Spousal Concordance and Cross-Disorder Concordance of Mental Disorders: A Nationwide Cohort Study

Hsieh Ming-Hong,Ju Po-Chung,Chiou Jeng-Yuan,Wang Yu-Hsun,Wang Jong-Yi,Chang Cheng-Chen 대한신경정신의학회 2022 PSYCHIATRY INVESTIGATION Vol.19 No.10

Objective Although both partners of a married couple can have mental disorders, the concordant and cross-concordant categories of disorders in couples remain unclear. Using national psychiatric population-based data only from patients with mental disorders, we examined married couples with mental disorders to examine spousal concordance and cross-disorder concordance across the full spectrum of mental disorders.Methods Data from the 1997 to 2012 Taiwan Psychiatric Inpatient Medical Claims data set were used and a total of 662 married couples were obtained. Concordance of mental disorders was determined if both spouses were diagnosed with mental disorder of an identical category in the International Classification of Diseases, Ninth Revision, Clinical Modification; otherwise, cross-concordance was reported.Results According to Cohen’s kappa coefficient, the most concordant mental disorder in couples was substance use disorder, followed by bipolar disorder. Depressive and anxiety disorders were the most common cross-concordant mental disorders, followed by bipolar disorder. The prevalence of the spousal concordance of mental disorders differed by monthly income and the couple’s age disparity.Conclusion Evidence of spousal concordance and cross-concordance for mental disorders may highlight the necessity of understanding the social context of marriage in the etiology of mental illness. Identifying the risk factors from a common environment attributable to mental disorders may enhance public health strategies to prevent and improve chronic mental illness of married couples.

정신적 취약성을 가진 범죄 피해자의 진술에 대한 심리학적 지원

문성원 한국피해자학회 2018 被害者學硏究 Vol.26 No.3

Korean society began to show overt concern for the crime survivors since the Victim Protection Act implemented in 2005. The essence of support for them is psychological in nature, because crime survivors mostly suffer psychologically compared to other ways. The experience of being a crime survivor adversely affects the psychological well-being of healthy people without mental disorders; it would worsen the vulnerability of people with mental illnesses. The crime survivors with mental disorders were vulnerable cognitively and emotionally before being a victim to a crime, and experiencing the crime made them more vulnerable. Psychological support should include help for their aggravated emotional and cognitive state evoked by the crime in order to prove that they are victims in their legal statement. This study explored the mental vulnerability caused by the experience of being a victim of crime, and the cognitive functioning including memory and emotion of crime survivors with mental disorders such as mental retardation, autism spectrum disorder, schizophrenia, and recurrent depression and those who are children. Then, this study examined the current state of psychological support related to court procedures including overall support system for crime survivors and in the verification process. Additionally, the real examples of cases of people with mental disorders were discussed, problems of current legal perspectives were analyzed, and current problem of the system that does not consider the mental disorders in the interview with crime survivors for the statement was identified. Finally, future prospects of the support of crime survivors were suggested including strengthening the professional competence in psychopathology and forensic service, the development of specific protocols according to mental disorders, specific technique development for mental disorders using the example of autism spectrum disorders, providing supplementary tools for recording the statement of survivors of crime with mental disorders. 범죄 피해자가 되는 경험은 많은 부정적인 영향을 피해자들에게 끼치지만 그중에서도 특히 심리적인 부분에 대해서 가장 많은 영향을 미친다. 따라서, 범죄 피해자들에 대한 지원은 이러한 심리적 고통 속에서도 피해자들이 자신들의 피해 사실을 충분히 밝힐 수 있도록 돕는데서 시작한다. 범죄 피해 이전에 심리적으로 건강했던 사람들조차도 피해 경험을 통해 정신적 측면에서 곤란을 겪게 되는 만큼 정신적 장애를 가지고 있던 사람들의 범죄 피해 경험은 이들의 피해 진술을 더욱 어렵게 만들 수 있으므로, 국가에서는 이 부분에 대해 특히 구체적이고 체계적인 지원을 해야 할 의무가 있다. 이 연구는 이러한 국가적 의무와 관련해서, 정신적 장애를 가지고 있던 피해자들의 피해 진술을 전문적으로 지원할 수 있는 방법을 찾고자 하는 목적으로 행하여졌다. 이를 위해 먼저 범죄 피해 경험으로 인해서 유발될 수 있는 기본적인 심리적 변화와 정신적 장애를 가진 사람들의 인지 및 정서 특성을 정신적 장애별로 검토하여 이들의 피해자 진술 절차에서 유의할 점을 찾고자 하였으며, 다음으로, 현행 피해자 지원 시스템이 정신적 장애를 가진 사람들에 대해서 어떤 방법으로 접근하고 있는지를 실제 사례들을 통하여 확인하였고, 마지막으로 이러한 분석 결과를 토대로 향후 정신적 장애를 가진 피해자들에 대한 지원이 어떠한 내용으로 구성되어야 할 것인지에 대한 제언을 마련하였다.

정신질환자에 대한 차별행동에 미치는 영향요인

문난영 ( Moon Nan-young ),김석선 ( Kim Suk-sun ),길민지 ( Gil Minji ) 한국보건사회연구원 2018 保健社會硏究 Vol.38 No.3

본 연구의 목적은 대중매체가 정신질환자에 대한 차별행동에 영향을 미치는지 간접적으로 조사하기 위해 시행되었다. 일반성인 109명, 정신건강전문가 108명을 대상으로 정신질환자의 범죄에 대한 두려움, 회복에 대한 인식, 사회적 편견, 차별행동의 차이 및 두 집단의 정신질환자에 대한 차별행동에 미치는 영향요인을 파악하였다. 연구대상자들에게 대중매체의 영향력을 평가하기 위하여, 정신질환자의 범죄에 대한 내용의 시나리오를 제공한 후, 자가보고 설문지를 시행하였다. 범죄에 대한 두려움 Measurement of Fear of Crime, 회복에 대한 인식 Recovery Knowledge Inventory, 사회적 편견 Community Attitude toward the Mentally Ill, 차별행동 Opinion about Mental Illness 척도를 사용하였다. 기술통계, 독립 t-검정, 피어슨 상관계수, 위계적 다중회귀분석으로 자료 분석하였다. 연구 결과, 일반성인이 정신건강전문가보다 정신질환 회복에 대한 인식, 사회적 편견, 차별행동이 부정적인 것으로 나타났다. 또한, 일반성인은 회복에 대한 인식이 6.8%, 사회생활제한이 41% 차별행동에 대해 설명력을 보였다. 정신건강전문가는 사회생활제한과 지역정신보건개념이 차별행동에 대해 41.3%의 설명력을 보였다. 본 연구의 결과는 범죄와 정신질환자에 대한 대중매체의 역할이 중요함이 간접적으로 제시하였다. 따라서, 일반성인과 정신건강전문가 각 집단별 정신질환을 가진 범죄자의 차별행동을 낮추기 위한 중재 프로그램 개발이 필요하며, 정신질환자에 대한 대중매체 보도를 개선 할 필요가 있다고 제언한다. The purpose of this study was to examine whether media reports related to criminal behavior foster stigma toward people with mental disorders, to compare stigma between general adults and mental health professionals, and to determine whether fear of crime, recovery knowledge, and prejudice toward the mental disorder are associated with discriminatory behavior toward people with mental disorders. The participants were 109 general adults and 108 mental health professionals. After reading the crime scenarios in which a murderer with mental disorders, they responded to the questionnaires. The finding reported that general adults had significantly more stigma toward the mental disorder than mental health professionals. In hierarchical regression model, recovery knowledge and social life restriction regarding prejudice were significantly associated with discriminatory behavior among general adults. In mental health professionals, fear of crime, recovery knowledge, and social life restriction and concepts of community mental health regarding prejudice were significantly related to discriminatory behavior toward people with mental disorders. The results indicated that media reports related to criminal behavior fostered stigma toward people with mental disorders. These results suggest that it is necessary to develop appropriate media guidelines and an intervention program to reduce the discriminatory behavior toward people with mental disorders.

정신질환 소년원생의 현황 및 처우방안

권수진 한국소년정책학회 2018 少年保護硏究 Vol.31 No.3

In recent years, the percentage of juveniles with mental disorders in juvenile reformatories have been increasing to the extent that one forth of protected juveniles are found to have mental disorders or developmental disabilities. The increase in the number of protected juveniles with mental problems has raised concern that mental disorders can be a cause of accidents in reformatories, including violence among juveniles and self-injury. Also, considering that a major purpose of the juvenile reformatory is to protect and rehabilitate juvenile offenders, it is crucial to provide effective treatment to protected juveniles with mental disorders. Against this backdrop, this study aims to make suggestions to improve the treatment of protected juveniles with mental disorders by examining the current state of the juvenile reformatory in terms of the provision of medical care and rehabilitation. For this purpose, the study conducted a survey of staffs who work at the Juvenile Classification Review Board and juvenile reformatories. Also, this study conducted interviews of teaching staff and medical staff of juvenile reformatories concerning possible improvement measures for the effective treatment of mentally disordered juveniles under detention. The survey and interviews were designed to identify major problems and to obtain opinions of reformatory staff regarding the treatment of juveniles with mental disorders. Especially, the questions delved into the issues of how to make dispositions for medical care and by what standards; of how to improve the medical care of mentally disordered juveniles in general reformatories; and of how to operate a facility for medical protection of juveniles. The results of the staff survey show wide consensus among teaching and medical staff that there is an urgent need of increasing medical and rehabilitative care for protected juveniles with mental disorders or developmental disabilities. Also, in order to improve the effectiveness of medical care, it was pointed out that reliable standards for classifying juveniles should be established to provide individualized medical care. In addition, a large number of respondents and interviewees pointed out that one of the most pressing issues was the shortage of medical staff, especially full-time psychiatrists and clinical counselors at reformatories. The establishment of a new juvenile medical care and protection institution is suggested as a possible solution to the issues mentioned above. In addition, this study concludes with a set of suggestions on how to improve the effectiveness of the treatment of mentally disordered juveniles. First, the results of the survey and interviews show that the improvement of the physical environment at the reformatories can contribute to mitigating the issues of mental disorders. Second, it was repeatedly pointed out that there was an urgent need to increase the personnel in charge of rehabilitation and medical care, especially psychiatrists and clinical counselors. Third, in addition to the establishment of a specialized facility for medical protection of juveniles, it needs to facilitate the provision of clinical service for juveniles who stay at the general reformatories. Forth, one of the ways of providing clinical service to protected juveniles is to make use of resources in the community by strengthening cooperation with diverse clinical experts. Lastly, it should be noted that treatment within the reformatory needs to be connected to treatment in the community so that juveniles with mental disorders can be effectively supported in the process of returning to the society. .

정신장애 범죄자에 대한 교정처우에 관한 연구 : 사회내 처우를 중심으로

류은숙(Ryu Eun Sook) 한국공안행정학회 2015 한국공안행정학회보 Vol.24 No.1

Mentally-disordered offenders have a significant history of offending behavior and pose a significant risk to themselves and others, requiring a special care and careful management. Legislation and practice in the placement and treatment for mentally-disordered offenders is different in countries such as Germany, Japan, the United Kingdom, and the United States. However, it is obvious that each country creates the legal frameworks and assessment, court and discharge procedures for mentally- disordered offenders, and tries to provide community based treatments and various diversions at all stages of criminal justice system to the offenders with mental disorders. By contrast, Korea's criminal justice system for mentally-disordered offenders depends disproportionately on correction facilities such as an institute of forensic psychiatry and prison. Furthermore, there are very few community-based treatments and alternatives such as diversions for offenders with mental disorders. These problems exacerbate the already elevated risk for re-arrest and incarceration of mentally disordered offenders in Korea. Based on this study, this researcher proposes several recommendations to improve the problems of the correctional treatment for offenders with mental disorders in Korea. First, it is necessary to set up a more efficient and integrated regulation to provide a definition of the mentally-disordered offenders and to provide more appropriate correctional treatments for individuals who have mental health issues coming into contact with the criminal justice system. Second, specific regulations concerning criminal mental assessment need to be specified in the legal code. Criminal justice agencies should comply with the recommendations as well as information from the expert assessment. Third, more effective community treatments for mentally- disordered offenders should be implemented in the criminal justice system as soon as possible. It is critically necessary to introduce intervention programs specialized in each mental disorder and a new probation official system for mentally-disordered offenders only. Above all, diversions for offenders with mental health problems should be established in all stages of criminal justice procedures. Finally, community treatments for mentally-disordered offenders should make the best use of resources of the private and public mental health facilities and professionals in the respective communities. 정신장애범죄자는 다양한 범죄행동을 보이면서 동시에 정신질환과 약물남용, 성격장애, 그리고 성적인 문제와 같은 복합적인 문제를 지니고 있기 때문에 특별한 치료와 관리가 필요하다. 주요국에서는 정신장애 범죄자들을 위한 법적 규정과 평가, 재판, 그리고 퇴소절차들을 마련해 놓고 있으며 형사사법시스템의 모든 단계에서 사회내 처우와 다양한 다이버전들을 제공하려고 노력하고 있다. 반면에 정신장애 범죄자에 대한 한국의 형사사법체계는 치료감호소와 교도소와 같은 교정시설에 많은 부분 의존하고 있는 것으로 나타났다. 더욱이 이들을 위한 사회내 처우와 다이버전과 같은 대안적 처우들은 거의 전무한 상태였다. 이러한 문제들은 한국에서 정신장애 범죄자들의 재범의 위험성과 범죄의 흉포성을 더욱 악화시키고 있다. 이 연구에서는 한국의 정신장애 범죄자에 대한 교정처우를 발전시키기 위해 몇 가지 제언을 도출하였다. 첫째, 정신장애 범죄자에 대한 구체적인 정의와 교정처우에 대한 통합적인 법적 규정이 마련되어야 한다. 둘째, 범죄자의 정신상태를 평가하는 구체적인 방법이 법적 규정내에 확립되어야 하고, 여기에는 다양한 정신건강전문가, 평가도구, 평가의 법적 구속력 등이 포함되어야 한다. 셋째, 정신장애 범죄자에 대한 정신건강전문가팀, 특수개입프로그램, 특수보호관찰제도, 다이버전, 문제해결법원, 그리고 중간처우시설 등과 같은 사회내 처우가 조속히 설립되어야 한다. 마지막으로, 사회내 처우는 지역사회에 있는 민간자본인 사립 및 공립 정신건강시설과 전문가들을 최대한 활용해야 한다.

정신보건법과 정신장애인의 인권

이철호(Lee cheol-ho) 한국헌법학회 2007 憲法學硏究 Vol.13 No.4

This article deals with (1) The Mental Health Law and (2) Human Rights of Persons with Mental Disorders. The various mental patients are increasing gradually who don"t adapt themselves to new sense of value out of the development of industrial society. These people occasionally commit shocking crimes such as murder and arson in the mental process beyond our comprehension There are many difficulties in the constitution of the mental health act and cure custody act. Because from the beginning, both the human rights of the psychiatric patients, as well as the protection of civilians from the risk of the unpredictable and impulsive behavior of such patients had to be considered. Compulsive hospitalization of persons mental disorder should be due process of law and, after seperation, their human rights should be respected. So, the direction of mental health care should be defined as ""establishment of due process of law and respect of human rights"", and ""from hospitalization to cummunity mental health care"". In this study, current law and practice relating to mental disorder in Korea are reviewed and international standards and foreign laws are also examined, and finally, several improvement measures of persons of persons of mental disorder are suggested. And for persons with mental disorder who did not commit crime, ① es-tablisgment of due process of law in the course of hospitalization and leaving hospital, ② protection of rights and improvement of treatment for hospitalized persons mental disorder, ③ strengthening welfare character in the mental health law ④ establisment of community mental health care system are suggested.

정신장애 범죄자에 대한 강제적 의료조치와 보안처분

허일태 ( Il Tae Hoh ) 한양대학교 법학연구소 2011 법학논총 Vol.28 No.4

Many of mentally disordered people harm others or themselves. Especially, they have more potential to commit violent crimes than mentally normal people. According to the doctrine of responsibility, a punishment is not imposed in that they have no capacity for their action due to their mental disorder. Or a less severe punishment is imposed with causes for penalty reduction in that they have limited capacity for their action. Therefore, the cure-custody systems or involuntary admission are essential for mentally disordered people to protect themselves, others and society. With respect to crimes with mental disorder, Korea enacted Mental Health Act and Cure Custody Act. Mentally disordered people who have the potential of crimes are involuntarily admitted to a mental hospital by severe requirements based on Mental Health Act. And mentally disordered offenders who committed a crime are treated with rehabilitation measures based on Cure Custody Act. Both Mental Health Act and Cure Custody Act are likely to run counter to human rights protected by the Constitution in that they take away personal liberty. With regard to mentally disordered people and offenders, improvements are required to keep a balance between restriction on personal liberty and fundamental rights under the Constitution. i) The Constitution in Korea guarantees a right to personal liberty for all the people. It is restricted by due process of law only in case of harming others by abuse of the right to personal liberty. Thus, deprivation of personal liberty such as arrest without warrant is limited to a suspect under criminal law. The requirements are very severe and accordingly need criminal activities more than 3 years and possibility of destruction of evidence and an escape. If a person who never commit a crime is deprived of his right to personal liberty in that he just has a potential to harm oneself or others, it means a violation of personal liberty guaranteed by the Constitution of Korea. ii) It is possible that a mentally disordered person is involuntarily admitted to a hospital with agreement by a guardian or related expert. That might restrict or infringe a right to personal liberty protected by the Constitution. In addition, Mental Health Act provides that involuntary admission is applied to a mentally disordered person having a potential to harm not only others but also himself. It is doubtful that involuntary admission should be applied to even a mentally disordered person having a potential to harm himself. Considering that people have the right of self-determination on their own bodies, government interference should be limited as much as possible. iii) When a mentally disordered person is involuntarily admitted to a mental hospital, his opinion should be first respected. Also involuntary admission should be limited to only when there is lots of potential to harm others. iv) The object of cure-custody is ``A person who has a high rate of recidivism``. This judgemental standard might lead to excessive expansion of eligibility. All people have a potential to commit a crime and can make same mistakes. To justify isolation of a mentally disordered person from society, there should be dangers or probabilities socially unpardonable. Thus, ``the danger of recidivism``, one of requirements for compulsory treatments, should be modified into ``probability of recidivism``. v) If a prosecutor apply for cure-custody, he should ask a mentally disordered person to undergo a prior mental examination by a suitably licensed or certified examiner. Human cognitive ability and mental capacity are object of mental science or brain science rather than object of normative judgement and a substantial portion of them can be explained. Therefore, the judgemental standard and contents of mental examination should be set up precisely through the use of medical knowledge and technology. vi) If it is revealed that treatments such as involuntary admission are unreasonable, a judicial approach and review has to be fulfilled by the Habeas Corpus Act. vii) Adequate facilities and systems for the treatment are required because the major objective of involuntary admission and cure-custody is to treat a disease, mental disorder. The quality of the treatment, material resources and human resources such as related experts play a crucial role in treatments and improvements for mentally disordered people. Finally, if China is to accept the basis of Korean Mental Health Act and Cure Custody Act, it also needs to accept Korean Habeas Corpus Act and National Human Rights Commission Act of Korea. Only by doing that, China can prevent the abuse of compulsory treatments of mentally disordered people.

독일의 정신건강제도 발전과 정신건강 현황

임정선 한독사회과학회 2019 한독사회과학논총 Vol.29 No.4

Since the first enactment of the Mental Health Act in 1995 in Korea and its amendment in 2017, discussions on mental health policies and systems have been actively conducted. This study attempts to examine the historical background and changes in the development of the mental health system in Germany, and by analyzing the recent status of German mental health, to provide basic data on preparing policies and systems for people with mental disorders in Korea. In Germany, people with mental disorders had been the target of poor relief, and after the 1800s, they were sequestered and treated in large mental hospitals. Later, through the social reforms that began in the 1960s, people with mental disorders were recognized as persons with human rights, and then, as social psychiatry developed, people with mental disorders were being treated. And mental health systems and mental health services have been built around the community so that they can return to society. Mental disorders are also subject to social insurance as they are recognized for their status just as physical illness. In this mental health system, there have been significant changes in the treatment, rehabilitation and awareness of people with mental disorders. In particular, over the past 20 years when mental health systems and mental health services have been operating reliably, there has been a change in the perception of mental disorders and the aspect and distribution of mental disorders over the last two decades. There has been a change from the perception that mental disorder is a minority disease, to the perception that it could happen to anyone along with the spread of depression. In recent years, mental health has emerged as a forerunner in quality of life and current industrial structures, and has become the subject of German society as a whole. The fact that mental health is no longer limited to psychiatric services, but has become a “cross‐cutting issue” involving child care, education and labor, suggests a great implication for the arrangement of Korea's mental health system and policies. 한국에서 1995년에 정신보건법이 처음 제정된 후 2017년에 개정되면서 정신건강정책 및 제도에 대한 논의가 활발히 진행되고 있다. 본 논문에서는 독일의 정신건강제도 발전의 역사적 배경과 변화과정을 살펴보고, 이러한 변화에 따른 최근의 독일 정신건강 현황을 분석함으로써 한국의 정신장애인을 위한 정책 및 제도 마련에 기초자료를 제공하고자 하였다. 독일에서 정신장애인은 빈민구제의 대상이었다가 1800년대 이후에는 대형정신병원에 격리되어서 치료 및 보호를 받았다. 이후 1960년대 시작된 사회개혁을 통해 정신장애인을 인권을 가진 인격체로 인정하게 되었고, 사회정신의학이 발전하면서 정신장애인을 치료하고, 이들이 다시 사회로 복귀할 수 있도록 정신건강제도 및 정신건강서비스가 지역사회를 중심으로 구축되었다. 또한 정신장애는 신체질환과 같은 지위를 인정받게 되면서 사회보험의 대상이 되었다. 이러한 정신건강 체계에서 정신장애인의 치료 및 재활과 인식에도 큰 변화가 있었다. 특히 정신건강제도와 정신건강서비스가 안정되게 운영된 지난 20여 년간 정신장애에 대한 인식과 정신장애의 양상 및 분포에 큰 변화가 있었다. 정신장애가 소수에게서 발생하는 질병이라는 인식에서 우울증의 확산을 계기로 누구에게나 발생할 수 있는 장애라는 인식으로 변화하였고, 최근에 와서는 정신건강이 삶의 질과 현재의 산업구조에서 전면으로 부상하면서 독일 사회 전체의 주제가 되었다. 정신건강은 더 이상 정신의학적인 서비스로 제한되는 것이 아니라 육아, 교육, 노동 등을 포함하는 ‘크로스 커팅 이슈(cross-cutting issue)’가 되었다는 점은 한국의 정신건강제도 및 정책 마련에 시사하는 바가 크다.

캐나다의 정신장애 범죄자에 대한 정신건강전략 연구

허경미 한국교정학회 2016 矯正硏究 Vol.- No.71

There are increasing social concerns about the treatment of mentally disordered offenders in light of a recent series of violent crime. The debate on the correlation between mental illness and crime continues. However, correctional strategies for the treatment of mentally disordered offenders are very necessary. Canada has prepared a very systematic mental health strategy for mentally disordered offenders. This began after the Ashley Smith inquest that occurred in 2007. Therefore, the purpose of this study is as follows. First, this study analyzes the strategies for corrective treatment of prisoners with mental disorders in Canada, and will examine their characteristics. Second, this study aims to find a way to improve policies for the corrective treatment of prisoners with mental disorders in the future in Korea. In November 2008, Canada created the Federal-Provincial-Territorial Working Group on Mental Health. The WGMH developed The Mental Health Strategy for Corrections with assistance from the Mental Health Commission of Canada. The Correctional Service of Canada announced the Mental Health Action Plan for Federal Offenders on May 1, 2014. The Government's Mental Health Action Plan focuses on five Pillars for Action: Timely Assessment, Effective Management, Sound Intervention, Ongoing Training and Development, Robust Governance and Oversight I found the policy implications from the Canada Mental Health Action Plan as follows. First, it should require the upholding of mental health-related laws. Second, correctional institutions should be required to be connected with external institutions for treatment. Third, it should place emphasis on treatment and specialized medical facilities for offenders with mental disorders. Fourth, we need to build a network of mental health and criminal justice agencies and private organizations. Fifth, we have to accurately survey mentally disordered offenders. These are the highest priority tasks; moreso than any correction of mentally disordered offenders. 최근 정신장애자 범죄자에 의한 연이은 강력범죄로 인하여 정신장애 수용자의 교정처우에 대한 사회적 관심이 높아지고 있다. 정신장애의 범죄의 원인성에 대한 논란은계속되고 있지만, 정신장애 범죄자에 대한 교정처우전략의 필요성은 시급하다. 그런데캐나다는 2007년 10월에 발생한 여성재소자 애슐리 스미스의 교도소 내 자살사건을계기로 정신장애 수용자에 대한 교정처우전략을 매우 체계적으로 준비하고 집행 중에있다. 따라서 이 연구는 첫째, 캐나다의 정신장애 수용자에 대한 교정처우전략을 분석하고, 그 특징을 살펴볼 것이며, 둘째, 이를 통하여 향후 한국의 정신장애 수용자에 대한 교정처우정책의 개선방향을 모색해보고자 한다. 캐나다 교정국은 2008년 11월에 수용자 정신건강을 위한 연방 및 지방교정국 협의체를 구성하였다. 이 협의체는 캐나다 정신건강위원회의 지원을 받아 수용자의 정신건강 및 정신장애 치료를 위한 전략을 수립하여 2012년에 교정시설 정신건강전략을 발표하였다. 이 전략은 프레임워크와 집행전략 등 두 가지의 기본적인 틀을 가지고 있다. 캐나다 교정국은 정신건강전략을 구체적으로 실행하기 위하여 2014년 5월 1일에 교정시설 정신건강행동계획을 발표하였다. 정신건강행동계획은 연방교도소 수용자의 정신장애 여부에 대한 적시평가, 효율적인 관리, 적당한 개입, 교도관 등에 대한 지속적인훈련, 강력한 관리 및 감독 등의 다섯 가지 전략을 명시하였다. 그리고 그 집행여부에대한 모니터링을 캐나다 교정감사관이 매년 공공안전부장관에게 백서 형태로 보고하고있다. 캐나다의 정신장애 범죄자에 대한 교정처우전략을 통하여 다음과 같이 정책적 시사점을 얻을 수 있다. 첫째, 근거법의 정비가 필요하다. 현행 국민건강보험법, 치료감호법, 형집행법 등으로는 지속적인 치료는 어렵다. 둘째, 외부치료기관과의 연계가 필요하다. 지역사회의 전문의료시설 및 의료진의 지원이 필요하다. 셋째 치료시설 확충 및전문의료진의 확보가 선행되어야 한다. 현재 부족한 치료감호소 및 교정시설의 의료진의 충원이 시급하다. 넷째, 형사사법기관 및 민간정신치료기관과의 네트워크를 구축해야 한다. 수사기관과 교정기관, 그리고 보호관찰소 및 지역사회의 정신의료시설과의 협업이 필요하다. 다섯째, 수용자에 대한 정신장애 여부에 대한 정확한 진단이 가장 우선되어야 한다.

후유장애 평가 의뢰된 환자에서의 신경인지기능의 임상적 특성

김원형,정승호,강민희,이정섭,배재남,김철응 대한신경정신의학회 2010 신경정신의학 Vol.49 No.6

ObjectivesZZThe purpose of this study is to investigate the clinical characteristics of neurocognitive functions in patients with traumatic brain injury referred for mental disability evaluation. MethodsZZThe neurocognitive functions of 293 patients, who were referred for mental disability ev-aluation, were assessed using a computerized neurocognitive test. The patients were divided into three groups according to head trauma history and brain imaging studies. We also measured their intelligence and memory, using the K-WAIS and the Rey-Kim Memory Test. ResultsZZThe group with organic mental disorder showed more impaired concentration, langu-age, memory, intelligence, executive function and visuospatial function than those with nonorganic mental disorder without traumatic brain injury. The group with organic mental disorder also showed greater impairments in selective attention, some part of language, long-term memory, and hypothesis formation than those with postconcussional disorder. The group with organic mental disorder obtained lower intelligence and memory test scores than those with postconcussional disorder and nonorganic mental disorder without traumatic brain injury. There was no difference in in-telligence or memory between postconcussional disorder and nonorganic mental disorder without traumatic brain injury. ConclusionZZPatients with postconcussional disorder share the characteristics of neurocognitive function with organic mental disorder and nonorganic mental disorder without traumatic brain injury. We suggest the computerized neurocognitive test that evaluated details of neurocognitive functions for patients with traumatic brain injury referred for mental disability evaluation.