a psychiatrist, and by administrative admission. The diagnostic admission duration is two weeks, and for extension, a consistent opinion of two psychiatrists, most of the time from different institutions, following approval by the Ministry of Health and Welfare is needed. Involuntary admission was shrunk from 6 months to 3 months, with the set implication that the patient themselves will agree to the admission after the acute phase passes.


Along with this, after a month of involuntary admission, a patient receives an evaluation from the Admission Suitability Review Board, established around the same time as the Mental Health and Promotion and Welfare Act. Here, the review board will interview the patient, along with the analysis of the information from experts. Due to this need for a wide range of information, the National Center for Mental Health developed the Admission Management Information System (AMIS) under the Ministry of Health and Welfare, Republic of Korea.


The purpose of this study was to “overview the current status of involuntary admission and to develop future involuntary admission policies and mental health welfare systems of the Republic of Korea.”


Methodology

3 sections for data management:

  1. General information about the patient admitted into the primary hospital (primary psychiatrist's name, contacts for the one in charge of the secondary patient diagnosis)

  2. Information regarding patient's information (“[identification number, medical insurance coverage, type of admission, current psychiatric symptoms and diagnosis, and other physical disorders]”)

  3. Information of the patient’s guardians/family (identification number, relationship, address, and contact number)

This study analyzed 34,685 cases of involuntary admission recorded in AMIS from July 1, 2017, to June 30, 2018, with more male subjects (62.8% vs. 37.2%). Chi-squared tests* were used to examine differences in types of diagnoses, types of age groups by diagnoses of the patients, and types of admitted hospitals. An ANOVA* test was also used to examine the differences in the length of hospitalization and the types of admitted hospitals. Lastly, a Least Significant Difference* (LSD) test was used after the results of the study, also known as a post-hoc analysis.

Results

{Medical Insurance Coverage} 1. Medical Insurance (70.8%)

2. Medical Aid (28.5%)

{Source of Secondary Diagnosis} 1. By a psychiatrist from a public or designated institution (67.8%)

2. By another psychiatrist from the same institution (24.6%)

3. By a psychiatrist who admitted the patient (8.4%)

{Current Psychiatric Symptoms and Diagnosis} 1. Schizophrenia spectrum disorders (38.1%)

2. Substance use disorder (29.1%)

3. Mood disorders (17.9%)

{Type of Admitted Institution} 1. Admitted to private hospitals (87.4%)

2. Admitted to hospitals (50.6%)

3. Admitted to long-term care hospitals (34.2%)

4. Admitted to general hospitals (13%)

5. Admitted to national and public hospitals (12.6%)

{Type of hospitalization} 1. Protective hospitalization (93.2%)

2. Administrative admission (6.7%)

{Total Duration of Involuntary Admission} 1. 31–90 days (39.3%)

2. 15-30 days (18.2%)

2. <14 days (16.6%)

4. 91-180 days (15.6%)

5. ≥181 days (10.3%)

{Location of Number of Admissions (calculated per 100,000 residents in the region)} 1. Gyeonggi Province (26.1%, highest)

2. Seoul City (12.6%)

3. South Gyeongsang Province (10.2%)

4. Incheon City (7.6%)

5. North Gyeongsang Province (6.9%)

The ANOVA test to pick out the differences in the hospitalization duration based on the diagnosis showed that patients with F7 (Mental retardation) had the longest stay duration of 118 days. An LSD post-hoc analysis showed that patients diagnosed as Organic, including symptomatic mental disorders had shorter stay duration compared with patients diagnosed with F2 (Schizophrenia and schizotypal and delusional disorders) and F7 (Mental retardation), while having a significantly longer stay duration compared to the rest of the diagnoses.

The second ANOVA testing showed the effect of the type of admitted hospital on stay duration:

General Hospital: 42 ± 49 days

Mental Hospital and Clinic: 78 ± 76

Long-term care Hospital: 81 ± 81

Long-term care Facility: 116 ± 103


Review

The results of the study imply that the revision in the Mental Health Promotion and Welfare Act was effective in lessening the number of involuntary admissions, which may be seen in a positive light because the number of people admitted to mental institutions without their consent was a whopping 57,000 people, according to Seoul Mental Health Statistics in 2014.


There were some problems with the original Act due to family members having the authority to lock one up when they didn’t have any mental problems for their personal issues, such as greed over a family will and more. In fact, a movie called “Insane” in 2016 was based on similar events happening at the time of the old Act.


However, this percentage seemingly reflecting self-aware mentally ill patients raises some questions such as, if someone were truly in a mentally unwell state, how would they have been able to realize if they are in need of hospitalization? What if they have no family? What if they are past the age of legal guardians?


Perhaps the percentages reflect more voluntary admission into mental institutions because the number of people admitted into mental institutions has just shrunk that much, not only for people that were wrongfully getting put into those institutions but for those that truly need help but are unable to get it due to the stricter requirements.


Could the fact that 2023 was an extremely eventful year so far in terms of the number of fear-striking murders and attacks be a related result of this reformed Mental Health Promotion and Welfare Act?


Conclusion

The study concludes by comparing the gender proportion reflected in the collected data in South Korea with those in European countries, which had similar proportions (62.8% men, 37.2% women). Then it once again repeats the general criteria that must be met to be involuntarily admitted, which are “1) the existence of a mental illness, 2) necessity for treatment, and 3) a danger to oneself and to others.” In South Korea, all three criteria must be met to be admitted. Before the Mental Health Promotion and Welfare Act was implemented, voluntary and involuntary admissions respectively constituted 38.4% and 61.6% in December 2016, but in April 2018, voluntary hospitalizations constituted 62.9% and constituted 37.1%.


The study finalizes itself with a summary of its findings:

The total number of admissions on average for every 100,000 people: 67

Most common type of involuntary admission: Admission by legal guardians

Secondary diagnosis by a psychiatrist from other institutions: 67.8%

Most common diagnosis: Schizophrenia and schizotypal and delusional disorders

Average length of hospitalization: 74.4 days


Lastly, the study recognizes its limitations:

  1. The study limited itself to involuntary admissions registered in AMIS only.

  2. The study struggled to gather a variety of information about the patients in the study as this article surrounded statistical analysis on past data sets.

  3. The study struggled to come up with the long-term effects of the revised Mental Health Act as it was modified not too long ago.


Statistical Key


Chi-squared Test: The Chi-squared Test is a non-parametric statistical test used to test your initial hypothesis about the distribution of categorical data.

ANOVA (Analysis of Variance) Test: The ANOVA test is a statistical test used to measure the dependent variable changes compared to the changes in the independent variable in collected data.

Least Significant Difference Test: The LSD is a statistical test used to test the rejection of the assumption that the means of paired data is significantly different (null hypothesis), based on the analysis of variance, using the F-ratio, the ratio between the group variance to the within-group variance.





Works Cited

Bevans, Rebecca. “One-way ANOVA | When and How to Use It (With Examples).” Scribbr, 6 March 2020, https://www.scribbr.com/statistics/one-way-anova/. Accessed 20 August 2023.

The Concise Encyclopedia of Statistics. “Least Significant Difference Test.” Springer, 9 March 2019, https://link.springer.com/referenceworkentry/10.1007/978-0-387-32833-1_226. Accessed 20 August 2023.

Corks, Daniel. “I'm Not Mad: Involuntary Psychiatric Hospitalization in S Korea.” KOREA EXPOSÉ, 31 May 2017, https://koreaexpose.com/involuntary-psychiatric-hospitalization-south-korea/. Accessed 20 August 2023.

Hwang, Tae-Yeon, et al. “Analysis of involuntary admissions in Korea through the admission management information system.” International Journal of Law and Psychiatry, vol. 68, 2020. ScienceDirect, https://www.sciencedirect.com/science/article/pii/S0160252720300029#bb0015. Accessed 19 8 2023.

Turney, Shaun. “Chi-Square (Χ²) Tests | Types, Formula & Examples.” Scribbr, 23 May 2022, https://www.scribbr.com/statistics/chi-square-tests/. Accessed 20 August 2023.

6 views

Comments


bottom of page