ICJ preliminary report on mission to study mental health reforms in Japan

by | Jun 29, 1988 | News

The ICJ published its preliminary report on a mission to Japan in April 1988 to examine both the reaction to the important reforms of the Mental Health Law and the measures being taken to implement the reforms.

These were passed unanimously and come into force on 1 July 1988.

The members of the mission were two eminent psychiatrists, Dr. T.W. Harding of Geneva and Dr. Harold M. Visotsky of Chicago, an expert in mental health law, Judge Joseph Schneider of Chicago, and the Secretary-General of the ICJ, Niall MacDermot. The first three had carried out a similar mission in 1985. Their report made a considerable impact and is said to have helped persuade the government and parliament to amend the law.

Among the most important changes noted since the 1985 mission are:

  •  provisions for voluntary admission to psychiatric hospitals, which should now become the rule rather than the exception;
  • increased emphasis on rehabilitation which, to be realised, will require adequate resources not yet guaranteed by the Mental Health Act; and
  • the new procedure for review by Psychiatric Review Boards.

These Boards have been criticised as not complying with Japan’s obligation under international law to provide appeal procedures to a court for involuntary patients wishing to be released. However, these criticisms could be overcome by administrative decisions of the kind suggested in the report, which would ensure that the Review Boards functioned as tribunals with proper procedures for due process. The mission was impressed by an innovative provision enabling the Review Boards to make recommendations for the better treatment of patients.

Other recommendations of the mission are for:

  • adequate training and certification of each psychiatric profession, resulting in adequately qualified psychiatrists, social workers, clinical psychologists, psychiatric nurses and occupational therapists;
  • a review of hospital standards to ensure their capacity to deliver acute, intermediate and custodial care;
  • a more equitable and efficient system of reimbursement of professionals;
  •  the development of psychiatric departments in general hospitals so as to integrate psychiatry within the mainstream of medicine;
  •  a close linkage between psychiatric hospitals and a spectrum of community services consisting of outpatients clinics, sheltered workshops, vocational training and social retraining programmes, so as to make possible much earlier release from hospital; and
  • a qualified inspectorate at national level to ensure a high standard of medical treatment, and that the human rights of patients are being fully respected.

Improvements since 1985 are to be found in the number of patients treated in hospitals and discharged within less than a year;

  • moderate increases in out-patient programmes associated with the hospitals; and
  • increases in open wards and opportunities for patients to leave the hospital alone or escorted in small groups.

However, while there is more talk about expanding treatment programming, the lack of professional staff, and particularly a low-yield reimbursement plan has stifled all but minimal progress. In many hospitals there are elderly patients with only minor psychiatric problems who should be cared for more appropriately in old people’s homes.

The report also makes recommendations for evaluation and operational research projects to overcome the sense of stagnation, and for coalitions of individuals and organisations at national and prefectural levels to monitor the implementation of the mental health code, and of respect for the human rights of mental patients.

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