정신질환자 위기관리체계의 이중구속 상황과 입법과제

Abstract

The purpose of this study is to examine the situation in which the revised mental health welfare law is not achieving the expected results from the perspective of legislative failure and propose legislative tasks. This study analyzed the problem of inpatient control policy through the relationship between the practitioner who carries out the crisis management task of mental illness and the mental illness which is the service target in the public mental health welfare center. Specifically, this study analyzed the relationship between the mentally ill who experienced mental crisis without the risk of self-harm and the practitioner who carried out the crisis management in terms of the Bateson's double-bind theory. As a result of analysis, legislative supplementation that can secure effectiveness of inpatient control policy is summarized into three as follows. First, a way to resolve the fear of hospitalization of persons with mental illness should be sought. Second, in addition to hospitalization, mental health welfare centers should institutionally establish their own alternatives to stabilize the crisis. Third, even when requesting hospitalization, a system should be enacted that allows the mental health welfare center practitioner to be authorized to influence the choice of hospitalization type and the decision of discharge. Based on the analysis results, this study proposed the improvement of community crisis management service system and the use of psychiatric advance directives for mental illness as a legislative task to supplement the mental health welfare law. Specifically, the new legislation aims to improve risk management services centering on non-medical residential services and peer-supported housing, and to give practitioners the authority by registering psychiatric advance directives in the mental health welfare center.