Amendments to the Mental Health Act in Taiwan and England

2007年7月，台灣與英國都剛完成精神衛生法的修法。事實上，在修法前，台灣的精神衛生法於1990年就已經誕生，而英國的1983年精神衛生法更早已存在超過20年。經過大約20年的時間，不僅兩國的社會、政治與經濟環境早已大不同，社會對精神衛生問題的態度以及因應的服務措施也有許多變革，因此精神衛生法有必要迎合社會環境的改變進行更新。本文首先將針對兩國的修法內容進行比較，以了解其修法上的架構與特色。幾項與精神衛生法相關的爭論與服務措施，本文也將一併提出討論。另一方面，精神衛生政策總是受到主流政治偏好的影響。就立法而官，令人訝異地，台灣與英國兩國呈現出相似的威椎態度。例如，在英國修法過程中，由衛生那與內政部所共同提出有關強制治療的法條草案一直受到人權倡導團體的反對，並被批評是關注大眾安全更甚於服務使用者的自由。同樣地，在台灣，對服務使用者的強制治療也受到批評與要求改革的呼聲。即使面臨服務使用者與倡導團體的反對，兩國的精神衛生法仍然維持了法案中固有的強制手段。有評論者認為對公眾安全的集體焦慮已經影響了兩國精神衛生法的發展。更多相關的倫理議題將於本文中進行討論。

關鍵字

精神衛生法；人權；強制治療

並列摘要

In July 2007, the amendments of Mental Health Act have just been finished both in Taiwan and England. Before revising, actually, in Taiwan the Mental Health Act has been enacted since 1990. In England the Mental Health Act 1983 has existed even longer than twenty years. After around two decades, there are so many changes in social, political and economic contexts as well as service facilities of and public attitudes towards mental health problems. Thus, it is necessary to modernise the Mental Health Act to adjust to the contemporary societal situation in both countries. Some points of similarities as well as differences in the revised legislation will be presented and contrasted to help understand the essential framework and its identical characters. A couple of debating themes concerning Mental Health Act and related service practice in England and Taiwan will be discussed as well. On the other hand, mental health policy has been shaped by mainstream political preferences. It is astonishing to find a similarly authoritarian attitude towards mental health service users in terms of legislation. In England, for example, sections concerning compulsory treatment had attracted advocate groups to fight against the controversial Mental Health Bill proposed by the Department of Health and the Home Office which would be more concerned about public safety than service users' liberty. Similarly, in Taiwan, compulsory treatment of service users has been criticised and urged for change. Even facing challenges from service user groups and advocates, the amendments to the Mental Health Act remain these enforcing devices. It is argued that the collective anxiety over public safety has driven the development of Mental Health Act in these two countries. More ethical issues will be presented in the essay.