The patient refuses to go to the ER.

1) If clear danger (means / plan), call 112 (police) / 119 (EMS) — involuntary transport possible with family consent. 2) After physician evaluation, use the guardian / administrative-admission path. 3) If the patient is violent, your safety first — don't try to force them. In crisis, call 1577-0199 for expert guidance.

Will the patient resent us for life if we involuntarily admit them?

Short-term anger is possible. But many patients later express gratitude that "my family stopped me back then". Post-recovery, an honest family conversation ("we weren't ignoring your rights — safety came first") helps repair the relationship.

Post-discharge they aren't taking medication.

Common problem. 1) Discuss side effects / alternative meds with the physician, 2) consider LAI (long-acting injectable) — once monthly, 3) accompany outpatient visits, 4) sort meds by day, 5) at relapse signs, go to psychiatry / 1577-0199 immediately.

Psychiatric ER guide (for family) — self-harm, suicide attempt, psychosis, 4 paths of involuntary admission, Mental Health Welfare Act §43-44 rights and procedure

When family face a psychiatric crisis (suicide attempt, self-harm, psychosis, severe depression, mania, drug overdose), Korea provides almost no education on what to do. Key guide: ① immediate-risk assessment (means, plan, attempt in progress), ② call 119 or accompany directly to ER, ③ list of hospitals with psychiatric ER (university hospitals, National Center for Mental Health, etc.), ④ on arrival, evaluation (self/other harm risk, treatment necessity), ⑤ 4 admission paths — voluntary, consent, protective-guardian, administrative (Mental Health Welfare Act §43-44, 2017 amendment), ⑥ patient rights (right to counsel, objections, Mental Health Review Committee review at 30 days). The most common family question "how do I get them involuntarily admitted?" — answer: protective guardian (2+) application + 1 specialist diagnosis + Mental Health Review Committee review at 2 weeks. When the patient refuses, the administrative-admission path (head of local government or police) applies. Family checklists for before-ER, on-arrival, and post-admission.

1. 7 scenarios of "psychiatric emergency"

Suicide attempt in progress or just after
Severe self-harm (bleeding, overdose)
Psychosis (self/other harm from hallucinations / delusions)
Severe depression with suicidal ideation
Mania, severe agitation
Severe eating disorder (BMI under 14, electrolyte crisis)
Drug / alcohol emergency (withdrawal, intoxication)

2. Psychiatric ER vs general ER

All Korean general-hospital ERs receive psychiatric patients, but only some operate a "psychiatric ER" or psychiatric emergency-admission unit:

National Center for Mental Health (Seoul Gwangjin-gu) — 24h psychiatric emergency
University-hospital psychiatry ERs (SNU, Samsung, Severance, Asan, Korea U, Hanyang, Chung-Ang, Ewha, etc.)
Regional psychiatric hospitals (50+ nationwide)

General ERs handle physical emergencies first and consult psychiatry. Psychiatric admission decisions are made by the consult psychiatrist.

3. Family checklist before going to ER

Immediate

Stay in the same space as the patient (don't leave them alone)
Block / confiscate suicide / self-harm means (drugs, ropes, knives, rooftop access)
119 or self-drive to the ER
In urgent cases, 112 (police accompaniment — if patient is violent or refusing)

What to bring

Patient ID and health insurance card
Current medications (name, dose, schedule) — photo of bottles / prescription
Prior psychiatric records (if any)
Family guardian ID (needed for admission decision)
Cash / card (hospital bills)
Clothes, toiletries (in case of admission)
Phone, charger

4. ER procedure on arrival

Triage: physical emergency first (self-harm sutures, gastric lavage, etc.)
Psychiatry consult request: family clearly states "need a psychiatric evaluation"
Psychiatrist evaluation: self/other harm risk, treatment necessity, admission / outpatient decision
Family interview on admission: guide through the 4 admission paths
Bed assignment: general psychiatry ward or seclusion (isolation)

5. 4 admission paths (Mental Health Welfare Act, 2017 amendment)

Path	Conditions	Review
1. Voluntary (§41)	Patient consent	None (patient decides)
2. Consent (§42)	Patient + 1 guardian consent	None; if patient requests discharge, cannot refuse (within 72h)
3. Guardian (§43)	2 guardians + 1 specialist diagnosis (self/other harm risk, need treatment)	Mental Health Review Committee assesses admission appropriateness at 2 weeks
4. Administrative (§44)	Application by head of local government or police + specialist diagnosis	Review at 2 weeks

6. Who is a "guardian"?

Mental Health Welfare Act §39:

Spouse
Direct blood relatives (parents, children, grandparents, grandchildren)
Siblings
If none of the above, relatives with a support obligation

The 2017 amendment added the "2 guardians" requirement, making single-guardian involuntary admission difficult. With only 1 family member, use the administrative-admission (local government) path.

7. Patient rights

Right to counsel (notification within 24h of admission)
Right to object (Mental Health Review Committee within 14 days)
First review within 2 weeks of admission; every 3 months thereafter
Right to request discharge
Right to family visitation / calls
Right to report human-rights violations (Human Rights Commission, 1577-1391)

8. What family should do after admission

Week 1

Meet with doctors and nurses, provide info on the patient's baseline state
Hear admission orientation and treatment plan
Assess your own mental health too (family depression / PTSD common)

Weeks 2–4

Regular visits (so the patient doesn't feel "abandoned")
Attend the Mental Health Review Committee (if needed)
Plan outpatient care after discharge with the physician

Post-discharge

Safety check the home (permanently block suicide means)
Accompany outpatient appointments / medication management
Family mental-health groups / self-help
Save 1577-0199 etc. as speed dials
Learn relapse signs

9. Cost

Health-insurance covered. Psychiatric admission cost is similar to general admission. Out-of-pocket 20% (outpatient), 20% (inpatient). With cost-sharing special exemption (severe mental illness, F20, F31, etc.), out-of-pocket drops to 10%. Average 1-week admission 300,000–500,000 KRW (family burden).

10. Common family misconceptions

"Involuntary admission makes the illness worse": false. Appropriate treatment enables recovery. But respect patient rights and follow proper procedures.
"Psychiatric records last forever and block jobs / marriage": only the patient can access psychiatric records (Personal Information Protection Act). A few jobs (civil service, military, certain licenses) have disqualifying provisions — almost never applied in practice.
"Admission means drug addiction": psychiatric medications have low dependence (SSRIs / antipsychotics have almost none; only benzos somewhat).