정신병원과 시설 내 격리･강박의 문제점과 제도개선방안

Seclusion and restraint of inpatients or inmates within mental hospitals and some facilities has become natural or familiar in our society. However, there is also a simultaneous hatred and fear for mental hospitals and facilities in which violence becomes possible. We need to find the origin of how mental hospitals and facilities, which should be spaces for treatment and care, are converted into inhuman spaces through seclusion and restraint, and our systems and practices that allow seclusion and restraint comes from what roots. Confinement and binding of people is the beginning of animal treatment, and in the process people are depersonalized. While seclusion and restraint in correctional facilities are punitive to maintain order, seclusion and restraint in mental hospitals are therapeutic to maintain the safety of individuals and others. However, the boundaries between individual safety and collective order are ambiguous, and there is always a risk that treatment will be converted into punishment. Therefore, the role of the law should exist as a symbol to prevent treatment from turning into punishment and care itself into violence, but our seclusion and restraint regulations, which are provided in the Mental Health and Welfare Act, have long lost such control in reality. This paper looks back in time for institutions that are the basis for seclusion and restraint, and examines the role of drugs in psychiatry, one of the reasons why modern psychiatry can govern the mentally ill. In addition, it will point out the problems of illegal forced transportation by the private sector, which can be called the first violence, and suggest specific measures to reform seclusion and restraint system. Specific improvement measures for seclusion and restraint include clarification of restrain concepts, requirements and procedures, establishment of standards for use of chemical restraint, and regulation of qualification and education for restrain enforcement personnel.