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.

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.

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.

The challenges related to a new medical insurance policy for ultrasounds and their solutions

In the Republic of Korea, medical insurance coverage for ultrasounds began on October 1, 2013 for four major categories of illness: cancer, heart disease, cerebrovascular disorders, and rare and incurable diseases. However, several problems associated with this ultrasound insurance coverage have arisen: broad classification of ultrasound examination procedures, small and distorted insurance fees, and inappropriate insurance fee calculation methods. In order to prevent the deterioration of medical quality as well as confusion in the medical field, it is necessary that the Ministry of Health and Welfare, the Korean Medical Association, and other ultrasound-related academic societies cooperate to subdivide the classification of ultrasound examination procedures, modify the insurance fee, and properly calculate the ultrasound insurance fee.

After designation of Research-driven Hospitals

In April 2013, the Korean Ministry of Health and Welfare designated 10 hospitals as "Research-driven Hospitals" for 3 years, which meant that these hospitals met the predefined government standards for research in terms of organization governance, human resources, equipment, etc. The project on Research-driven Hospitals comprises two programs: one is the Evaluation and Designation Program, and the other is the Systems and R&D Budget Support Program. The latter is composed of two tasks: making and improving the support systems, such as a tax system, to foster research in the designated Research-driven Hospitals; and allocating the R&D Budget to only the winners of the competition among the designated hospitals according to the National Health Technology Plan. The R&D funding will be about 1.2 trillion KW ($1 billion US), and half of this funding will be allocated during the first 9 years. The former program is to formulate the standards and rules for Research-driven Hospitals and to evaluate and designate a qualified hospital as a research-driven hospital. Although there have been many concerns regarding the project, we are hoping that this project will go well and achieve great success, making the Research-driven Hospitals in Korea among the world's best. In fact, we hope that the Research-driven Hospitals will not only foster research that will bridge the current gap between basic and clinical research but also improve the current health care environment and develop the health technology industry, and finally help people lead healthier lives as well as help patients and their families recover faster from disease.

1 Years after beginning of DRG services system

Today's diagnosis related group (DRG) services system has improved medical insurance fees and subdivisions of disease compared with the past DRG system, but does not appropriately take into account the development of complications of severe disease and does not properly compensate care providers for the costs of using the newest medical devices. The Korean DRG system model needs to reflect the medical environment and the latest developments. Therefore, Cooperation with the government, medical service personnel, and citizens is necessary for the improvement of the DRG services system.

2. The role of anthropological approaches in health and welfare education / 医学教育

  The first role of anthropology in health and welfare education is to provide and cultivate viewpoints for understanding other cultures, including cultural relativism and holism, which is considered to be the basis of cultural competence. Second, this paper deals with legitimate peripheral participation as an example of the theoretical contributions of anthropology to medical, health, and welfare education. Third, ethnography, the method used in anthropology, has a further potential to be applied to qualitative studies of health and welfare. Constructive dialogue between anthropologists and medical specialists should be promoted to consider health and welfare education in the future.

Indicadores de bienestar y desarrollo infantil en México / Child wellbeing and development indicators in Mexico

Objetivo. Aportar evidencia e insumos para seguimiento del bienestar infantil en México. Material y métodos. Ajustando para el diseño muestral, se armonizó información para niños menores de 10 años de la ENSANUT 2012 con indicadores y metas nacionales e internacionales. Resultados. El 8.37% de los niños nació con bajo peso (<2 500 g). No se realizó el tamiz neonatal a 9.19% de los niños nacidos vivos. De los niños menores de 5 años, 78.03% recibió lactancia materna hasta los cuatro meses. De las madres de recién nacidos, 69.5% recibió capacitación sobre estimulación temprana. El 28% (23% en áreas rurales) de los niños recibió cinco consultas de vigilancia del desarrollo antes de cumplir dos años. Un 29% de los niños tienen o están en riesgo de tener una discapacidad. Conclusiones. En México existen progresos así como retos pendientes en la atención al desarrollo infantil. Se requiere crear estándares y valores nacionales de referencia y un sistema de monitoreo, tamizaje, canalización y atención para promover el bienestar y el desarrollo infantiles.

Objective. To provide evidence and input for monitoring child welfare and wellbeing in Mexico. Materials and methods. Adjusting for sampling design, information from ENSANUT 2012 for children <10 years was compared with national and international parameters and goals. Results. While 8.37% of infants were born with low birth weight (<2 500 g), neonatal screening was not performed on 9.4% of newborns. Of children <5 years, 78.03% were breastfed until at least four months. Among mothers of newborns, 69.5% received training in early stimulation. At the national level, 28% of children (23% in rural areas) received five medical consultations to monitor their early development. 29% of children either had a disability or were at risk of developing one. Conclusions. Progress has been made in Mexico in terms of services promoting early child development and wellbeing but important challenges persist. National standards and a system for monitoring, screening, referring and providing care for child development and wellbeing are necessary.

Defining Physiatry and Future Scope of Rehabilitation Medicine

To identify the 'physiatry' in a single word is difficult. This may be due that physiatry originated from two different fields, physical medicine and rehabilitation and focuses on assisting the general improvement of functional recovery in disabled patients. In addition, physiatry has new markets to develop; health and welfare. Therefore, the identity of physiatry will change depending on how physiatrists act in these fields. We attempt to define the physiatry from several aspects.

A Study on Link of Health and Welfare Service and Barrier's Factors of Visiting Nurses and Social Welfare workers / 간호학회지

PURPOSE: The purpose of this study was to explore the link between health and welfare service and barrier's factors by reviewing the connection between the public health center's visiting nurse and social welfare center's social workers METHOD: A survey by mail or a face-to-face interview of 151 visiting nurses in 25 public health centers and 48 social welfare workers in general social welfare centers in Seoul, was preformed from Feb. 12, 2001 to Mar. 15, 2001. The data were analyzed with frequency, percentage, mean value, paired t-test and independent t-test using SPSS/WIN 7.5 program. RESULT: 1. 'The necessity and degree of cooperation with social welfare workers of visiting nurse' scored average 4.49 and 3.19, and 'The necessity and degree of cooperation with visiting nurse and social welfare workers' scored average 4.81 and 3.15 on the five-point scale ; there was a significant difference between the two variable in visiting nurse and social welfare workers. 2. In barrier's factors which health and welfare service offer to, visiting nurses showed statistically significant higher score than social welfare staff ; 'job factor', 'resource factor', 'clients factor', 'individual ability factor' CONCLUSION: In order to provide link system that hold clients in common in public health center and social welfare center, it is recommended a case management team should be constructed and educate visiting nurses for case manager.