從英國與荷蘭經驗談精神疾病犯罪人處遇與復歸

Discussion on the Treatment and Rehabilitation of Criminals with Mental Illness from the Experiences of the United Kingdom and the Netherlands

近年來，由於少數精神疾病患者犯下重大暴力犯罪，致使民眾被害恐懼感高升，因此，政府為回應民眾有效處遇或監控具暴力高風險精神疾病患者之期待，已於2021年7月29日核定之強化社會安全網第二期計畫，規劃設置司法精神醫院及司法精神病房，並建立社區銜接機制，期使精神疾病患者有效分流處遇及復歸社區。此外，亦於2022年2月18日修訂刑事訴訟法、刑法及保安處分執行法，增訂暫行安置規定及修正監護執行方式、時間、處所等，期從法制面建全刑事司法與社會安全網對於具暴力高風險精神疾病患者之犯罪預防與處遇作為。
本文蒐集英國及荷蘭對於精神疾病觸法者於社區、監獄及司法精神醫院/鑑定中心等處所之醫療及照護處遇的理念、鑑定、執行處所與復歸等相關具體措施，期能為我國相類處遇或機關(構)推動之參考。
參考英國及荷蘭經驗，提出建議：
一、精神醫療處遇原則，以適性醫療處遇取代可治療性。
二、建構司法精神醫院，落實醫療模式，完善司法醫療處遇品質。
三、我國司法精神醫院收治對象應納入各類醫療型保安處分，健全社會安全網。
四、我國精神衛生法精神疾病應思考納入反社會人格違常。
五、英國、荷蘭對於犯罪人司法精神照護資源導入方式不同，但都係以於醫療場域實施為主。
六、我國現行法制及實務實部分融合英國、荷蘭之法制及實務。

In recent years, due to a small number of mentally ill patients committing major violent crimes, the public's fear of being victimized has increased. Therefore, in order to respond to the public's expectation of effectively dealing with or monitoring patients with violent high-risk mental illness, the government has approved the second phase of the strengthening social safety net plan on July 29, 2021, planning to set up forensic psychiatric hospitals and forensic psychiatric wards, and establish a community connection mechanism, so that patients with mental illness can be effectively diverted and returned to the community. In addition, on February 18, 2022, Code of Criminal Procedure, Criminal Code of the Republic of China and Rehabilitative Disposition Execution Act were amended to add temporary placement regulations and custody enforcement methods, time, location, etc. were revised, with a view to building a comprehensive criminal justice and social safety net from the perspective of the legal system for crime prevention and treatment of persons with mental illness at high risk of violence.
This article collects the concept, appraisal, place of execution, and rehabilitation of mentally ill offenders in communities, prisons, and forensic psychiatric hospitals/appraisal centers in the United Kingdom and the Netherlands. It is expected that it can serve as a reference for similar treatment or promotion by agencies (institutions) in our country.
With reference to the experience of the UK and the Netherlands, suggestions are made as follows:
1. The principle of psychiatric treatment, replacing treatability with appropriate medical treatment.
2. Construct a forensic psychiatric hospital, implement the medical model, and improve the quality of forensic medical treatment.
3. The subjects admitted to forensic psychiatric hospitals in our country should be included in various medical rehabilitative measures to improve the social safety net.
4. In our country's Mental Health Act, mental illness should be included in antisocial personality disorder.
5. The United Kingdom and the Netherlands have different ways of importing forensic mental care resources for offenders, but they are all mainly implemented in the medical field.
6. The current legal system and practice are partly integrated with the legal system and practice of the United Kingdom and the Netherlands.