The following is an article ‘Japan as No.1’ that was written by President Manabu Yamazaki M.D., in the Journal of The Japanese Association of Mental Hospitals, January 2012 issue, which we are accusing.

Manabu Yamazaki, MD.,

President, The Japanese Association of Psychiatric Hospitals

<Foreword> ‘Japan as No. 1’

A Happy New Year!

I would like to appreciate your entire cooperation of the last year for us.

We, all of the executives, are doing to do our best to aim for the reform and development of psychiatric practices in Japan this year.

I hope your more support and commitment to our Association than the former year.

Well I visited WHO’s office on the 28th of March 2011, and addressed to persons concerned a lecture about the history, today’s condition, and future of psychiatric practices in Japan.

Afterwards I attended the Forum to abolish the gap of state of metal health among people, to be held on the 10th of October, 2011, at WHO.

I gave a speech there on the important role of our Association in Japan.

I also addressed a lecture on the subject ‘Mental Health in Asia; the present situation and our problems’, in the regional meeting of WPA, on the 3rd of October 2011, to be held in Kaohsiung, Taiwan.

I have noticed that the conditions of psychiatric practices in Japan is not correctly understood by people involved, by my seeing psychiatric care systems and talking with persons concerned mainly in Europe and the States for these years.

Surprisingly people involved in psychiatric care in EU and the States never know the present state of psychiatric care in Japan not at all, except the too huge number of psychiatric beds amounted to 350,000, and have even the suspicion that the cruel treatment just like done in prisons must be usually common in Japan.

I think such views about us must be the entire prejudice that mental hospitals and their treatment for inpatients in Japan is same as those of Europe and the States of passed days, having had so many inhabitants with psychiatric illness unnecessarily maybe in 1950’s.

However I believe absolutely that such prejudice must have been founded by Japanese thinking too theoretically that so long staying in mental hospitals is wrong without doubt, stupid scholars strongly influenced by the overseas way, or people earning by blaming mental hospitals in Japan.

Of course we have to reflect that we have spoiled to sending information on psychiatric care in Japan to overseas people concerned so far.

By the way, in my idea, deinstitutionalism performed in Europe and the States are having two aspects; one is to solve monetary crisis of the Government, another is to have been performed as one of politic movements for special purposes.

You can understand why, if you see Italian situations of now.

Psychiatric unit having around 15 beds belonging to general hospitals in Italy can’t accept acute psychiatric patients, so that families of those patients are taking burdens caring such patients at their houses against their will. Some patients in the state of acute psychosis are too heavily sedated by long-acting neuroleptics, so not to violate their ADL at their homes.

Most of conditions of psychiatric care in northern Italy whose finance is enough are good, but in contrast psychiatric services in southern Italy are extremely desperate because of financial lack of local Government.

Anyway such countries reduced psychiatric beds as the States, U.K., Canada and Italy are facing the needs to increase psychiatric beds again as before, and are increasing them now!

By such reason, the words of ‘resettlement into community, shortening of hospitalized days and prevention from being hospitalized’ are absolutely stupid! When we will perform actions like those foolish actions as same as done in overseas countries as EU and the States, we will ruin ourselves surly.

If we will reform psychiatric care in Japan in the same way as done in EU and the States, families and patients in Japan also have to take heavy burdens instead of hospitals.

I remember a miserable patient I have seen in a mental hospital in London yet, who was pissing, but at same time pushing his head on the wall of a bathroom due to loss of strength of his body, slobbering by side effect of taking too massive neuroleptics.

This is why that we will mimic the reform of mental hospitals performed in Europe and the State is so stupid!

I think we shouldn’t imitate such obviously failed reform in EU and the States as I mentioned like above.

We have to perform the reform of mental hospitals in Japan more slowly, apart from reforms in overseas countries.

I believe that the all aspects like access, cost, and outcome of our medical services are most distinguished in the world.

I think mental hospitals in Japan is No. 1 in the world!.

So we, all of Japanese people involved in psychiatry, have to be proud of ‘Japan as No. 1’, and introduce the Japanese way to all over the world.

Finally I would like to say ‘A Happy New Year!’ again.

With my wishes for your cooperation and kind support for us.

Thank you.

To the Japanese Association of Psychustric Hospitals

31th of January, 2012

Japan National Group of Mentally Disabled People

Re, We protest and ask for retraction of the article ‘Japan as No.1’ that was written by President Manabu Yamazaki M.D., in the Journal of The Japanese Association of Mental Hospitals, January, 2012.

And furthermore, we demand you to write a written apology, and answer to our following written inquiries.

The small article ‘Japan as No.1’ written as a New Year’s greeting, by President of your Association( in the Foreword of the Journal of The Japanese Association of Mental Hospitals, January, 2012.) is never approved and overlooked not only inside but outside Japan, from the point of view that it is extremely full of misunderstanding important facts and truth.

We can’t understand his negative evaluation on the reforms of psychiatric services in EU and the States., as well as the false justification of poor conditions of most mental hospitals in Japan.

We can’t believe why Japanese psychiatric systems having the greatest number of psychiatric beds amounted to 350,000 in the world and doing continuously the worst institutionalism just like jails, are No.1!

We want to know why he insists that reducing psychiatric beds should be not good, and both of efforts for ‘return back into community’ and shortening averaged hospitalized days should be the matter.

We can’t know why he blames for people trying to improve mental care system and working advocacy of human right of people with mental illness, in those abusive words.

We can’t overlook his opinion as the President’s message, because it must be entirely main policies of the Japanese Association of Mental Hospitals.

We believe your Association has showed officially your views in the form of President’s message, then we have to point that your Association has lost the public mission in the psychiatric care in Japan right now!

Repeatedly we request an apology and retraction for President’s article in mass, and protest firmly against President’s article.

And we ask for your official answers to following our questions, by the end of February.

I, Concerning on ‘internationally prevalent prejudice against huge beds and continuation of cruel treatment like jails or former European asylums, in Japan’; that your President wrote in your Association’s Journal.

1. Why do you prohibit people involved in advocacy of human rights of inpatients from entering in the mental hospitals?

Do you think how many hospitals are permitting people outside entering, inspecting and helping inpatients? ; we think they are very partly.

We want to why you do prohibit people from entering for inspection, though you are saying ‘Japan as No.1’

2. Physical restricts and seclusion for inpatients are most highly seen in Japan all over the world, and unfortunately they are increasing even now!

How do you justify many kinds of violation of human rights of inpatients, forced treatment and forced work remaining in mental hospitals?

Though the side effects of any improved types of Electric Convulsion Therapy(ECT) are fully known, ECTs are increasingly performed in Japan.

We don’t think ECTs are appropriate treatment.

On the other hand you recognize that you are No.1 all over the world, how do you think about ECTs including those questions?

Why don’t you allow ‘some notorious mental hospitals’ for so poor condition, as members of your Association?

We believe what we mentioned above are never ‘unreasonable prejudice’, but misunderstanding by your Association. How do you think about this?

3. If you have enough confidence to give humane treatment for inpatients,

you should permit ex-patients groups and people involved in advocacy, entering in hospitals as well as opening their assessment in public, though in due process privacy of individuals should be kept then.

II. On concerning what he wrote that some people in Japan has been promoting ‘unreasonable prejudice against mental hospitals in Japan.

Though he says those people are, men thinking theoretically, stupid scholars badly influenced by the overseas way, or people earning by blaming mental hospitals in Japan, do you think so really?.

1. What is this, really indeed, the saying by President of The Japanese Association of Mental hospitals really? We have no words to say more to him.

We think Dr. Manabu.Yamazaki should resign his official post to another person, after he finished an enough apology to people concerned not only inside but outside Japan.

It may be thought he is not suitable to the public role of President of your Association. What do you say?

2. If the small article written this January by President Yamazaki is the official view of your Association, do the Japanese Association allow slandering people to say objections?

If this is true, you, the Association have to dissolve your organization very soonest, then you would be wise to reorganize yourself as a recognized organization supported by highly judgment to be able to hearing criticism from others. You could change in such way. How do you think about this?

III. Concerning on the view that deinstitutionalism developed in Europe and the States has two aspects; one is financial difficulty to maintain mental hospitals, and another is part of political movements seen in Italy.

1. Everybody knows all over the world that both of deinstitutionalism in the States having started at Kennedy’s Presidential Message and the reform in Italy were the great movements for human rights. We believe such s view about deinstitutionalism are universally understood among people concerned in the world.

Why do only Japanese mental hospitals deny it? We think your understanding about the deinstitutionalism is not recognized as reasonable matter. Why can you insist that only your way should be good against all of overseas trends in psychiatric care? What do you say?

IV. Concerning on What he wrote that Government of the States, UK, Canada and Italy, and so on are increasing psychiatric beds again nevertheless former reducing.

1. We think people intending to increase beds are only part of psychiatrists in the world, especially like conservative people in Italy.

However such overseas trend can’t justify the old fashioned and worst institutionalism ; the number of psychiatric beds is ‘No.1’ in the world as its number as well as ratio of beds between population.

So overseas trends doesn’t justify to maintain the huge psychiatric beds in Japan. What do you say?

V. Concerning on his saying that the words of ‘back into community, shortening of hospitalized days and prevention from being hospitalized’ will lead to ruin ourselves , and strength burdens of families, by performing actions like those foolish actions as same as EU and the States.

1. We would like to ask him why the words of ‘back into community, shortening of hospitalized days and prevention from being hospitalized claimed in EU and the States’ are thought to be so stupid.

And also we want to know why the psychiatric care reformed in EU and the States will strength burden for both of families and patients by reason of unwillingly increased family-care.

We think this idea is just your excuse for your maintaining huge beds in Japan?

We demand the clearest explanation of you officially concerning that people doing their utmost efforts to promote ‘back into community, shortening of hospitalized days and prevention of being hospitalized’ should be all stupid.

You have to explain directly for expatients’ group and people concerned doing those efforts why they are foolish.

We request you should answer to people like those what points of efforts to improve psychiatric care are stupid. We think you should have responsibility to explain about President’s message of this January.

VI. Concerning on his saying that reform in Japan should be done more slowly and carefully than in the States and Europe, not to repeat mistakes of reform in EU and USA.

We demand your responsible answer to us later again, after we have confirmed whether reform in EU and USA was really the failure or not, by corresponding with overseas people concerned.

1. We would like to know how long time do you need actually to finish the reform in Japan? And, what part of mental hospitals in Japan will you improve so carefully?

2. For example, why won’t you many of highly long stayed inpatients who have been hospitalized in mental hospitals unwillingly for over thirty years promote to return back into community? Are you just watching they well die in hospitals in future?

As the principle of UN(1992) shows, any persons with disabilities can have right to live in community! We think institutionalism is going against such human right. How do you think about human right of such highly long stayed inpatients?

VII. Concerning on his saying that the level of psychiatric care in Japan is No.1 in the world, at cost, access and outcome which shows quality of barometer of medical provision.

1. What is the reliable evidences of his saying ‘I think mental hospitals in Japan is No. 1 in the world’? The word of ‘think’ is not appropriate then. He should say always his idea upon actual facts.

Don’t you know that many mental hospitals in Japan are situated outside cities? Is this showing good access for patients?

How do you think that legal number of psychiatrists in mental hospitals is very lowered, entirely apart from legal number of doctors in the other ‘common’ hospitals?

What is the actual meaning of his word ‘outcome’? What is the evidence that ‘outcome’ in mental hospitals in Japan is the best in the world?

We demand the clearest answers for these questions of ours.

2. We think any kinds of barometers measuring quality of medicine should be examined on enough comparison with overseas data. Then you have to say that Japan is No.1, as results of thorough investigation of all kinds of scientific data, but not by choosing selfish parts of data.

It’s obviously irresponsible that he never discusses the cost-performance which is the key concept of medical economy. Such incomplete understanding by your Association might be mistaken not only inside but also outside Japan.

So we think you should take back the President’s message of this January!

For the reasons written above, we protest and ask for retraction of the article ‘Japan as No.1’ that was written by President Manabu Yamazaki M.D., in the Journal of The Japanese Association of Mental Hospitals, January, 2012.

And furthermore, we demand for you to open the written apology.

（All translated by Taro NAMASE, Ryoji ARIZUKA）