Emergency visits post-Mental Health Promotion and Welfare Act 2017: Suicide/self-harm attempts in Korea

Abstract Background South Korea has one of the highest suicide rates among OECD countries, with rising cases among young adults. The 2017 revision of the Mental Health Promotion and Welfare Act requires an additional diagnosis by an external psychiatrist from a national or public institution for involuntary hospitalizations exceeding two weeks, to protect patient rights and ensure safe treatment. This study investigates whether the revised Act impacted suicide and self-harm attempts presenting to emergency departments (EDs). Methods We analyzed 2014–2020 data from the Emergency Department-based Injury In-depth Surveillance (EDIIS) system, which includes 23 tertiary hospital EDs in Korea. A Regression Discontinuity in Time (RDiT) design assessed changes in monthly case counts before and after the Act’s implementation in May 2017. Analyses were stratified by gender and age. Results Following the Act’s implementation, suicide attempts significantly increased, particularly among women aged 20–39. RDiT analysis estimated an average increase of 94 monthly suicide attempts. Depression became the leading motive for suicide attempts, and voluntary discharges due to refusal of psychiatric treatment rose. Conclusions This study identified a significant increase in suicide attempts following the 2017 revision of the Mental Health Promotion and Welfare Act, with the most pronounced effect observed among young adult women. Although the legislation was designed to safeguard patient rights, it may have inadvertently impeded timely access to psychiatric care. These findings highlight the importance of revisiting current policies to balance the protection of individual rights with the need for timely and effective mental health interventions.