[Life] Escorting to Medical Treatment ≠ Forced Hospitalization: A Comprehensive Look at the Mental Healthcare System

A female teacher in Kaohsiung was recently escorted to the hospital by health authorities, sparking controversy over forced hospitalization. In response, Dr. Lee Chun-hung, Secretary-General of the Taiwan Psychiatric Association, stated today (15th) that escorting patients to medical treatment is an emergency measure, and subsequent hospitalization depends on the individual's condition and risks. Due to the diversity of clinical situations, patient willingness may change, and family and community pressures can also be sources of stress, making hospitals' positions difficult. He hopes society can provide more understanding. #Reported by Liu Pin-hsi, Radio Taiwan International# The female influencer teacher in Kaohsiung, surnamed Lin, faced frequent investigations by her school due to campus incidents, leading her to repeatedly post accusations and vent her dissatisfaction on Facebook. She had already taken a leave of absence in February of this year. However, when the school notified her in early June to attend a school affairs meeting, she allegedly had an emotional breakdown and posted on her Facebook page asking about the "highest floor of the school." The local mental health center immediately activated the "Social Safety Net Crisis Intervention Team" on June 4th, escorting the teacher to the hospital for treatment and admission. After five days in the hospital, she was discharged on the 9th. She subsequently posted on Facebook about her feelings of unease and helplessness during the process, stating she was deprived of her freedom like a major criminal and compromised to be hospitalized due to "fear" after persuasion. The Kaohsiung City Health Bureau emphasized that the individual had multiple suicide reports and medical records, prompting the activation of the social safety net for active protection and assistance in seeking medical treatment. Sufficient explanations were provided during the process, and the patient and her family gave "informed consent," with no "forced hospitalization" scenario occurring. Escorting to Medical Treatment vs. Forced Hospitalization According to the "Mental Health Act," the current mental healthcare system clearly defines "escorting to medical treatment" and "forced hospitalization" as two distinct stages. "Escorting to medical treatment" is for protecting personal safety in emergencies, while forced hospitalization involves human rights and requires assessment by a specialist physician and court ruling. Dr. Lee Chun-hung, Vice Superintendent of Taoyuan General Hospital, Ministry of Health and Welfare, and Secretary-General of the Taiwan Psychiatric Association, told Radio Taiwan International that according to the "Mental Health Act," for individuals with mental illness or suspected mental illness, if they are assessed to be at risk of self-harm or harming others, they will be escorted to a medical institution by police or firefighters for treatment, which is termed "emergency disposition." Dr. Lee pointed out that there are two main bases for initiating "emergency disposition": first, considering the risk situation on-site, such as individuals sitting on a "parapet wall" preparing to jump or holding a gas tank to detonate; second, the health authority assists in checking risk information in the system to confirm if there are any relevant records. He said: "(Original sound) The risk information presented in the system comes from several sources. First, it includes reports from the community and neighbors. For example, family members repeatedly report that their family member is at risk of suicide, and they have even harmed themselves with a knife several times recently. Or, from the neighborhood, village chiefs, neighborhood chiefs, or the building management committee, this person has caused some disturbances in the community, even similar to the knife incident in Miaoli previously." Dr. Lee further explained that in addition to considering on-site risks and system assessments, the consent of the individual and their family should also be obtained. However, in practice, many individuals lack insight into their condition, or although they agree to board an ambulance after persuasion by medical staff and relatives, they may change their minds midway. In such cases, a comprehensive judgment must be made. If emergency disposition is not taken based solely on the individual's wishes, tragic events may occur. Severe Patients: Forced Assessment Before Applying for Forced Hospitalization Once individuals with mental illness or suspected mental illness are escorted for medical treatment, subsequent procedures are handled by the hospital. Dr. Lee stated that the hospital will first assess whether the individual is a "severe patient," which generally refers to someone whose mental state is detached from reality. If the individual is a severe patient and is at risk of self-harm or harming others, a specialist physician will evaluate whether inpatient or intensive outpatient treatment is necessary. If hospitalization is deemed necessary but the patient refuses, the process of forced assessment will begin. Forced assessment requires relevant documentary evidence, including a diagnosis of a severe patient and reasons for forced hospitalization. Currently, hospitals apply to a review committee composed of professionals for permission for forced hospitalization. Starting August 1st of this year, this will change to a court review, where hospitals will apply to the court for forced hospitalization of severe patients to ensure personal freedom. Regardless of whether it is the current application to the review committee or the new system in August requiring application to the court for forced hospitalization, during the period of forced assessment and obtaining permission for forced hospitalization, severe patients must be kept in the hospital or institution. This unavoidable period of restricting personal freedom for a short time is called "emergency placement." According to the "Mental Health Act," the emergency placement period is 7 days, and the forced assessment should be completed within 3 days from the start of the emergency placement, ensuring the patient receives necessary treatment and rights protection. Non-Severe Patients: Persuasion for Voluntary Hospitalization However, in reality, many suspected mental patients escorted for medical treatment due to risks of self-harm or harming others are not severe mental patients. Dr. Lee pointed out that some individuals attempting suicide due to workplace disputes, relationship problems, or financial difficulties do not exhibit symptoms of mental illness and do not meet the criteria for severe patients. These patients will not undergo the subsequent procedures of forced assessment and forced hospitalization. Hospitals can only try their best to persuade them into "voluntary hospitalization." If the patient insists on refusing, the hospital can only let them leave. In practice, this situation often leads to misunderstanding from family and friends. He said: "(Original sound) So, many family members, and even friends of the patient, come back to argue, saying why didn't you try harder to persuade them then, or why did you let them go back then, because there have been cases where patients committed suicide after returning home from the hospital. But I must say, because this is a protection of human rights by our country, and if a person's suicide is not based on a pathological state but on free will, then using methods of restricting personal freedom for suicide prevention may not necessarily help their prognosis. Because locking them up to prevent suicide, you will eventually be discharged." Dr. Lee emphasized that most of these patients are fully conscious and understand the conditions for hospitalization and their rights and obligations. Hospitals will first actively persuade these patients to sign a treatment consent form, and relevant documents will be attached to their medical records. For patients who "voluntarily" hospitalize, the discharge conditions are the same as for general internal or surgical inpatients. When the patient wishes to be discharged, and the treatment team determines that there is no need for forced hospitalization, they will be allowed to leave. The only difference is that due to the versatility of ward design, the emergency rooms or wards for this type of psychiatric care do not distinguish between forced and voluntary hospitalization, which is why the teacher in the news incident mentioned that "as soon as I stepped into the psychiatric emergency room, the iron gate was closed." Discrepancies Between Patient, Family, and Community: Hospitals Caught in the Middle Dr. Lee stated that the current "Mental Health Act" is quite strict. The hospital's actions are not only included in hospital accreditation but also supervised by the health bureaus of various cities and counties. The public can also file complaints regarding doubts. Violations of relevant regulations are subject to penalties, and hospitals must act in accordance with the law. However, he admitted that hospitals are sometimes "caught in the middle," blamed by the patient on one side and resented by family and the community on the other. He emphasized that clinical situations are diverse. For example, in voluntary hospitalization, some patients agree to be hospitalized after persuasion by relatives and friends in the emergency room or outpatient clinic but later complain that they were forced. Sometimes, the patient does not express their feelings at the time and is merely "full of grievances." The clinical setting is very busy, and the medical team cannot meticulously discern or ascertain their inner thoughts. Dr. Lee stressed that whether it is escorting to medical treatment or arranging hospitalization, the medical team is caught between many parties, making their job very difficult. He called on the public to give them more understanding. Dr. Wang Jen-pang, Chairman of the Taiwan Psychiatric Association, emphasized that the association understands the public's concern for patient rights and public safety but hopes that all sectors of society will understand the relevant systems with correct legal and medical information to avoid unnecessary misunderstandings and panic. Dr. Wang also reminded that mental illness, like other illnesses, requires understanding, support, and appropriate treatment, not stigmatization and labeling. He warned that if the public misunderstands the mental healthcare system due to partial information, it may increase the difficulty for patients and their families to seek help, which is not conducive to early detection and treatment of the disease. (Editor: Hsu Chia-yuan) ※ Cherish life, suicide cannot solve problems. The 24-hour toll-free helpline 1925 (Yi Jiu Ai Wo) is here to accompany you through difficult times. Further Reading: Teacher's Mental Breakdown on Campus: Who Will Catch Them?