La ley de salud mental en Argentina / Mental health law in Argentina

Resumen Este artículo repasa temas de importancia en relación a la salud mental en la Argentina. En primer lugar, el estado de situación del país y las recomendaciones de la Organización Mundial de la Salud en referencia a que, en los países de ingresos bajos y medios, más del 75% de las personas con trastornos mentales, neurológicos y por consumo de sustancias no recibe tratamiento alguno. Se repasan los recursos humanos en Argentina y su comparación con otros países. Se enfatiza en la necesidad de contar con atención primaria capacitada en salud mental y a reorganizar los sistemas y servicios de salud. También se hace referen cia a la ley de Salud Mental 26657 creada en 2010 y los problemas que han llevado a que todavía no se haya implementado en forma completa, el debate sobre esta ley y el reclamo actual de los familiares por la falta de respuesta a sus necesidades, y por ello la importancia de su implementación. Por último, se exponen los efectos de la pandemia COVID sobre la salud mental de la población en general.

Abstract This article reviews important issues in relation to mental health in Argentina. In the first place, its situation in the country and the recommendations of the World Health Organization in reference to the fact that, in low- and middle-income countries, more than 75% of people with mental, neurological and substance use dis orders do not receive any treatment. Human resources in Argentina and its comparison with other countries are reviewed. Emphasis is placed on the need for trained primary care services in mental health and to improve the organization of health systems and services. Reference is also made to the Mental Health Law 26657 enacted in 2010, and the problems that have led to it not yet being fully implemented, the debate about this law, and the current claim of family members for the lack of response to their needs, and therefore the importance of its imple mentation. Finally, the effects of the COVID pandemic on the mental health of the general population are exposed.

Involuntary Hospitalization System: An Ethical Analysis Based on Mental Health Law of the People’s Republic of China / 中国医学伦理学

Involuntary hospitalization system is a controversial issue in international mental health legislation. During the legislation and implementation process of Mental Health Law of the People’s Republic of China, the substantive and procedural elements of the involuntary hospitalization system have always been under dispute and discussion. These disputes have profound ethical implications, highlighting the phenomenon of the coexistence of "insufficient" and "excessive" regarding China’s involuntary hospitalization system in protecting individual autonomy. From the perspective of public health ethics, the values of respect, justice, and care can provide ethical guidance for improving the involuntary hospitalization system and promoting the construction of mental health law.

Characteristics of Psychiatric Patients Referred by Police to an Emergency Department / 신경정신의학

OBJECTIVES: This study compared the demographic and clinical characteristics of police referrals with referrals from other sources to a psychiatric emergency department. METHODS: A retrospective cross-sectional study was conducted on the data from the psychiatric emergency department of Ulsan University Hospital from January 2014 to October 2017. The study sample consisted of 79 psychiatric patients who were referred by police, and the characteristics of this group were compared with those of 240 psychiatric patients who were referred by other sources. The collected data were analyzed using a chi-square, Fisher's exact test, and independent sample t-tests. RESULTS: Among the 1768 psychiatric emergency visits, 89 (5.0%) were referred by police, and among the 79 referrals by police chosen as the study group, there were 4(5.1%) cases of emergent psychiatric admission. These patients referred by police were more likely to be male and in a lower socio-economic status. Police referrals were more likely to exhibit violent behavior, be restrained, and more likely to visit after working hours. They were notified more rapidly to the psychiatric department, less notified to other departments, and visited the psychiatric outpatient clinics less after discharge from the emergency department. CONCLUSION: The study results highlight the importance of understanding the characteristics of psychiatric emergency patients referred by police and identifying the problems of the current psychiatric emergency services. Systems need to be developed that clarify the roles of police in psychiatric emergencies and facilitate collaboration between police and mental health institutions.

Influence of "Mental Health Law of the People's Republic of China" on psychological counseling in colleges and universities: An interview study on the heads of psychological counseling centers in colleges and universities in Beijing / 中国心理卫生杂志

Objective:To investigate the impact of China's Mental Health Law on the work of psychological counseling in colleges and universities, and to explore ways to improve the law. Methods: Totally 12 heads of college and university counseling centers in Beijing were conducted with semi-structured interviews. The average age of the interviewees was (40 ±7) years old, with master or doctor degrees in psychology or related disciplines. The method of content analysis was used to analyze the interviewees' understanding of the " Mental Health Law". Results: All of the 12 interviewees had gained some understanding of the "Mental Health Law", and accordingly amended the regulation of their counseling centers. Also, interviewees suggested the positive and negative impacts brought by the law, such as enhancing practitioners' legislative sense, clarifying their responsibilities and boundaries as college and university counseling, as well as difficulties to distinguish psychotherapy and psychological counseling, ambiguity in the legality of working with students who were diagnosed with mental disorders. Moreover, interviewees threw out suggestions on improving the law from the aspect of industry standard, supervision department and vocational qualification. Conclusion: The execution of "Mental Health Law" improves practitioners' legislative sense, clarifies their responsibility. Nevertheless, it does not clearly distinguish psychotherapy from psychological counseling, and be lack of regulation on the psychological counseling industry.

Critique of Mental Health Welfare Law in Korea : Focusing on Involuntary Hospitalization Criteria / 신경정신의학

Under new mental health and welfare law, involuntary admission is allowed only for persons with mental illness based on the narrowed criteria of mental illness when they meet both need for treatment and danger to themselves and others. These stringent danger criteria along with narrowed definition of mental illness may prevent timely intervention for people with acute psychosis. It is claimed that the danger criteria is essential to keep up with international (UN, WHO) principles for legislation of mental health acts and laws of advanced countries. The international principles, however, do not necessarily call for stringent danger criteria for involuntary hospitalization. Danger criteria are not also prerequisites for involuntary hospitalization in many advanced countries. In countries with strict danger criteria, complementary measures seem to be taken for the drawback of danger criteria. As for the involuntary hospitalization by legal guardians, the complicated qualification for legal guardians may hinder prompt admission. The required number of legal guardians also needs to be changed from two to one person. Even in the situation where involuntary hospitalization is deemed urgent, there is no way to transport the patients to the hospital for assessment or temporary admission unless the police judges the patients to be dangerous to themselves or others. Outpatient treatment order can be an alternative to involuntary admission. However, it is rarely used since the order cannot be applied to those who do not have history of admission due to danger. For voluntary admission, status conversion to involuntary admission needs to be allowed in case of aggravation of symptoms to meet involuntary admission criteria. In addition, informal admission needs to be introduced to avoid unnecessary formal procedures for patients admitting voluntarily to open ward. In view of all these issues with new mental health and welfare law, entire revision of new mental health law is urgent to balance the rights to proper treatments and protection of human rights of persons with mental disorder.

The New Mental Health and Welfare Law in Korea: Issues with Additional Diagnosis by External Psychiatrist and the Role of Admission Review Committee / 신경정신의학

The new Mental Health and Welfare Law in Korea was revised to require additional diagnosis by a psychiatrist from another public or designated hospital for involuntary admission beyond 2 weeks. In addition, it features the newly established Admission Review Committee for better protection of human rights. The provision of the additional diagnosis by an external psychiatrist resulted from misinformation about the distinction between the second opinion for medical assessment and the review of admission by independent authorities. An additional diagnosis is not required by an external doctor since it is not for review of adequacy of admission but just for second opinion for better medical assessment. Given the limited number of qualified public hospital psychiatrists, additional diagnosis by external psychiatrists does not seem practical unless private hospital doctors are required to visit neighboring hospitals. The current method of cross checking between neighboring doctors is not in accordance with the principles that review should be done by independent authorities. The Admission Review Committee also does not seem to serve the purpose since the role of the Committee is limited to document review, while the proper role of the Committee is left to individual doctors. Admission review should be performed through a thorough interview with the patient by a judicial (or quasi-judicial) authority. Law revision is urgently needed to ensure proper judicial (or quasi-judicial) review of admission, and to streamline unnecessary procedures such as the additional diagnosis by external doctors.

Perspectiva de la salud mental en el contexto colombiano. Comentarios sobre la Ley 1616 de salud mental / Perspective of mental health in the Colombian context. Comments on Law 1616 of mental health

Se presenta una reflexión crítica sobre varios puntos relevantes que se contemplan en el desarrollo de la Ley de Salud Mental 1616 del 2013, como también una discusión sobre la existencia simultánea de dos modelos de atención, uno centrado en la hospitalización psiquiátrica, donde el principal referente es el trastorno mental y otro, desde la concepción de carácter psicosocial.

A critical reflection is presented on several relevant points that are contemplated in the development of the Mental Health Law 1616 of 2013, as well as a discussion about the simultaneous existence of two models of care, one focused on the hospital psychiatric hospitalization, where the main reference is the mental disorder and another, from the conception of psychosocial character.

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.

Analysis of the impacts by the implementation of the Mental Health Law on the complaint services at psychi-atric hospitals / 中华医院管理杂志

Objective To explore and compare the contents of complaint letters at psychiatric hospitals before and after the implementation of the Mental Health Law of the People’s Republic of China (MHLC),figure out measures to improve the complaint satisfaction and settled rate,reduce the number of complaints and re-complaint rate.Methods 1376 complaint letters were compared and analyzed in this retrospective research for statistics analysis and comparison,covering 958 letters received before the implementation of MHLC (from 2008 to 201 1 )and 418 letters received after the implementation of MHLC (from May 1st 2013 to April 30th 2014).Results Most of the complaints focus on hospital staff attitude before and after the implementation of MHLC, accounting for 39.67% and 30.38%respectively.The complaints targeted mostly at the outpatient clinic 46.45% and 49.28% respectively. Significant changes are found with the contents,departments and main reasons of the complaint letters. Conclusion The causes and the influencing factors of such changes were analyzed,and measures to improve the complaint services at psychiatric hospitals were proposed.

El rol del psicólogo en la guardia del HIGA Eva Perón: una mirada desde lo histórico ­ institucional ­ particular / Psychologyst role in HIGA´S Eva Perón emergency room: from historical, institutional and particular views

La Ley Nacional de Salud Mental exige que "la atención en salud mental esté a cargo de un equipo interdisciplinario integrado por profesionales, técnicos y otros trabajadores capacitados con la debida acreditación de la autoridad competente"; y que "se incluyen las áreas de psicología, psiquiatría, trabajo social, enfermería, terapia ocupacional y otras disciplinas o campos pertinentes". En octubre de 2011 se inició una experiencia interdisciplinaria que tendrá implicancias en los modelos clásicos de abordaje y en la formación de los nuevos profesionales. Los tiempos actuales han dado lugar al surgimiento de patologías mentales cada vez más complejas que exigen ampliar las herramientas de atención. Las nuevas formas de abordaje determinan el trabajo psicoterapéutico con el paciente en crisis, la orientación familiar y la constitución de redes de contención alternativas que faciliten la superación de la situación que determinó la consulta. Resulta prioritario favorecer el trabajo conjunto entre disciplinas diferentes y complementarias como son la medicina y la psicología con el fin de trabajar en forma integral sobre las aristas mencionadas. En esta presentación se sintetiza la experiencia lograda con la incorporación del especialista en psicología a la sala de emergencias de un Hospital General y sus eventuales proyecciones

A Lei Nacional de Saúde Mental exige que "o atendimento em saúde mental fique por conta de uma equipe interdisciplinar integrada por profissionais, técnicos e outros trabalhadores capacitados e com a acreditação correspondente da autoridade competente"; e que "sejam inclusas as áreas de Psicologia, Psiquiatria, Trabalho social, Enfermagem, Terapia ocupacional e outras disciplinas ou campos pertinentes". Em outubro de 2011, iniciou-se una experiência interdisciplinar que terá implicações nos modelos clássicos de abordagem e na formação dos novos profissionais. Nos tempos atuais tem surgido patologias mentais cada vez mais complexas que exigem ampliar as ferramentas do atendimento. As novas formas de abordagem determinam o trabalho psicoterapéutico com o paciente em crise, a orientação familiar e a formação de redes de contenção alternativas que tornem possível a superação da situação que determinou a consulta." Resulta prioritário favorecer o trabalho conjunto entre disciplinas diferentes e complementares como a Medicina e a Psicologia com o intuito de trabalhar integradamente sobre as aristas mencionadas. Nesta apresentação, sintetiza-se a experiência atingida com a incorporação do especialista em Psicologia à sala de emergências de um Hospital Geral e suas eventuais projeções.

Argentine National Mental Health Law establishes that "mental health attention must be in charge of interdisciplinary teams integrated by professionals, technicians and other trained workers with adequate accreditation given by competent authorities". It includes "people pertaining to different areas of psychology, psychiatry, social work, nursery, occupational therapy and other pertinent disciplines". On October of 2011 began an interdisciplinary experience that will change classical models of facing new aspects of mental health and training professionals for its care. Our time has given place to new and more complex mental pathology that obliges to widen the attention tools. New ways of facing patient´s care determine psychotherapeutic work in crises, familiar orientation, and building up alternative contention networks that will facilitate bettering conditions that determined the consultation. It is a priority to favor team activities among different and complementary disciplines such as medicine and psychology to treat the patient as a whole. This presentation sintesizes experiences gained by incorporating psychologists in Emergency Room assistance and future projection of the proceeding.

Assessment of Continuing Hospitalization Judgement Guideline in Mental Health Review Board / 신경정신의학

OBJECTIVES: The aims of this study are to test the applicability of the continuing hospitalization judgement guidelines of The Primary Mental Health Review Board and to provide the basic data for the development of valid guidelines. METHODS: The request sheets submitted to Cheongju Primary Mental Health Review Board for continuing hospitalization from April 2009 to July 2001 were reviewed. The results according to the guidelines were compared with board's final decision. The aim in making these comparison was to determine the factors affecting the board's decisions. RESULTS: Cheongju Primary Mental Health Review Board assessed 1223 requests during the period, and declined 65 of those requests. The sensitivity and specificity for dissent of the algorithm in the guidelines are 51.6% and 97.0%, respectively. The patterns of data in the sheets from the mental facilities were different from the psychiatric hospital or the clinic. The presence of a guidance's signature, mental status, and specialist's opinion could be factors affecting the board's decision. CONCLUSION: The result suggests that distinguished guidelines are needed for mental facilities. Social support systems and functional impairments may be meaningless because they did not affect the board's decision or could be replaced by other factors. The algorithm and judgement system should be revised to increase sensitivity for dissent. Further research is required concerning the development of standardized guidelines on the judgement for continuing hospitalization.

Review of Articles on Psychiatric Hospitalization in Mental Health Act / 신경정신의학

The Mental Health Act is an initiative aimed at changing and shaping mental health services and protecting human rights of persons with mental disorders. Since its legislation in 1995, four amendments have been made to the Act according to issues related to public concerns. Despite this Act, debate remains surrounding the human rights protection of the mentally ill. Further, Supreme Court precedents have been set related to the Mental Health Act. This study aimed to provide information regarding hospitalization procedures in the Mental Health Act with some lawsuits. Although annual numbers of patients involuntarily hospitalized have not been reported, it has been estimated that a small percentage of these individuals have are given review relating to the appropriateness of their hospitalization. The conditions set forth regarding involuntary admission in the Korean Mental Health Act are so inclusive and obscure that courts have had to request more evidence related to the inevitability of hospitalization in ensuing lawsuits. Involuntary hospitalizations in Korea are regarded as private contracts between hospitals and the family of mentally ill patients. Therefore, it is critical when patients are involuntarily hospitalized under the Mental Health Act, that others are not punished for illegal detention. Since the Protection of Personal Liberty Act took effect in 2009, most related lawsuits have been in regard to hospitalized patients in psychiatric facilities. Balancing the right to be treated and the right to refuse treatment is complex and intricate. More resources need to put into mental health to improve the protection of human rights in mentally ill patients in Korea.

O espírito das leis e as leis do espírito: a evolução do pensamento legislativo brasileiro em saúde mental / He spirit of the law and the laws of the spirit: the evolution of Brazilian legal thought in the realm of mental health

Examina a evolução das leis e normas da República brasileira relativas ao padecimento mental, demarcando três períodos. No período inicial (1890-1910), caracterizado pela introdução do tema da patologia mental no campo das preocupações do Estado, o interesse fundamental foi o reconhecimento e a preservação dos direitos dos portadores dessas patologias; nesse período, a alteração mental é entendida em termos de neuropatologia. No período de ampliação da ação estatal (1911-1945) permanecem os interesses observados no período anterior; a interpretação de adoecimento mental não sofre alterações substanciais, a despeito do alargamento de sua abrangência. No período do desenvolvimentismo brasileiro (1946-1982), marcado por uma descontinuidade em relação aos períodos anteriores, prevalece um espírito econômico-desenvolvimentista, expresso na vigorosa ampliação do parque hospitalar e amparado por um pensamento humanista de tons conservadores; mantém-se o interesse na proteção dos portadores de doenças mentais.

The article explores the evolution of the Brazilian republic's laws and norms on mental illness during three periods. The first (1890-1910) saw the topic of mental pathology introduced into the State's realm of interest, with the main concern being to recognize and preserve the rights of those displaying such pathologies. During this period, mental alterations were understood in terms of neuropathology. The following period (1911-1945) saw expansion of government initiatives, with the same concerns as the previous period. The interpretation of mental illness did not undergo any major changes, although it broadened in scope. Marked by a discontinuity in relation to previous times, Brazil's developmentalist period (1946-1982) saw an economic developmentalist spirit hold sway, underpinned by humanist thought of conservative propensity. It brought a vigorous growth in the number of Brazilian hospitals, while interest in protecting the mentally ill continued.

Review of Group Psychotherapy: For Its Activation of Practical Applications / 신경정신의학

In Korea Mental Heath Law came into operation in 1997, and the management of the mentally ills has become an important issue and it is inevitable to train mental health workers for the management of the mentally ills. The purpose of the management seems not only to care the patients' symptoms but also to improve the quality of life. Nowadays, in the best approach of treatment and management it is difficult that one to one management is used because of the cost limitation and management efficacy. So it is highly recommended that the group approach should be used. Hence 'the activation of group psychotherapy' is very important for the effective treatment and efficient management of the mentally ills. And therapists should know group psychotherapy well and to use it properly. In these viewpoints, we first introduced various types of group psychotherapy generally, including Yalom's group psychotherapy which focus on the interpersonal relationship and is the representative type of group psychotherapy. And then we classified group psychotherapy simply, describe the concepts of practical application of group psychotherapeutic approach. And last on the basis of understanding group psychotherapy in this paper, we explored the necessity of its activation on the practical setting and the surrounding circumstances.