精神科強制住院標準與趨勢之簡短回顧及對於台灣的啟發

The Legal Criteria and Trend of Compulsory Psychiatric Admission: A Mini-review and Implications for Taiwan

世界各國之精神衛生法強制住院之規定及實踐各異，國際精神衛生法之立法趨勢以保障人權為上。最近臺灣出現無差別殺人事件，強制住院的適用範圍成為爭議。檢視世界各國精神衛生法及臺灣之法律標準及趨勢，做為臺灣精神衛生法之修法參考，此乃最佳時機。利用關鍵字，於電子文獻資料庫蒐集不同國家精神衛生法強制住院之標準及趨勢。自臺灣衛生福利部收集強制住院及全民健保精神科住院每年住院人次（2005-2014 年），計算兩者比例，觀察其趨勢。與美國相反，東亞國家，包括臺灣，強制住院不需經過法院程序。但是，臺灣精神衛生法採用軟性家戶長主義，其在人權保障方面各方面表現較佳。而且，自2005 年至2014 年，臺灣強制住院的數目與比例下降達5 倍之多。與許多西方國家不同，臺灣精神衛生法2007 年修訂後，對於強制住院產生下降趨勢之影響。在保障人權及減少強制住院而言，相較於其他國家，臺灣精神衛生法表現優良。 但是，仍需要探索臺灣自願住院過程中，是否有隱藏性的脅迫措施。

The stipulations and practices of mental health law have been various globally. But human rights protection is the trend. Haunting Taiwan, recent episodes of indiscriminate killing have regenerated the debate on broadening practices of compulsory psychiatric admission. Now is the best timing to examine the legal criteria and trend of compulsory psychiatric admission around the world and its implication for Taiwan. Using keywords, we retrieved literature addressing criteria and trend of compulsory psychiatric admission in different countries from digital literature databanks. From the Taiwan Ministry of Health and Welfare, the authors also retrieved the annual numbers of compulsory psychiatric admission and the psychiatric admission covered by national health insurance (NHI) in 2005-2014. Rates of compulsory admission over NHI admission per year were calculated to observe the trend. Contrary to the U.S., in East Asian countries including Taiwan, decisions on compulsory psychiatric admissions are not made through court procedures. However, adopting soft paternalism, the 2007 Taiwan Mental Health Act ranks high in human rights protection. Furthermore, the numbers and rates of compulsory psychiatric admission had decreased by five times from 2005 to 2014. In contrast to many Western countries, Taiwan has had a recent decreasing trend of compulsory psychiatric admission which might be induced by its 2007 legislation reform. The 2007 Taiwan Mental Health Act has served the purpose of human rights protection well when compared to its counterparts of other countries. In the future, it is important, to explore whether there are significant hidden coercion practices in voluntary admission in Taiwan.