[Administrative-based outreach activities in Gunma Prefecture: preventative crisis intervention via a "compulsory transfer center"].
Part of the Gunma Mental Health Center (a mental health welfare center), the Gunma Psychiatric Emergency Information Center (IC) is a de facto compulsory transfer center that centrally handles the compulsory transfer to medical examinations and hospitals of people with psychiatric issues who are detained by the police within Gunma Prefecture and conducts outreach activities for people with various social difficulties. The dichotomy in compulsory transfer is the conflict between the medical benefit to the patient and the demand for safety by the family and local residents. A triage system focusing on both the degree of risk to others and the necessity of treatment was thus implemented by Gunma Prefecture in the late 1990s, with the IC established as a compulsory transfer center. IC outreach activities commenced due to requests from healthcare centers and local authorities. For those patients deemed by the IC as requiring treatment, voluntary psychiatric examination is promoted where possible. However, the potential for and methods of crisis intervention through involuntary treatment via compulsory transfer are also explained to patients, families and local residents. Support for relapse prevention can also be provided following involuntary hospitalization via compulsory transfer. In this way, the IC, which is in charge of compulsory transfer and conducts outreach activities in cooperation with healthcare centers and local authorities, considers the demand for safety by the local community while respecting the medical benefit to the patient. Furthermore, as the IC is an administrative body rather than a hospital, a treatment contract with the patient is not always necessary and involvement can continue even in the face of patient resistance. We present herein the case of a patient who, together with his family, strongly rejected medical and welfare involvement. The changing situation surrounding the patient and family was appropriately handled through continued outreach activity support. Consent for this case presentation was obtained from the patient and family following explanation that no personally identifiable information would be revealed.
Gunma Prefectural Psychiatric Medical Center.
Koichi
K
Ashina
D003134:Commitment of Persons with Psychiatric Disorders; D003159:Community-Institutional Relations; D003419:Crisis Intervention / Q000379:methods*; D006801:Humans; D007253:Information Centers; D007564:Japan; D008297:Male; D008875:Middle Aged; D014218:Triage