Koreans’ perception of mental hospitals is not very good, often regarding these facilities as places that rough-handle patients, detaining and restraining -- or even beating -- them while providing little treatment true to its name.

A mental health crisis response center, which opens in Gyeonggi Province soon, aims to change that notion by shifting paradigm in psychiatric treatment.

Professor Kim Seong-su, director of New Gyeonggi Province Mental Hospital's mental health crisis response center

The nation’s first mental health crisis response center, to be set up within the New Gyeonggi Province Mental Hospital, will provide emergency psychiatric treatment to people suffering from mental illnesses. The hospital has 50 beds and 53 medical professionals, including five psychiatry physicians. It will begin to admit patients in early June, through its mental health crisis response center.

"The WHO's recent QualityRights guideline recommends countries to build mental health crisis response center instead of traditional psychiatric hospitals," said Doctor Kim Seong-su, the director of the new center, in a recent interview with Korea Biomedical Review.

The difference between a psychiatric hospital and a mental health crisis response center is that the latter approaches critical mental illness through community-centered treatment, Doctor Kim emphasized.

Traditional psychiatric hospitals are admitting people with mental illness based on vague standards, according to Kim. On the other hand, the new center accepts the patients to support their return to society after brief but intensive treatment by regarding them as psychosocially vulnerable people suffering from acute psychological symptoms, Kim explained.

Therefore, Kim said, a large part of the center is centered on improving access to quality mental health and social services and promoting the rights of people with mental health conditions, psychosocial, intellectual and cognitive disabilities.

"Conventional mental health facilities have regarded mental illnesses as problems, hindering their recovery in many instances," Kim said. "It is not uncommon that in today's treatment, patients are locked away in solitary confinement with no human interaction and are sometimes even chained to their beds."

Such a process makes the patients feel powerless and experience extensive restrictions on their basic human rights, he pointed out.

Gyeonggi Province Mental Hospital staffs hold a meeting at the hospital's Covid-19 screening center at the hospital in Yongin, Gyeonggi Province.

The center plans to abide by the WHO's guideline on “no coercive treatment, open dialogue with patients, and peer support from people with lived experience of mental illnesses” in tackling such conditions.

"One of the WHO's biggest suggestions is a non-coercive approach in treating patients," Kim said. "In general, when we receive patients at a psychiatric hospital, we either put the patient in solitary confinement or restrain them to prevent self-harm or to ensure the safety of others."

However, recent researches show that such an approach can hinder the recovery of patients and may even scar them for life, he added.

"Therefore, a non-coercive, human rights-based treatment without binding patients has recently been proposed," Kim said.

Asked about the risk of sudden harmful outbreaks from patients that may occur due to non-coercive treatment, Kim stressed that patients “do not suddenly show violent tendencies.”

"There is a provocative factor that happens before the patient starts acting violently, and the factor escalates before turning into a full-blown situation," Kim said. "Therefore, it is important for physicians to use their communication skills or identify and intervene before the patient is provoked."

If the medical staff act accordingly, most situations can be avoided, Kim added.

Kim stressed that a hospital, when building a mental health crisis response center, can also set up a "comfort room" that can calm down patients or an intensive room where the patients can be safe without restraints.

"The centers can also have a mobile response team on standby to control any sudden situations," Kim said.

Regarding open dialogue, Kim stressed that the key to treating acute psychological symptoms is to keep the patient intact to their social network.

"Traditional treatment normally made the patients feel secluded from society as they were normally confined by themselves," Kim said. "However, there have been promising researches that have shown that participation by the patient's community, such as family and friends, from the beginning of the treatment, has a great impact on the treatment outcome."

According to Kim, the treatment process has had great success in Finland.

"Finland has been conducting the open dialogue treatment since the 1980s," Kim said. "The method showed the 85 percent recovery rate in first-onset psychosis patients, while half of the patients were able to quit their drugs afterward."

For peer support, the center plans to hire people with lived experience of mental illnesses in helping the patients.

"While physicians treat the patients, no one is more suitable then helping the patients than other patients that have experienced similar mental illnesses," Kim said. "The center plans to hire former patients as staff to better help and relate with the patients."

Using the WHO guideline, the center will aim to improve the long-standing mental health system problems in Korea.

"By using the new guidelines, we plan to improve the three indicators -- maximum duration untreated psychosis (DUP) rate, re-hospitalization, and suicide rate after treatments – which have been pinpointed as the long-standing problem in the country mental illness care," Kim said. "In the case of psychosis, it is known that the shorter the period from the onset to the first treatment can make the prognosis of the patient better."

However, Korea has a maximum DUP of 14 months, which is nearly five times longer than the WHO's recommendation of three months, Kim added.

The director also stressed that the quality of the existing inpatient treatment needs to be improved as the rate of re-hospitalization for patients reached 40 percent one month after discharge, and the suicide rate within one month after release also reached 10 times that of the general population.

"The ultimate goal of the new center is to develop a system that enables efficient emergency hospitalization, innovative quality of inpatient treatment, and continuous case management after discharge," Kim said.

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