South Korea has one of the highest suicide rates among OECD countries, and suicide and self-harm among young adults continue to increase. In 2017, the Mental Health Promotion and Welfare Act was revised to strengthen the protection of patient rights by introducing stricter procedural requirements for involuntary psychiatric hospitalization, including mandatory external psychiatric evaluations. This study evaluated whether these policy revisions were associated with changes in patterns of suicide and self-harm. This study analyzed nationwide multicenter surveillance data from the Emergency Department-based Injury In-depth Surveillance (EDIIS) system, which includes the EDs of 23 tertiary hospitals across South Korea, from 2014 to 2020. A quasi-experimental Regression Discontinuity in Time (RDiT) design was applied to estimate changes in monthly suicide- and self-harm-related ED visits following implementation of the revised law in June 2017. Following the policy revision, suicide- and self-harm-related ED visits increased significantly, with an estimated increase of approximately 95 additional cases per month. Concurrently, discharges against medical advice due to refusal of psychiatric treatment increased, whereas psychiatric inpatient admissions decreased. These findings remained consistent across multiple model specifications and bandwidth selections. The 2017 revision of the Mental Health Promotion and Welfare Act was temporally associated with a significant increase in suicide- and self-harm-related ED visits. The findings suggest that stricter procedural requirements for involuntary psychiatric hospitalization may have unintentionally created barriers to timely psychiatric intervention for high-risk individuals. These results highlight the importance of balancing the protection of patient autonomy with access to effective and timely mental health care.
Hong et al. (2026) studied this question.