Perfil epidemiológico dos pacientes psiquiátricos internados involuntariamente em um hospital psiquiátrico do sul catarinense de 2012 a 2016 / Epidemiological profile from psychiatric patients admitted involuntarily in a psychiatric hospital in the south of Santa Catarina state from 2012 until 2016

A internação involuntária ocorre sem o consentimento do paciente, solicitada por terceiro e que deve ser notificada ao Ministério Público Estadual em até 72 horas (Lei 10.216/2001). Este é um estudo retrospectivo, quantitativo e descritivo que, através da análise de prontuários (n=350) avaliou o perfil epidemiológico dos pacientes internados involuntariamente num hospital psiquiátrico do extremo sul catarinense, no período de janeiro de 2012 a dezembro de 2016, obtendo-se o perfil: sexo masculino, com média de 38,77 anos, solteiro, residente com pais e/ou irmãos, ensino fundamental incompleto, empregado e/ou autônomo, não usuário de drogas, com mediana de uma internação psiquiátrica no período, portador de esquizofrenia, mãe e/ou pai como acompanhante responsável na admissão e alta hospitalar por melhora clínica. A avaliação do perfil epidemiológico de pacientes internados involuntariamente possibilita maior compreensão dessa população, ainda submetida a aspectos polêmicos sobre diagnósticos e decisões terapêuticas, colaborando assim para a elaboração de políticas públicas de saúde mental mais efetivas.

The involuntary admission happens without the patient's approval, solicited by a third party and which must notified to the State Public Ministry within 72 hours (Law 10.2016/2001). This is a retrospective, quantitative and descriptive study that, through the analysis of medical records (n = 350) evaluated the epidemiological profile of patients hospitalized involuntarily in a psychiatric hospital in the extreme south of Santa Catarina, in the period from January 2012 to December 2016, obtaining the profile: male gender, averagely aged 38.77 years old, single, residing with parents and/or siblings, incomplete primary school, employed and/or autonomous, non-drug user, with a median of one psychiatric hospitalization in the period, diagnosed with schizophrenia, accompanied by a parent as a responsible during admission and hospital discharge due to clinical improvement. The evaluation of the epidemiological profile of involuntarily admitted patients makes it possible for greater comprehension of this population, still being submitted to polemic aspects about the diagnostics and therapeutic decisions, thus collaborating to the elaboration of more effective public mental health policies.

Medidas coercitivas desde el punto de vista psicológico del paciente / Coercive measures from patients' psychological point of view

Introducción: se han hallado dos herramientas de evaluación fiables y válidas que miden las repercusiones psíquicas que las técnicas coercitivas tienen sobre los pacientes mentales. La existencia de estas herramientas habilita la continuidad en la investigación sobre la temática. Objetivo: revisar las preferencias de los pacientes de las instituciones de salud ante las distintas medidas coercitivas. Métodos: se realizó una búsqueda bibliográfica sistemática en bases de datos digitales y otras fuentes. Se realizó revisión por pares de los trabajos, utilizando como criterio temático de inclusión, la pertinencia en los temas a tratar. Tras el examen del resumen, cuerpo y conclusiones, se seleccionaron aquellos cuyo contenido se refería a: (1) las vivencias de los pacientes y personal cuando se aplicaban las medidas coercitivas; (2) preferencias de los pacientes sobre estas; (3) medidas preventivas; y (4) cuidados necesarios. Desarrollo: Los estudios revisados apuntan al peligro ético que desarrolla el uso o la mala aplicación de estos protocolos coercitivos. Se debe tener en cuenta que la integridad física del personal sanitario también corre peligro en el tratamiento de pacientes psiquiátricos. En esta disyuntiva entre preservación de la dignidad del paciente y seguridad del personal, han sido propuestas diversas medidas tanto accesorias/compensatorias como sustitutivas de estas técnicas perjudiciales para la salud mental de los pacientes. Conclusiones: La comunicación entre el personal que implementa estas medidas y el paciente que las recibe, es esencial para una buena alianza terapéutica y el correcto desarrollo del tratamiento(AU)

Introduction: Two reliable and valid assessment tools have been found that measure the psychic impact of coercive techniques on mental patients. The existence of these tools enables continuity in research on the subject. Objective: This paper reviews the preferences of the patients of the health institutions about different coercive measures. Methods: A systematic bibliographic search was carried out in digital databases and other sources. Peer review of the works was carried out, using as a thematic criterion of inclusion, the relevance in the topics to be treated. After examining the summary, body and conclusions, those whose content referred to were selected: (1) the experiences of the patients and staff when the coercive measures were applied; (2) patients' preferences about these; (3) preventive measures; and (4) necessary care.. Body: The studies reviewed point to the ethical danger that leads to the use or misapplication of these coercive protocols. It should be taken into account that the physical integrity of health personnel is also at risk in the treatment of psychiatric patients. In this dilemma between the preservation of the patient's dignity and the safety of the personnel, various measures have been proposed, both ancillary and compensatory, as well as substitute for these techniques that are detrimental to the mental health of patients. The purpose of these measures is to avoid the use of these coercive techniques. Conclusion: communication between the personnel implementing these measures and the patient receiving them is essential for a good therapeutic alliance and the correct development of the treatment(AU)

Need for the complete revision of the Mental Health and Welfare Act

Involuntary treatment or compulsory admission to mental health facilities has long been a controversial issue in the field of mental health, because these practices infringe on the right to choose of a person with a mental disability and increase the risk of abuse for several reasons, not only limited to medical factors. Although the current Mental Health and Welfare Act took effect on May 30, 2017 in Korea, considerable controversy about the content of the regulation and the practical applicability of the law has emerged among mental health professionals. The earlier treatment of patients would become difficult due to the strict criteria for involuntary admissions, and the unrealistic procedures for admissions in the Act might be hard to apply in the field. Thus, a complete revision of the current Mental and Welfare Act is needed in the near future to protect the benefits of early treatment and the human rights of persons with mental illnesses in terms of how laws regarding admissions are enforced.

Critical Review on Amendment Bill of Mental Health Act / 신경정신의학

The Korean Mental Health Act, enacted in 1995, was entirely amended 20 years later and the amendment was passed by the National Assembly plenary session on May 19. 2015. The amended Mental Health Act reflects the recent rapid changes in the mental health environment and contributes one more step toward securing human rights for people with mental illness. However, after review of some major issues, it is doubtful whether there was sufficient discussion on the national mental health policy and whether a national consensus was obtained. This paper describes some problems within the amended Act and discusses several ways to improve the Act. Patients' autonomy and medical paternalism are typical major concerns in the field of medical ethics. Especially for patients with mental illness, it is difficult to maintain a balance between those two concerns because there is often an inability to assign responsibility for those concerns. Therefore, a revised Act should take into account these two concerns. When creating subordinate legislation ahead of the enactment of the amendments on May 30, 2016, establishment of a more reasonable and efficient system is expected ; if there has been sufficient discussion with related organizations and professionals and sufficient consideration of the realities of various medical fields. Such expectations should improve public mental health welfare.

Admission Status Conversion from Voluntary into Involuntary, Is It Illegal / 신경정신의학

OBJECTIVES: The current Korean Mental Health Act (KMHA) indicates that a patient, who voluntarily gave their permission for admission into a mental health facility, has the right to be discharged upon personal request. However, there is no clause in the KMHA that allows a change in a patient's voluntary status under special circumstances. The purpose of this study was to investigate problems that may arise from the lack of such a clause ; problems that can result in misinterpretation and lead to the prohibition of voluntary admission status conversion. METHODS: Previous cases presented to the National Human Rights Commission of Korea were investigated in order to determine the current state in Korean psychiatric practice regarding the conversion from voluntary to involuntary admission status. In addition, examples of similar mental health legislation in use by the United Nations (UN), World Health Organization (WHO), and several advanced countries pertaining to such conversions were investigated. These examples were used as models for making recommendations for possible changes to the KMHA. RESULTS: From 2010 to 2014, more than 220 petitions were filed with the National Human Right Commission of Korea. The petitions involved voluntarily institutionalized patients who had their requests for discharge rejected. Based on mental health regulations of the UN, WHO, and such countries as the United States, England, Canada, Australia, and Japan, the KMHA should include a provision that, upon receiving a discharge request, allows for discharge refusal if the voluntarily admitted patient is considered not mentally fit. CONCLUSION: The results suggest that the absence of a regulation allowing admission status conversion in the current KMHA is inappropriate. Rectification of this absence is urgently needed.

Internação Psiquiátrica Involuntária: estudo comparativo das Normas de Saúde Mental do Brasil e Inglaterra/País de Gales / Involuntary Psychiatric Admission: comparative study of Mental Health legislation from Brazil and England/Wales

A internação involuntária é uma medida controversa que pode levar a violação de vários direitos humanos. Nessa perspectiva, faz-se necessária uma legislação para definir e limitar as circunstâncias em que isso pode ocorrer. Políticas e leis bem formuladas podem promover o desenvolvimento de serviços acessíveis na comunidade, estimular campanhas de sensibilização e de educação, e estabelecer mecanismos legais e de supervisão para prevenir violações aos direitos humanos. Nesse contexto, este estudo descritivo-comparativo apresentou como objetivo analisar as semelhanças e diferenças entre as legislações em saúde mental relacionadas à internação psiquiátrica involuntária no Brasil e Inglaterra/País de Gales. Utilizou-se para o levantamento de dados de pesquisa bibliográfica e pesquisa documental. A análise foi realizada a partir da Lista de Checagem da Organização Mundial da Saúde (OMS) para a Legislação de Saúde Mental. Para a etapa de comparação dos dados das duas jurisdições, foi utilizado o método comparativo. Sobre os resultados da comparação da Lista de Checagem da OMS com as legislações do Brasil e Inglaterra/País de Gales, na legislação brasileira foram encontrados 52 (31,32%) dos 166 padrões da OMS, enquanto que na legislação da Inglaterra/País de Gales foram encontrados 90 (54,2%). A partir da análise foi possível concluir que: a legislação da Inglaterra/País de Gales traz procedimentos mais claros e detalhados sobre "internação involuntária" e possui "mecanismos de fiscalização" mais eficazes do que o Brasil; apesar das lacunas quanto aos procedimentos para apelações contra decisões de incapacidade e a revisão da necessidade de um tutor, a legislação apresenta uma boa cobertura sobre "competência, capacidade e tutela", tema de elevada importância, principalmente após a ratificação da CDPD, e que o Brasil não aborda em sua legislação; a legislação brasileira elenca um rol maior de "direitos fundamentais", porém não prevê "penalidades" quanto ao descumprimento desses direitos. Já a Inglaterra/País de Gales cobre amplamente essa questão. As principais semelhanças entre Brasil e Inglaterra/País de Gales referem-se aos padrões que necessitam de revisão: "Pacientes voluntários", situações de emergência", direitos econômicos e sociais", "questões civis" e "grupos vulneráveis". Ambas jurisdições também apresentam o mesmo nível de cobertura quanto a "pesquisa clínica e experimental", e "tratamentos especiais, isolamento e restrições". Em suma, a análise das legislações de saúde mental apresentada neste trabalho sugere que documentos internacionais de direitos humanos, como o Livro de Recursos OMS, são instrumentos importantes e que podem nortear a construção de legislações. É necessário também que a formulação de leis e políticas de saúde mental esteja articulada com os documentos internacionais de direitos humanos como a CDPD. Espera-se que o presente estudo traga a tona a reflexão das autoridades competentes sobre a necessidade de solicitar auditorias mais profundas no âmbito da legislação nacional de saúde mental, realizadas por comitês multidisciplinares, como recomendado pela OMS. A legislação de saúde mental deve estar num processo de constante evolução, centrada na busca da consolidação dos direitos das pessoas com transtornos mentais

Involuntary admission is a controversial measure that can lead to violation of various human rights. From this perspective, legislation must define and limit the circumstances in which this may occur. Well-formulated policies and laws can promote the development of accessible services in the community, stimulate awareness and education campaigns, and establish legal and supervisory mechanisms to prevent human rights violations. In this context, this descriptive- comparative aimed at analyzing the similarities and differences between the mental health' laws related to involuntary psychiatric admission in Brazil and England/Wales. In order to collect data, the author used bibliographic and documentary research. The analysis was based on the World Health Organization's Checklist on Mental Heallth Legislation. To compare data from the two jurisdictions, the author used the comparative method. Results comparing the WHO Checklist with the laws from Brazil and England/Wales showed that the Brazilian legislation meets 52 (31.32%) of the 166 WHO standards, while legislation in England/Wales meets 90 (54.2%). Some conclusions resulted from the analysis: the law from England/Wales establishes clearer and detailed procedures for "involuntary admissions" and has "oversight and review mechanisms" more effective than Brazil; despite the shortcomings in the procedures for appeals against disability decisions and the review of the need for a guardian, the legislation presents a medium compliance of "competence, capacity and protection", a subject of high importance, especially after the ratification of the CRPD, and Brazil does not address these issues in its legislation; Brazilian establishes a larger list of "fundamental rights", but does not provide "penalties" for the breach of those rights, while England/Wales meets WHO criteria in relation to this issue. The main similarities between Brazil and England/Wales refer to standards that require review: "voluntary patients", "emergency treatment", "economic and social rights", "civil issues" and "protection of vulnerable groups." Both jurisdictions also have the same level of compliance regarding "clinical and experimental research", and "special treatments, seclusion and restraint". In sum, the analysis of mental health legislation presented in this paper suggests that international human rights documents, such as the WHO Resource Book, are important tools which can guide the construction of legislation. It is also necessary that the formulation of mental health laws and policies are articulated with international human rights documents such as the CRPD. In this sense, this study may bring light for a reflection from competent authorities on the need to have audits for national mental health legislations, carried out by multidisciplinary committees, as recommended by WHO. Mental health legislation should be in a process of constant evolution, focusing on the search for the consolidation of rights of people with mental disorders