“Three years ago, when I visited Australia to talk with experts about mental health care, I saw the welcoming and smiling faces turn to expressions of horror as I explained the rate of compulsory treatment in Korea,” said Shin Kwon-chul, a professor at the University of Seoul Graduate College of Law.

Professor Shin thus began his speech at the international forum for integrating the mentally disabled into society held at the National Center for Mental Health Monday, highlighting the higher rate of involuntary psychiatric admissions in Korea compared to other OECD countries.

According to 2013 data from the National Center for Mental Health, 67 percent of 69,511 patients admitted to mental health institutions had been found to be committed involuntarily. The number was notably higher than that of Germany with 17 percent, the U.K. with 13.5 percent, France with 12.5 percent, and Italy with 12 percent.

Another data from the OECD showed that Korea was the exception among OECD members to see the number of psychiatric beds per 100,000 people increase from 1991 to 2011, whereas the other member countries saw a general trend of fewer psychiatric beds during the same period.

In Korea, compulsory treatment has been used as the first easy solution for treating the mentally ill. The Korean Mental Health Act, the principal legislation on treating the mentally ill, was created in 1995 and had built a long-standing tradition of placing patients in mental institutions against their will.

Under the law, doctors had hospitalized a patient for up to six months with the approval of the patient’s legal guardians without a second opinion.

Korea also had the longest average stay in hospitals for mentally ill patients among OECD countries, with the patients spending an average of 116 days in 2011 – around four times the OECD average, according to the International Journal of Mental Health Systems.

At the turn of the 21st century, however, the system came under fire for infringing upon fundamental human rights with more than 10,000 complaints filed between 2010 and 2015 over human rights violations, according to the National Human Rights Commission.

Critics have pointed out that under this system, patients had little say in the decision-making process which was instead handed over to private individuals, such as family members or doctors.

Last year, these criticisms were heard by the upper courts with the Constitutional Court ruling existing laws as “unconstitutional.” Revisions were then made to the law for the first time in 20 years, ushering in new changes.

The new Mental Health Act, effective as of May 30, lets doctors order involuntary commitment for a patient for up to only 14 days with the legal guardian’s consent. Three months of hospitalization is allowed only after getting a confirming second opinion.

The hospital must also submit a report to a designated committee comprised of 30 members specializing in psychiatry, law, and human rights, within three days of hospitalization. The group then decides whether the patient needs involuntary treatment, with which the hospital must comply.

However, despite the reforms, the system still grants the family the authority for decision-making admission and discharge from mental health institutions unlike that of other countries.

“I’ve wondered why the Korean system differs in this respect,” Professor Shin said. “It seems to be primarily a cultural issue where people feel more comfortable with the family making decisions for their loved ones rather than have a faceless government institution do so.”

However, some experts criticize the law lets parents and relatives leave mentally ill, leaving room for abuse by forcing individuals into institutions against their will. Families have been found to do so in the past to avoid having to care for the patients individually, driving up the rate of involuntary admissions nationwide.

Australia, in contrast, showed a starkly different approach regarding treatment for the mentally ill.

“In New South Wales (NSW), compulsory treatment is used only as a last resort and only when voluntary treatment has not been successful,” said Judge Anina Johnson from the NSW Executive of the Council of Australasian Tribunals.

In Australia, and in NSW specifically, the system is geared towards trying to incorporate the mentally ill into society. The mentally ill are guided in a way so that they are more able to maintain and carry on independent lives, Johnson added.

The NSW Mental Health Act 2007 follows six most important principles that uphold the belief that the patient should have the right to determine their future and to make choices about their life and circumstances.

What’s more is that family and friends do not have decision-making authority when deciding whether they should be receiving compulsory treatment.

The decision is, instead, made by a Tribunal composed of a lawyer, psychiatrist, and a related professional. Members of the court often have experience with mental illness themselves or experience with a family member with a mental illness, Johnson added.

The tribunal sits down with the patient, the patient’s guardian, a lawyer, and medical staff to decide whether the involuntary stay should continue.

A video recording of a tribunal meeting, presented at the forum here, exemplified the NSW’s approach. The video showed the tribunal panel sitting down with the patient. One such tribunal session showed the patient expressing his thoughts.

“The voices aren’t bothering me as much as before,” the patient said as he sat in front of the NSW panel in the video. “I just want to find a job. I want to get back to work as soon as possible.”

Although Korea still has some ways to go before reaching international standards in mental health care, Johnson ended her lecture on a positive note, indicating that the Korea has made notable progress that is in some respects better than that of foreign countries.

“The Korean Act includes some significant human rights provisions that the NSW legislation does not,” said Johnson. “I was impressed to read of the requirement for community education, human rights training and the obligation on the government to offer [the mentally ill] with opportunities that will allow them to live full lives in the community, through work, education, and activity.”

“Both NSW and Korea have hard work ahead to fulfill the promise of their legislative schemes and to accord people living with mental illness their full human rights,” Johnson said.