本研究目的在於探討台灣、日本及英國之精神衛生法的內容有何異同及日本及英國之精神衛生法有哪些可供我國修法之參考? 研究方法採文獻研究法(Archival Research),以較宏觀的角度將台灣、日本及英國的精神衛生法從橫斷面及縱剖面進行跨國比較研究。 研究結果發現,我國精神衛生法公布施行迄今十三年,尚未修法,其中許多條文也已不符社會需求,且有2/3條文侷限於精神醫療,相較於日本精神醫療只佔1/3、英國只佔1/5條文。分析結果發現我國精神衛生法除保護精神病人權益有待加強,精神病患犯罪之治療、精神病患財產管理及保護、強制住院自動審查制度等,我國都付之闕如。 研究者經比較研究台灣、日本及英國的精神衛生法之重要條文內容、修法趨勢及經驗,對於我國修法之建議如下: 1.修正立法目的:「增進國民心理健康,預防及治療精神疾病,保障病人權益及福利,協助病人回歸社會、自立及參與社會經濟活動。」 2.修正衛生署及地方衛生局「得設」精神疾病防治審議委員會改為「應設」,並強化「精神疾病防治審議委員會」的功能。 3.增列「強制門診治療」、「強制社區治療」、「強制社區鑑定」及「緊急強制留置」之規定,提供多元強制鑑定及強制治療的方式。 4.修正「精神病患強制鑑定,除要有二名精神科專科醫師之診斷一致,也必須要有該院職員在場證明」,以維護病人權益。 5.增列「設置獨立公正之委員會,審查強制住院是否有繼續之必要」及「建立自動審查制度」,以保障病人之人身自由權。 6.修正「嚴重病人之定義」,其文字應明確化。 7.修正「家屬之定義」,應參考民法,以避免同詞異義。 8.刪除「精神衛生法第19條」,有關家屬或保護人需負連帶賠償責任之相關規定。 9.增列「精神病患家屬之權利」,家屬並非只有義務,而沒有權利。 10.增列「精神病患約束及隔離之處理標準及作業程序」,包括:診斷、執行原因、方式、時間、次數、用藥、精神症狀及專業人員應視察之次數等,並都應詳實記載於病歷,以保障精神病患人身自由,不致遭受不當的人權侵害。 11.增列「精神病患強制鑑定、強制住院或精神病犯強制住院,病人、家屬或保護人有申請出院的權利」,以保障精神病患人權。 12.增列「司法對精神病人犯罪治療之相關規定」,以保護病人人權及落實治療重於監禁。 13.增列「精神病人財產管理及保護之相關規定」,以保護病人財產權。 14.增列「精神衛生、社會福利及職訓就業等相關規定之整合」,以精神病人為中心,提供整體及連續之社區復健服務,協助精神病人早日回歸社會。 15.增列「每五年定期檢討修法」。 我國精神衛生法修法,除參考日本及英國等先進國家之修法經驗及趨勢,也應參考世界衛生組織宣言及加強精神病人人權保護,落實精神醫療、社區復健、心理衛生保健三者並重。同時,精神衛生法修法仍應以尊重精神病人及保護病人權益為目的。而面臨修法之際,必須改變的是:修法腳步應加快、修法之目的、方向及架構應更明確、確保不同的團體都有公平參與修法的機會、要有足夠的相關研究作為修法參考之基礎及發展多元方案配套措施。
This study was undertaken with an objective to explore the salient features and the main differences of existing mental health legislations of Taiwan, Japan and England. The purpose was to see and obtain possible references and clues from the laws of those countries that may contribute in future amendment to Taiwan mental health laws. The archival research methodology approach was adopted in this study. With grander perspective, the comparative analysis of mental legislations of Taiwan, Japan and England were conducted in both cross-nation study and longitude study. According to the findings of this study, Taiwan mental health law in existence for the last 13 years has been dragging along without any noteworthy amendments. Many provisions in it haven’t been able to correspond to the needs of the changing society. This study exposes many shortcomings of the Taiwan mental health law which was found to be prioritizing and focused in wrong direction. As an ideal example, Japan’s mental health law has only one third of the provision related to psychiatric treatment while English mental health law has even less, one fifth for the same provision. However, on the contrary, a major chunk of Taiwan’s mental health law, two third of the total provisions, is related to psychiatric treatment, undermining other important areas. It was found that in our mental health law, besides the protection of patients’ rights which needs to be enhanced, other concerns, such as the treatment of criminals with mental illness, the management and protection of patient’s properties, the automatic review system of compulsory admission to hospitals and etc., were also found to be inadequate. Through comparatively analyzing the mental health legislations of the three countries in their main contents and tendencies and experiences of amending the law, the researcher offers some suggestions in amending Taiwan’s mental health law in the following line: 1. The objectives of amending the law: to enhance the mental health of our citizens, to prevent and treat mental disorder, to defend the rights and welfare of patients, to help patients return to the community and independently participate in the societal economic activities. 2. Compulsory setting up of Mental Disorder Prevention Review Commission in Department of Health and Public Health Bureau and enhancing the function of Mental Disorder Prevention Review Commission. 3. Adding the regulations about compulsory treatment in outpatient service, compulsory community treatment, compulsory community assessment and compulsory detention in emergency; providing diverse ways of compulsory assessment and compulsory treatment. 4. To protect the rights of patients, in doing the compulsory assessment, there should be two psychiatrists achieving consensus in the diagnosis in the presence of a staff member in the hospital. 5. Setting independent and just commission to review the necessity of compulsory admission to the hospital and establishing the automatic review system to protect patient’s personal freedom. 6. Redefining “severe” mental disorder to make the meanings of the words more definite. 7. Taking The Civil Law as reference to amend the definition of “family members”. 8. Deleting the 19th article of mental health law which is related to the indemnity responsibility of family members and guardians of the patients. 9. Besides the responsibilities, the rights of patients’ families should also be defined. 10. Defining the standard and process of restraining and segregating patients; to defend the personal freedom of patients and prevent them from improper violation of human rights, all related information, such as the diagnosis, reasons of execution, means, time, frequency, dosing, psychiatric symptoms and etc., should be recorded in the case histories in detail. 11. To defend patients’ human rights, when they receive compulsory assessment or compulsory admission to the hospital, they themselves, their families and guardians have the rights to apply for leaving the hospital. 12. Adding the related regulations about the treatment of criminals with mental illness in judiciary, which not only protect the human rights of patients but also emphasize treatment more than confinement. 13. Adding the related regulations about the management and protection of patients’ properties to defend their rights on properties. 14. Integrating the regulations related to mental health, social welfare and employment training; taking patients as the center to provide whole and continuous rehabilitation services in community and help them return to the society earlier. 15. Doing regular examination and amendment of the law for every five years. Besides taking other countries experiences and tendencies of amending the law, such as in case of Japan and England, we should also take the WHO manifesto as reference and improve the protection of mentally-ill patients’ human rights. Psychiatric treatment, rehabilitation in community and mental health care should all be equally emphasized. In addition, the amendment of mental health law should be focused to respect patients and protect their rights. In facing the coming amendment of the law, we should quicken our pace of amending, clarify the objectives, direction and structure of the amendment, ensure different group’s equal chances of participation, acquire enough related studies as the basis of amendment and develop diverse supplementary measures. The researcher hopes that this work will provide some insights to enable enshrinement of better and practical mental health laws in Taiwan’s context.
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