[비즈한국] As cases of patient deaths in psychiatric hospitals continue to occur, calls for reform of the "Psychiatric Hospital Evaluation System" are growing. Following the 2020 amendment to the Medical Service Act, which made "medical institution accreditation" for psychiatric hospitals voluntary, concerns were raised regarding a potential "decline in quality of care"—and these fears have now become a reality. Critics point out that health authorities have failed to actively manage psychiatric hospitals, thereby exacerbating harm to patients.
Under the Mental Health and Welfare Act, psychiatric hospitals are required to undergo an "evaluation of mental health promotion facilities" every three years. Prior to 2020, psychiatric hospitals were classified as "nursing hospitals" and were subject to mandatory "medical institution accreditation." However, with the amendment of the Medical Service Act, they were separated from nursing hospitals, making medical institution accreditation "voluntary," and allowing hospitals to undergo only the "psychiatric hospital evaluation" despite concerns over a potential decline in the quality of care.
The problem lies in the loopholes of the "psychiatric hospital evaluation" system. While the Mental Health and Welfare Act states that "the hospital director must undergo the evaluation unless there is a justifiable reason," there are no specific penalty provisions. Failure only results in a public announcement on the website of the Korea Institute for Healthcare Accreditation (KOIHA). Consequently, hospitals often refuse to undergo re-evaluation after failing, or even refuse the evaluation itself. According to data submitted by KOIHA to Representative Jeon Jin-sook of the Democratic Party of Korea, among the 140 facilities that failed the evaluation between 2021 and 2023, not a single one underwent a re-evaluation within a year. Chuncheon Yehyeon Hospital, which had passed its previous evaluation, refused the evaluation the following year after a fatal incident occurred in 2022.
Due to such attitudes from hospitals, pass rates are declining. According to the "Status of Mental Medical Institution Evaluation Results" disclosed during last year's parliamentary audit, only 39 out of 82 psychiatric hospitals passed the 2021 evaluation, a pass rate of just 47.6%. In 2022, 40 out of 64 passed, recording a 62.5% pass rate. The pass rate for psychiatric departments installed in hospital-level medical institutions has also fallen each cycle, with rates at 95.8% in the first cycle (2012–2014), 68.8% in the second (2015–2017), and 44.8% in the third (2018–2020).
Concerns about the "effectiveness" of these evaluations are also being raised. Haesang Hospital, where a fatal accident occurred in 2016, passed the 2021 evaluation, yet another fatal accident took place there this year. Situations involving suspected violations of restraint guidelines are being investigated. However, the 2021 passing evaluation report showed that the hospital received a "high" grade in items such as "having regulations for restraint" and "safely implementing and recording restraints."
Even for hospitals that undergo the stricter "medical institution accreditation" instead of the basic evaluation, concerns remain as they are excluded from interim on-site inspections. While interim on-site inspections are conducted as part of post-accreditation management, psychiatric hospitals maintain their accreditation solely through self-assessment. W-Jin Hospital, where a patient died while restrained in May, had received medical institution accreditation in 2021. As it was confirmed that the hospital had received an "achieved" rating in the item of "having and complying with appropriate and safe isolation and restraint regulations" at the time, critics argue that a fatal accident could have been prevented if interim on-site inspections had been conducted.
Regarding this, Oh Tae-hoon, head of the Korea Institute for Healthcare Accreditation, explained during the October parliamentary audit that "on-site inspections were excluded because psychiatric medical institutions find it difficult to operate and hard to hire staff."
Concerns regarding the evaluation and accreditation of psychiatric hospitals have been consistently raised since the implementation of the Medical Service Act amendment. In a research report submitted to the Korea Institute for Healthcare Accreditation in 2021, the Korean Mental Health Foundation assessed: "It can be seen that the pass rate has fallen as evaluation standards and methods have been strengthened over consecutive cycles. It is presumed that the lack of incentives for passing and the absence of any disadvantages for failing have influenced the low pass rates."
Meanwhile, the National Human Rights Commission of Korea (NHRCK) began an on-site investigation last month following a series of fatal accidents caused by isolation and restraint in psychiatric hospitals. A visiting investigation team consisting of NHRCK investigators, experts in mental disabilities, and legal professionals visited 20 psychiatric hospitals nationwide. The NHRCK plans to formulate measures to minimize human rights violations and make recommendations to relevant government ministries.