Before the medical community recovered from the shock that a mentally-ill patient stabbed psychiatrist Lim Se-won at Kangbuk Samsung Hospital to death several months ago, another horrible news hit the nation.

On Wednesday last week, schizophrenic Ahn In-deuk set fire to his apartment, randomly killed five neighbors fleeing the building with a knife, and injured 13 others. The victims included an elementary school child, a senior, and women.

As the tragedy occurred just as a revision bill to enhance involuntary psychiatric admissions hit a snag in the National Assembly, psychiatrists are urging lawmakers to adopt a “judicial admission system” to prevent the mentally disordered from committing a random homicide.

Why wasn’t Ahn admitted to hospital even after several incidents?

Was there any way to prevent the deranged arsonist from killing neighbors?

An older brother of Ahn reportedly sought the help of the police, a mental hospital, and an administrative institution to get his younger brother admitted two weeks before Ahn’s mass murder.

Why did the hospital refuse to admit him, then?

Under the Mental Health Welfare Act, an elder brother is not a legal guardian because he is not a linear family member. Unless a legal guardian earns a living for the mentally ill person and lives together, it is illegal to get the patient hospitalized forcefully. As Ahn lived by himself, the hospital might have refused to accept him without Ahn’s consent to comply with the law, observers said.

Also, why did the police officers -- who had arrived at the scenes when Ahn harassed neighbors so many times -– leave him unchecked?

The police do not have the authority to coerce a mentally ill person to be hospitalized. Under the Mental Health Welfare Act, an insane person at risk of harming his safety or that of a third person can be forcefully admitted to a mental health institution by a special self-governing city mayor, a special self-governing province governor, or the head of a city/county/district.

However, a police officer who arrives at the scene can only request a psychiatrist to conduct a medical exam and provide care to the mentally ill.

Then, why did the head of the self-governing city turn a blind eye to the appeal of Ahn’s brother?

Although the law allows an administration-intervened admission, it is rare that the head of the self-governing city takes responsibility and get the person hospitalized when he has a guardian, experts said.

Psychiatrists said the ridiculous law and the grim reality have combined to make it impossible to prevent the mass murder.

“Ahn’s brother seems to have done his best to get him admitted but finally gave it up. I’m convinced that if Ahn had been admitted, this kind of disaster would not have occurred,” said Paik Jong-woo, a professor of psychiatry at Kyung Hee University. “The nation’s underdeveloped mental health system cannot prevent such misfortune.”

He said introducing a system to let the state, such as the head of a city/county/district or a family court’s judge, decide psychiatric admission was not for the benefit of psychiatrists.

“Not a small number of male schizophrenic patients in their 30s and 40s are single and living by themselves. Their parents are aged, and their siblings usually do not take care of them,” Paik said. “If the current system remains unchanged, this kind of tragedy will only repeat.”

‘Court-intervened admission is the only way to prevent similar incident’

To keep psychos from endangering public safety, the Korean NeuroPsychiatric Association (KNPA) and Rep. Yun Il-gyu of the ruling Democratic Party of Korea have rolled up their sleeves.

Psychiatrists warned that unless the state intervenes in the management of the mentally disordered, a similar mass murder will occur any time. On Monday, KNPA and Yun claimed the most significant problem was that the mentally ill people who need to be admitted were left untreated in the local community.

They urged lawmakers to pass Rep. Yun’s revision bill on adopting a court-intervened admission system for the mentally ill, which Yun proposed in January.

The revision bill seeks to broaden the concept of a mentally ill person, scrap the system of putting all the treatment responsibilities on family, unify review procedures for involuntary hospitalization, and to allow a family court to decide a mentally ill person’s hospitalization.

The bill also aims to ban extension of hospital stay or coerced hospitalization without a review, and allow continued treatment after discharge under the “outpatient treatment order.”

KNPA President Kwon Jun-soo said, “Many bills have been proposed since the incident of the late professor Lim Se-won to prevent similar cases, but Yun’s bill is the most representative one.” The outpatient treatment order will work only when the bill passes and becomes a law, he emphasized.

Kwon said Yun’s bill was still pending at the legislation review subcommittee of the National Assembly’s Health and Welfare Committee.

“During the discussion at the subcommittee, the health and welfare ministry was opposed to the bill. However, unless this bill passes, similar incidents will keep happening,” he said.

Health ministry opposes to court-intervened psychiatric admission

The Ministry of Health and Welfare is cautious about introducing a court-intervened psychiatric admission system, saying making the system will not be the best option.

The ministry said it needed to review what kind of issues the current admission system had, by convening a review committee for admission appropriateness.

“We regard Ahn’s case irrelevant to the need for a court-intervened admission,” an official at the health and welfare ministry said. In this case, the biggest problem was that the police officers did not contact the mental health welfare center or the public health center after they had Ahn’s reports, he added.

“If they didn’t contact other institutions, they had the authority to get Ahn admitted to an emergency room. However, the problem was that the officers didn’t know Ahn’s mental conditions,” the ministry official noted.

As the local community could not check on Ahn, the government was searching for measures to address the issue, he added.