The effect of tightened compulsory admission laws on length of stay in emergency department for suicide attempters

Suicide remains a major public health concern in South Korea. The emergency department (ED) is key in initial care for suicide attempters. In May 2017, South Korea implemented the Mental Health Welfare Act (MHWA), which strengthened procedural requirements for compulsory psychiatric admission. These changes may have affected admission processes and ED length of stay (LOS). This study evaluated the association between implementation of the MHWA and ED LOS for suicide attempters. We conducted a retrospective observational study using the National Emergency Department Information System (NEDIS) database from 2016 to 2019. Patients aged ≥ 20 years who presented to level I or II emergency medical centers with intentional self-harm (ICD-10 codes X60–X84) and were admitted or transferred were included. To account for both the Mental Health Welfare Act (MHWA; May 30, 2017) and a subsequent Emergency Medical Services Act (EMSA) amendment (December 3, 2017), the study period was divided into three phases. Median ED LOS was compared using the Kruskal–Wallis test with Dunn’s post hoc analysis, and Cox proportional hazards regression was performed adjusting for age and sex. A total of 45,124 suicide attempters were analyzed. The median ED LOS for patients admitted to psychiatric departments was 7.4 h before the MHWA and 7.8 h after its implementation (P = 0.79). A statistically significant increase in ED LOS was observed in the period after both the MHWA and EMSA amendment (median 9.15 h; P < 0.05). In Cox regression analysis, no significant change was observed immediately after the MHWA (HR = 1.03, P = 0.60), whereas ED LOS was longer in the later period (HR = 0.91, P < 0.05). Implementation of the MHWA was not associated with a statistically significant immediate change in ED LOS for suicide attempters. The increase in ED LOS observed during the later study period likely reflects the combined influence of concurrent policy changes and broader system-level factors rather than the MHWA alone.