NHRCK Opinion on Operating Standards and Hospitalization Process of Psychiatric Hospitals Vulnerable to COVID-19 Pandemic
-Patients in overcrowded 9- and 10-bedded rooms particularly vulnerable to COVID-19 and not guaranteed the right to receive treatment-
-A secondary assessment by another psychiatrist of the same hospital likely to undermine the original purpose of the regulations relating to the hospitalization process-
The National Human Rights Commission of Korea(Chairperson Young-ae Choi) presented its opinion to the Minister of Health and Welfare calling for the improvement of operating standards of psychiatric hospitals that are vulnerable to the COVID-19 pandemic and devise effective measures about a secondary assessment of involuntary psychiatric patients in the COVID-19 situation that requires restricting access to mental health institutions to fulfill the original objective of the regulations relating to the hospitalization process and minimize the infringement of patients' rights.
The old Mental Health Act, which was introduced in 1997, sets a minimum space of 3.3m² for psychiatric patients, compared with 4.3m² for other types of hospitals, contributing to cramped and overcrowded conditions of mental health institutions. In particular, aside from limiting the number of patients per room to no more than 10, the Act does not define the minimum space between beds and paves the way for a violation of patient privacy. It has repeatedly been pointed out that the lack of personal space at psychiatric hospitals is the source of tensions and conflicts between patients with unstable mental conditions and weakens the effectiveness of treatment.
In February 2017, following the 2015 MERS outbreak, the health authorities introduced a wide range of measures to improve the standards for hospitals, which mostly contained multi-bedded wards, including expansion of wards and intensive care units, establishment of the maximum bed capacity of each room(4-6 beds) and requirement for sufficient space between beds, hand hygiene facilities and ventilation equipment. However, these measures have not been applied to psychiatric hospitals, which have higher bed density than other medical institutions. Thus, the Commission considers that the cluster of COVID-19 infections found in mental health hospitals like Cheongdo Daenam hospital were a foreseeable disaster.
Meanwhile, the Ministry of Health and Welfare adopted a measure on February 24 2020 that recognizes a secondary assessment of involuntary psychiatric patients only by a psychiatrist of the same institution, out of concern that a psychiatrist from a different hospital might be a carrier of coronavirus. The Commission observes that the doctor who works for the same institution as the one who gave the original assessment cannot be free from the interests of the hospital that he or she is employed and the secondary assessment might be no more than a formal procedure. It therefore believes that these new measures regarding the secondary assessment are not in line with the purpose of the regulations about the psychiatric hospitalization and are likely to undermine the trust in the legal procedures.
Moreover, given that the Mental Health Act adds an exception to the secondary assessment requirement for regions with a possible shortage of psychiatrists who are capable of providing a secondary assessment, it appears the Ministry of Health and Welfare has taken administrative action that is outside the scope permitted by the relevant law and would likely be held accountable for the harm caused to individual patients.
The Commission presented its views that any restrictions to visits by external specialists during a pandemic situation should be imposed to the extent that they serve the original purpose of the related regulations and minimize the infringement of procedural rights of psychiatric patients. It calls for alternative measures that protect the rights of patients, such as remote diagnosis by a psychiatrist from a different hospital.