Mark Mordechai, Keinan-Boker Lital
Israel Center for Disease Control, Ministry of Health.
Harefuah. 2007 Aug;146(8):618-22, 645.
The Israeli Treatment of Mental Patient Law of 1991 reflects an innovative approach which promotes the use of compelled treatment order in the community as the least restrictive environment alternative for involuntary psychiatric hospitalization. This law grants the Regional Psychiatric Committees with authorities regarding the involuntary placement of such patients by court. The proportion of court order induced involuntary psychiatric hospitalizations among the total psychiatric hospitalizations is increasing with time. The 2004 Correction to the Act, clause 29a, states that a psychiatric patient may be represented in the Regional Psychiatric Committee by a legal advocate, and settles the options to materialize this right. The 2004 Correction is not yet applied in all regions in Israel. The Committees do not usually promote compelled treatment in outpatient clinics as a follow-up or an alternative for involuntary psychiatric hospitalizations. Involuntary hospitalizations by court order bear no time limits despite a former decision of the Israeli High Court of Justice. The lack of an obligatory legal representation for the psychiatric patient further ensures that the option of compelled treatment in outpatient clinics is not satisfactorily considered. In our opinion, the current reality of involuntary hospitalization orders that bear no time limits; the underuse of the compelled out patient clinic treatment option; and the lack of obligatory legal representation for the patients, results in an inappropriate application of the treatment policy of least restrictive environment. The patient is often regarded as present-but-missing. The awareness to patients' human rights in the Israeli psychiatric system must be emphasized, and suitable resources should be allocated to promote the option of treatment and rehabilitation in the community as the least restrictive option. However, if patients' rights are not appropriately kept, public safety may well be compromised, as well as patients' rights.
1991年以色列《精神病人治疗法》体现了一种创新方法，该方法提倡在社区使用强制治疗令，作为非自愿精神病住院治疗的限制最小的环境替代方案。该法律赋予地区精神病委员会有关经法院对这类患者进行非自愿安置的权力。随着时间的推移，法院命令导致的非自愿精神病住院治疗在总精神病住院治疗中所占的比例不断增加。2004年对该法案的修订第29a条规定，精神病患者可由法律辩护人在地区精神病委员会中代表，并确定了实现这一权利的选项。2004年的修订尚未在以色列所有地区实施。委员会通常不推动在门诊诊所进行强制治疗，作为非自愿精神病住院治疗的后续措施或替代方案。尽管以色列高等法院曾做出过一项决定，但法院命令的非自愿住院治疗没有时间限制。精神病患者缺乏强制性的法律代表进一步确保了门诊诊所强制治疗的选项未得到令人满意的考虑。我们认为，目前非自愿住院命令无时间限制的现实情况、强制门诊治疗选项的使用不足以及患者缺乏强制性的法律代表，导致了限制最小环境治疗政策的不当应用。患者常常被视为“在场却缺席”。必须强调以色列精神病系统中对患者人权的认识，并且应分配适当资源，以推动将社区治疗和康复选项作为限制最小的选项。然而，如果患者的权利得不到妥善维护，公共安全以及患者权利很可能会受到损害。
