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김건우(Kunwoo Kim),홍진표(Jin Pyo Hong),이기경(Ki Kyoung Yi),나리지(Ri Ji Na),용효중(Hyo Joong Yong),이유진(Yu Jin Lee),황태연(Tae-Yeon Hwang),이종국(Jong-Gook Lee) 대한사회정신의학회 2012 사회정신의학 Vol.17 No.1
연구목적 : 본 연구의 목적은 첫째, 정신질환자의 인권 보호를 위한 격리 강박 지침 개정안을 개발하는 것이다. 둘째, 현 격리 강박 지침의 문제 점을 고찰하고 선진국의 국제적인 기준을 소개하는 것이다. 방 법 : 우리나라의 격리 강박 지침과 관련 법령을 미국, 영국, 호주, 뉴질랜드 등 선진국의 지침 및 법령과 비교 고찰하였다. 정신건강의학과 전문의, 간호사, 사회복지사, 국가인권위원회, 의료관리학 교수 등의 전문가를 대상으로 설문조사와 자문회의를 실시하였다. 결 과 : 기존 격리 강박 지침의 적응증과 지시 규정은 정신보건법과 모순되어 지침의 수정이 필요하겠다. 선진국의 지침과 비교하여 기존 지침의 내용은 세부적이지 못하여, 의사와 간호사의 의무가 명확히 구분되어 있지 않다. 의사의 지시 형태, 의사의 의무적인 진찰, 의무 기록, 허용된 격리 강박 시간 등에 대한 명확한 내용이 필요하겠다. 결 론 : 개정 지침이 정신보건 상황에서 실제적으로 사용될 수 있을 것이며 정신질환자의 인권 향상에 기여할 것이다. Objectives : The primary purpose of this study was to develop revised guidelines for seclusion and restraint to protect the human rights of mentally ill patients. The second purpose was to critically review the current status of guidelines and to introduce international standards of developed countries. Methods : We reviewed current guideline and administrative status in Korea and examined guidelines and regulations for seclusion and restraint in developed countries: U.S.A., United Kingdom, Australia, and New Zealand. In addition, survey of related specialists, advisory conference: advice of related and administrative experts, public hearing were done. Results : Current recipient indications and order regulations concerning seclusion and restraint guidelines contradict those of the Mental Health Act, thus, modification is needed. Compared to other countries, current seclusion and restraint guidelines are less specific. The responsibilities of physicians and nurses have not been clearly divided, and details concerning the form of the physician’s order, physician’s obligatory examination, medical recording and allowed time of seclusion and restraint are in need of clarification. The new seclusion and restraint guidelines have been revised and reviewed by experts in mental health field. Conclusion : Revised guidelines could be used practically in real life mental health situations and strengthen of human rights of current psychiatric inpatients.
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이유진,용효중,김건우,나리지,이기경,황태연,이종국,홍진표 대한생물치료정신의학회 2011 생물치료정신의학 Vol.17 No.2
Objectives:Since the order for medical treatment as outpatient has begun in Korea, there have been no requests due to the absence of specific details relating to its enforcement and lack of understanding of related specialists. We reviewed current guidelines and administrative conditions for order for medical treatment as outpatient in Korea, and examined examples of operation and related regulations of developed countries. Methods:Korean studies concerning development of the order for medical treatment as outpatient were inquired. We investigated the guidelines of other countries including U.S.A., Australia, United Kingdom and Canada. The survey of related specialists for the improvement of order for medical treatment as outpatient was performed. Results:Related specialists agreed that current order for medical treatment as outpatient needed more detailed guidelines for candidate patients, processes and management for noncompliance. Additionally, majority of the specialists suggested that candidates for order for medical treatment as outpatient should be extended for not only hospitalized patients but also patients in community. Conclusions:We reviewed detailed considerations regarding candidate recipients within current legislation, complemented post-enforcement report, management procedures, and stipulated actions for noncompliance, to be used as practical guidelines for application. More fundamental measures than complementation of guidelines, such as modification of related legislature will be needed to increase usage, and further details with reference to confidentiality of recipients and safety measures and financial support of treatment personnel will be needed.
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