Examining Views on Family in the Mental Health Act of Taiwan R. O. C

Background and Purpose: Taiwanese individuals with mental illness primarily rely on their family members for care and support when living in the community. However, family members oftentimes care for their loved ones without informational, instrumental, and emotional support from the mental health system. Research has identified the prevalence of caregiving burdens among these family members. Notably, these caregivers were also found to have poor health, and caregiving burden is associated with their distress and depressive symptoms.

The mental health system in Taiwan is guided by the Mental Health Act. To remedy the issues of inadequate community psychiatric resources, the latest Mental Health Act amendment in 2022 focused on enhancing psychiatric rehabilitation and support. This study purposes to examine how family members are delineated in this amended version of the Mental Health Act in order to shed light on the conceptualization of family in the law to guide future development of a support system for family members caring for a loved one with mental illness.

Methods: We retrieved archival data from the Legislative Yuan Gazette, including verbatim transcripts of the legislative sessions related to the latest amendment of the Mental Health Act in 2022. We conducted the traditional content analysis proposed by Hsieh and Shannon in 2005 to develop the coding scheme directly from the data without preexisting framework.

Results: Several articles of the amended Mental Health Act are associated with patients’ families, which were organized into three categories: family support, family protection, and family obligations.

The articles in the family support category include mandating psychiatric institutions to provide severely ill patients’ family members with the patient’s illness and treatment related information, and to involve family members in patients’ discharge planning. Governments are mandated to provide patients’ families with psychoeducation, emotional support, respite services, and hotline services. The Act also makes consultation services at community mental health centers available to family members.

The Act protects family members by guaranteeing family members seats in advisory councils at the central and local governments. The Act also protects family members against discriminatory reports in media outlets.

However, the Act also specifies areas of care obligations that family members shall shoulder. Family members are mandated to be candidates for the “designated protector” of a severely ill patient to safeguard the patient’s rights and interests. Moreover, family members are among the first to be notified shall the patient under institutional care become missing. Finally, family members shall take immediate emergency measures to intervene during psychiatric crisis and are responsible for paying for related expenses.

Conclusions and Implications: While the amended Mental Health Act in Taiwan requires governments to provide family members with support and protection, it continues to mandate family members to take on caregiving responsibilities. The findings echoed the societal expectations of family’s duty to care for ill loved ones in a collectivist culture, and reflected manifestation of the familism ideology as policy direction. Monitoring and advocacy are necessary to ensure policy implementation. Ongoing dialogues are crucial to balance family members’ obligations and wellbeing.