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| EDITORIAL |
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| Year : 2023 | Volume
: 37
| Issue : 1 | Page : 3-4 |
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Social security net for the mentally ill
Lian-Yu Chen M.D., Ph.D
Kunming Prevention and Control Center, Taipei City Hospital, Taipei, Taiwan
| Date of Submission | 25-Feb-2023 |
| Date of Decision | 26-Feb-2023 |
| Date of Acceptance | 27-Feb-2023 |
| Date of Web Publication | 28-Mar-2023 |
Correspondence Address:
Lian-Yu Chen
Floor 4, No. 100, Kunming Street, Taipei 108
Taiwan
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/TPSY.TPSY_11_23
How to cite this article:
Chen LY. Social security net for the mentally ill. Taiwan J Psychiatry 2023;37:3-4 |
Mental health issues in vulnerable population ranging from children to prisoners to middle-aged adults heavily afflict Taiwan. With the rapid development of the economic system, changes in family structures and the influence of social media, conflicts related to cyber-bullying, family issues, and treatment barriers related to financial difficulty or stigma, an urgent need exists to call for public attention to the deterioration of mental health in Taiwan. Strengthening and building out our social security net have been a focus of our policy implementation in Taiwan. Thus, to improve our mental health-care system is indeed a pressing issue that calls for greater resources and system reform.
The Ministry of Health and Welfare established the Mental Health Act (MHA) of Taiwan in 1990, aiming at promoting mental well-being, delivering mental health treatment, and supporting patients and their families. Not until 2007 the lawmakers passed an amendment to put patients and their families first, that policy reform and resource allocation were then based more heavily upon such ground to put patients who experienced mental health problems and their family first. After the amendment was made, compulsory admissions needed to receive approval from the Psychiatric Disease Mandatory Assessment and Community Care Review Committee. The number of compulsory admissions was decreased largely in comparison to 2006. Such a phenomenon implies the necessity of posttreatment procedures, providing assistance for the patient's family, and encouraging community-based rehabilitation. Thus, another amendment of MHA was passed in 2022, in which community support was emphasized. All of these changes aim at enhancing protection and treatment for the mentally ill.
Compulsory admissions and community treatment orders (CTOs) have been highly used in Norway since the Norwegian MHA was implemented in 1961 (www.lovdata.no/dokument/NL/lov/1999-07-02-62). While some patients experienced CTOs as a security net and an essential factor for staying well, others described them as a social control mechanism and a violation of their autonomy. A similar debate has also occurred in Taiwan. In addition to compulsive admissions, assertive community treatment (ACT) could also address unmet needs, manage future crises, and find solutions to daily life problems [1]. Unfortunately, the delivery of ACT in Taiwan might require further improvement. Furthermore, the mentally ill with comorbid substance use disorders are more than those without to have unmet need [2], suggesting that community-wide approaches are needed to address both mental disorders and substance use problems in this safety-net population. Patients with dual diagnoses are also more vulnerable to fall through the social security net and further increase the implementation of an integrated treatment program.
The issues to build social security net for the mentally ill are complex, involving more other than medical treatment delivery. For instance, a study in Los Angeles County, California, USA, showed that finding housing is the number one priority of depressed individuals, and the following are the needs to access quality health care, find work, and the requirements to improve spiritual well-being. It revealed that basic needs are essential for providing security and stability and crucial for mental health recovery. As a result, how to systematically engage community-based organizations, patients, families, and community members in improving the design of community-wide health policy initiatives is a challenging task [3].
The mentally ill with homelessness has a higher risk for mortality, disability, substance use disorders, and suicide. Adverse living conditions, combined with serious mental illness, substance use, trauma, and feelings of disaffiliation, can diminish the ability of people who are homeless to manage their general medical and mental health [4]. The appointment of mental health conservatorship can be a method to help homeless people of mentally ill from mental illness to transition and from the streets to residential psychiatric treatment. But it requires substantial resources from facilities that initiate such conservatorships and do not guarantee the resolution of long-term supportive housing needs [5].
In summary, a stronger mental health system is essential for the social security net. The Taiwanese government has not only made amendment to MHA but also to give more resources to further strengthen mental health service delivery as well as community support, aiming at enhancing protection and treatment for the mentally ill.
| Financial Support and Sponsorship | |  |
None.
| Conflicts of Interest | | |
The author reports no conflicts of interest in writing this editorial.
| References | | |
| 1. | Stuen HK, Rugkåsa J, Landheim A, et al.: Increased influence and collaboration: a qualitative study of patients' experiences of community treatment orders within an assertive community treatment setting. BMC Health Serv Res 2015; 15: 409.  |
| 2. | Chang ET, Wells KB, Gilmore J, et al.: Comorbid depression and substance abuse among safety-net clients in Los Angeles: a community participatory study. Psychiatr Serv 2015; 66: 285-94. |
| 3. | Khodyakov D, Williams P, Bromley E, et al.: Using stakeholder input to inform an innovative research and policy initiative to improve depression in safety net communities. Prog Community Health Partnersh 2017; 11: 93-8. |
| 4. | Department of Public Health, Los Angeles County: Recent Trends in Mortality Rates and Causes of Death among People Experiencing Homelessness in Los Angeles County. Los Angeles County, California, USA: Department of Public Health, 2021. |
| 5. | Choi KR, Castillo EG, Seamans MJ, et al.: Mental health conservatorship among homeless people with serious mental illness. Psychiatr Serv 2022; 73: 613-9. |
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