🏥 Shake-Shake Brother Is Discharged, Now What?
“Shake-Shake Brother” (a well-known homeless man with mental illness in Taipei) walked out of the hospital after a court hearing, sparking various positive and negative comments in society. Some hailed it as a victory for patient rights, while others online voiced concerns about past disturbances.
But after discharge is when the real challenge begins. According to statistics, the burden on individuals, families, and society caused by mental illness accounts for 22.8% of all diseases. Take schizophrenia patients as an example: their average life expectancy is ten years shorter than that of a healthy person, with higher incidences of cancer and cardiovascular diseases, and 6-10% of patients are homeless.
If whether or not to be discharged is the end point of our struggle for patient rights, then such human rights are far too cheap.
From previous child-killing cases to the Shake-Shake Brother incident, at least three dilemmas of Taiwan’s mental health system have been exposed.
1. ⚖️ Dilemma of the Legal System: Blurred Responsibilities
We all have experience seeking medical treatment, and a good “doctor-patient relationship” is key to effective treatment. However, our current “Mental Health Act”:
- Entrusts the power to restrict the personal freedom of mental patients to specialized psychiatrists and the review committees they participate in.
- This easily destroys the therapeutic relationship, making psychiatrists vulnerable to criticism or legal trouble during the process of involuntary commitment.
💡 Suggested Direction for Solution:
We should follow the example of advanced countries like the UK, USA, and Australia by establishing professional “Mental Health Courts” and “Drug Courts.” Let legal experts handle the judicial judgment of restricting personal freedom, while psychiatrists handle professional diagnosis and treatment.
The current “Mental Health Act” is a product of political compromise. The state should not build its social safety net on the fear of medical personnel possibly violating the law at any time; this is unjust.
2. 🏘️ Dilemma of Community Medicine: Lack of Resources
Involuntary treatment is a double-edged sword. Advanced countries replace it with a dense community mental health care system.
- Advanced Country Practices: For cases like Shake-Shake Brother, besides dedicated outreach care teams providing regular visits, the community is equipped with day-care centers, rehabilitation centers, vocational training centers, and sheltered workshops. If a condition becomes dangerous, the “Mental Health Court” intervenes to order mandatory community treatment or mandatory hospitalization.
- Encouraging Recovery: During the recovery process, governments even give incentive vouchers to encourage patients to reintegrate into society.
- Current Situation in Taiwan: This is completely incomparable to Taiwan, where the more one seeks treatment and the better one’s functioning becomes, the more likely subsidies are to be cancelled.
Patient rights should not just be about “whether to be discharged.” Their access to medical care, education, employment, and support are all part of human rights. By only fighting for discharge, does society wish to see patients suffering on the streets, eventually being placed in institutions due to functional decline, or tragedies occurring due to poor self-care?
3. 🧠 Dilemma of Mental Health Promotion: National Quality and De-stigmatization
We have never faced the fact that “understanding mental health and psychiatric care is an essential quality for citizens of a progressive nation.”
- Foreign Cases: Toronto, Canada, includes mental health promotion and mental illnesses in regular teaching materials. Their child and adolescent mental health promotion program even requires schools to promote “de-stigmatization” (Anti-stigma) in daily teaching activities.
- Current Situation in Taiwan: Ignorance of mental illness leads to patients becoming targets of witch-hunts whenever a high-profile case occurs. This dynamic cannot be changed simply by renaming “Schizophrenia” (formerly “Spirit Splitting Disease” in Chinese) to “Thought-Perception Dysregulation Disorder” (the new term in Taiwan), a process that already took an excessive amount of time.
💰 Reflections on Investment and Budget
The Lancet medical journal once published an article pointing out that Taiwan has blindly pursued GDP growth lacking a sense of well-being, while ignoring the negative impacts brought by social pressure.
- Advanced Country Budgets: 10% of the UK’s medical expenditure is for mental health; Japan specifies that 0.05% of GDP should be invested in mental health.
- Taiwan’s Budget: The annual budget for Taiwan’s Department of Mental and Oral Health is only 500 million TWD, and mental health accounts for only 3% of medical expenditures.
Taiwan should not be a country that only pursues “wealth”; we should build a nation that pursues “happiness.”
A Social Safety Net for Our Compatriots
A social safety net is about using love, patience, care, and sufficient resource investment to catch our compatriots when the vulnerable become even more vulnerable; it is not about using high walls and superior police force to isolate patients.
Shake-Shake Brother is discharged, but the holes in the social safety net remain. As stated at the beginning, the challenge is just starting. These challenges require rational understanding, sincere care, and resource investment to solve. Are we ready?