Articles

Recovery, self-help ... from our experience in Japan (presentation at the Alternative 2005 conference )(PDF file)

Civil rights remedy statement (to Ministry of Justice)(in another site)

Throwing Away the Key on the Mentally Ill (Article by Jens Wilkinson)(in another site)

== VIOLATIONS OF HUMAN RIGHTS AGAINST MENTAL DISABLED PEOPLE IN JAPAN ==

(This is a translation of a report following the United Nations Human Rights Code Committee in 1998. The Japanese government did the presentation but of course, they spoke very little about the abuse that we are facing.)

To Human Rights Committee:

Reported by Japan National Group of Mental Disabled People

=== Article 9: Right to Live ===

There are many cases that mental hospital patients get killed beaten by other patients or hospital employees.

==== Yamatogawa Hospital case ====

In 1993, a patient was transferred from Yamatogawa Hospital in Osaka to Hachio Hospital. There were a lot of external injuries. His bones in the rib were broken. Soon he died.

Doctors in Hachio Hospital reported this to the police. The patient's family sued against Yamatogawa Hospital and won the damage suit. The judge determined that the patient was beaten by other patients and Yamatogawa Hospital did not have enough employee to stop the violence, and Yamatogawa Hospital did not do enough medical treatment.

==== Yamamoto Hospital case ====

On March 5, 1997, nurses (male) of private (owned) Yamamoto Hospital in Kochi were accused of a bodily injury resulting in death. They beated and kicked a female patient, and beated her body into wall holding her feet. Consequently, she died.

Above cases were accidentally reported by insiders. Each one of our members have experienced and are experiencing violence of mental hospital employee.

External Communication Right is generally described in the Japanese Mental Health Law. However, it is very hard to communicate with patients in many hospitals, and particularly in those hospitals where hospital employees use violence daily, it is more hard.

The local government do not investigate the fact that many patients are daily beatened. Because they depend very much in private (owned) hospitals of hospitalization of patients. Even if the local government in fact knew the fact of the violence, they will not stop the violence.

There is a structural backgroud to these violences.

==== A mental disease prisoner in a medical jail was kicked by a guard and he died the day after ====

In January 17, 1995, Asahi Shimbun Newspaper reported that a prisoner was kicked by a guard and was killed the day after.

His corpse was not legally inspected for autopsy. The guard was accused on November 18, 1992 and was fined 200,000 yen (about $2000).

=== Article 7: Inhuman Treatments ===

==== A patient who was compulorily hospitalized was forced abortion, and the dead baby's brain was dissected for an experiment. ====

In May, 1984, a doctor T accused in Japanese Mental and Neurology Society against an experience on a patient who was compulsory hopitalized.

Doctor T was an assistant at Medical School, Gifu (National) University. According to him, the progress was as follows.

A patient (female) was compulsorily hopitalized in a private hospital in Gifu prefecture. Her doctor in charge was an assistant in Gifu University. The doctor transferred her to the Gifu University Hospital, and there was an abortion on February 2, 1984.

The (killed) baby's brain was dissected to investigate whether brain's neuro system is abnormal or not and the variation of medicine in the baby's brain.

There are two major issues

First, the abortion was done with no consent of the mother patient (compulsorily). According to medical records and nursury records, the mother begged again and again that she wants to have a baby.

Second, the abortion was done only with the patient's mother's consent.

Why did her doctor in charge transferred her to Gifu University Hospital?

The doctor in charge wanted the baby's brain in order to do the dissection. He wanted to investigate the brain for his promotion

He had no hesitation to ignore the mother's wish to be a mother.

There are no laws regarding patient's rights in Japan. There are no laws that guarantee "Informed Consent-ed" medicine. There are no laws that prohibits experiments against patients who are compulsorily hospitalized.

In fact, in university hospitals in Japan, many experiments are in place with no consent of the experiment-sample patient. It is a tradition for the university doctors to use patients for experiments for their promotion by writing papers.

==== Kurita Hospital case ====

On November 6, 1996, Mr.Kuraishi, the manager of Kurita hospital (a private mental hospital in Nagano) was arrested for fraud. According to the police process of fraud is as below. In Kurita hospital the authorities of hospital keep in-patients' bankbooks and Mr. Kuraishi had been drawing dead in-patients' money from bank without families' consent for 2 or 3 years. The amount of the money was about 4,000,000 yen.

After Mr. Kuraishi was arrested, maltreatment in Kurita hospital was disclosed.

Circumstances of hospital are very bad. Lights is on only in the morning and at the dinner for 15 to 30 minutes, and lights is off in bedrooms, so in winter in-patients live in the dark. There is no air-conditioner and only from December to February a heater is on only from 5 a.m. to 6 a. m, so in-patients cannot sleep without a pocket heater. In-patients can take a bath only once a week or ten days. 6 patients is pushed into the bedroom for 4 persons. These circumstances is under Mr. Kuraishi's direction.

Informants in Kurita hospital said that there was violence in the hospital. One female in-patient ran away from the hospital and she was caught back to the hospital, then she was restrained by a straight-jacket for one month by direction of Mr Kuraishi. One patient's family said that her daughter was beaten and her face was swollen and she ran away from Kurita hospital. Patient's family said that in-patient who did not obey the staff was beaten or was thrown into the locked seclusion room and staffs practices these punishments every day.

In Mental Health and Welfare Law, it is prohibited that doctors use a strait-jacket and a locked seclusion room for punishments, but in fact many member of our group has experienced that a strait-jacket and a locked seclusion room are much used for punishment.

Background of this violence is shortage of manpower. According to the conclusion of research by Nagano local government after Mr. Kuraishi arrested, there were 30 in-patients over the number which Nagano local government allowed and the number of doctors, nurse and pharmacists was under the standard which the law requires. Because of shortage of manpower staffs cannot practice proper medical treatments and nursing for a individual patient and staffs can only deal with mass of in-patients and can only control in-patients and staffs use violence to control patients.

In also Yamatogawa hospital there is shortage of manpower and staffs practice such violence as in Kurita hospital.

==== Inhuman treatments in mental hospitals ====

Treatments which invade human rights and neglect human dignity is performed everywhere. Such treatments are done not only in the private disreputable hospitals pursuing profits as Yamatogawa, Yamamoto, or Kurita, but also in some public ones.

For example, in Matsuzawa hospital (it is a typical public hospital managed by Tokyo local government and it recognized as one of top level hospital in Japan and designated as a hospital for training psychiatrists), although the highest standard of manpower is adopted, the open rate is less than 20% ( where the definition of a open ward is opening eight hours a day).

In the 11 of all 29 wards, there is no lock on toilet doors. Even in the ward of plastic surgery (for mental ill patients) there is no curtain around the bed, although patients often need to use a portable toilets. Ultimately there is a case of changing diapers in the hall.

In some fully locked wards in Matsuzawa, all patients are forbade to smoke. In other wards patients are allowed to smoke only 7 cigarettes a day on fixed time. And all patients in locked wards cannot have cash. In 2 fully locked ward a friend of a in-patients have not access to his/her friend.

But regrettably we must recognize that Matsuzawa hospital is one of the best hospital in Japan. In fact we patients have to endure such inhuman treatments because of no alternative hospitals. In Japan there is not the effective law and system to guarantee in-patients human rights. (Please refer to Article 9)

=== Article 8 Freedom from slavery and forced labor ===

==== Kurita hospital use patients who left from the hospital without wages or with very low wages ====

Beside the Kurita hospital there is a boarding house, and patients who left Kurita hospital are in it. They work at Kurita hospital as cleaning persons or cooks. But they did not receive proper wages. Some patients receive 10,000 yen per a month but many patients did not receive any money and only get cigarettes or sweets.

This boarding house dose not fit the legal standard of "rehabilitation facility" in Mental Health and Welfare Law. Patients lives in big one room and sleep in this big room.

Under this condition patients who left Kurita hospital and has no home to go, cannot chose alternatives. In community there is no effective supporting social resources for patients who left mental hospitals in Japan. So after Mr. Kuraishi arrested, patients must stay at this boarding house.

==== Forced labor in mental hospitals ====

In Japan many mental hospitals adopt "occupational therapy", but almost of all are not "therapy", because in-patients are forced to labor as so called "therapy". If a patient refuses to work, he/she will be punished or be threatened that if he/she refuse to work, he/she cannot move to a open ward or leave the hospital.

Other case is that patients are forced to work as assistant of nurses or other staffs. They are forced to change and wash diapers, to deal meals, to clean rooms, halls and lavatories, or to weed in the garden etc.. Patients cannot refuse to work by threat.

Many member of our group experienced those forced labor, and they say "Why cannot we rest in the hospital? Why have only psychiatric patients no rights to rest?"

=== Article 9: The right of liberty and security ===

==== Psychiatric Review Board dose not work ====

Japanese Government said that there is involuntary admission in Mental Health and Welfare Law but there is Psychiatric Review Board (PRB) to protect in-patients' human rights and to prevent inadequate involuntary admissions.

But PRB is not a independent tribunal. The window of PRB is the local government and PRB has not a independent secretariat. Local government has the power to admit involuntarily one to a mental hospital. Local government order to admit one involuntarily and same local government is a window of PRB.

In Mental Health and Welfare Law involuntary admission should be checked regularly, but in this regular check about 100 forms from mental hospitals are checked at one time. So this check is only formal check and there is no time to check a individual involuntary admission effectively. In fact in 1996 the number of regular check of involuntary admission is 84,392 and the number of the change of admission form is only 23 and the number of discharge from hospital is only 10.

In Mental Health and Welfare Law in-patients of mental hospital can complain to PRB about that involuntary admission is inadequate or treatments of mental hospital is inadequate. In Japan there are about 340,000 in-patients in mental hospitals, but the number of complaints to PRB is only 918 in 1996. After PRB system started, the number of complaints has never been over 1,000.

Why is the number of complaints only 1,000? There are three reasons.

Biggest reason is that long stay in-patients have no hope to live in the community. There is not a law which guarantee housing for the patients who left the hospitals. Furthermore they cannot live in the public apartments (please refer Article 26). There are no effective supporting system in the community, so long stay in-patients cannot leave hospital.

There are about 100,000 voluntary admission in-patients who have been in mental hospitals for over 5 years. They can leave the mental hospitals at any time under Mental Health and Welfare Law in principle. But they cannot leave the hospitals because there is no place to go.

There are about 50,000 involuntary admission patients who have been in mental hospitals for over 5 years. Even if PRB allows them to leave the hospital, PRB has no social workers or the supporting system for community life of them, so they cannot leave hospitals. Because they lost their home for long stay in mental hospitals and they have no place to go.

Second reason is the right of communication with outside is not guaranteed effectively. Although there are telephones even in locked wards, they are located closely to nurse offices, so patients cannot use them in secret. In addition, the patients are not allowed to have cash or a telephone card in many mental hospitals. Therefore they cannot use telephones any time they hope. And patients in locked ward cannot post their letters by themselves. They must ask staffs to post their letters. In bad circumstance mental hospitals staffs refuse their requests or burn their letters. So patients in mental hospitals in which there is maltreatment cannot complain to PRB.

Third reason is that insufficient explanation of PRB is given to patients. In Kurita hospital patients is not give any explanation about PRB against Mental Health and Welfare Law. In such bad circumstance mental hospitals as Kurita there is violation of Mental Health and Welfare Law. Even if patients accept the documents about PRB, some patients cannot understand the document, because the document is not easy to understand. And patients cannot complain to PRB effectively without representative lawyers but in Japan there is no law to pay the fee of lawyers of in-patients by the government. So most of in-patients cannot have their representative lawyers.

There are other problems in PRB system.

Although the right of choosing the hospital is not guaranteed in a involuntary admission case, a claim for changing the hospital cannot be accepted by PRB.

Even when patients acknowledged the necessity of admission, their hope to change the form of admission from involuntary to voluntary is not always admitted, although in Mental Health and Welfare Law voluntary admission is first choice admission form in principle.

In addition if patients submit a claim to PRB, they can know only the conclusion of examination. How their claim is discussed with what kind of materials are not informed to themselves and their lawyers. If patients are not satisfied with the conclusion of PRB, there is no upper PRB for complaints.

=== Article 10: the right of detained persons to be treated with humanity ===

==== Mental disordered prisoners must be isolated ====

In Japan there are lot of mental disordered prisoners in general prison, not only in medical units or in medical prisons. We cannot get a correct number of them, but many of mental disordered prisoners are isolated for 24 hours every day in general prison, if we consider on the basis of our experience of activities to protect the rights of mental disordered offenders.

Isolated mental disordered prisoners can talk to only prison officers, except when their families (if they have families) visit them once a month.

The reason why mental disordered prisoners must be isolated is that since they are mental disordered. Prison authorities think that they must be dangerous enough to disrupt prison order.

Moreover in Japanese prison the rights to receive adequate medical treatments are generally not guaranteed. Especially mental ill prisoners are even punished in place of receiving medical treatments. For example, if a mental ill prisoner screams by suffering from mental illness, almost always he/she would be punished. And if he/she commits suicide, he/she would be banded with a leather band and be thrown into a strip cell.

We had a experience in winter of 1976 that Mr. Kunio Suzuki -a member of our group- was frozen to death by the injection of Chrolpromazine that affects to lower the body temperature in Osaka prison. His mother took the State to a civil court and won the compensation for the death of her son. It is the first and last case that one can get the compensation for death of one's family in prison from the State.

=== Article 19: Freedom of opinion and expression ===

==== Mental disabled people have no freedom of speech (Ref. 2) ====

The requirements of the involuntary admission by the governor of local government are that one is mental disordered and is likely to injure oneself or others because of their mental disorder, unless he is hospitalized.

"Injure others " dose not mean only to injure others' body but also means "to injure others' honour" (described in the notification from the Minister of Health and Welfare).

Actually there were examples. One occurred in Shizuoka in 1980 that a policeman reported one person to the local health centre, since the person had distributed leaflets which accused of maltreatment of one mental hospital. The governor of Shizuoka local government order psychiatric examination of the person, fortunately conclusion of examination is that it is not necessary to admit the person involuntary.

Another case occurred in Kagawa in 1996 that Mr. Hosokawa was reported by the mental hospital's directer and local government order his psychiatric examination. Mr.Hosokawa accused of maltreatment of the mental hospital in which he had been admitted. The Civil Liberty Bureau accepted his complain and research the hospital. Then the directer of the hospital reported him because he injured the hospital's honour. Fortunately he could prevent involuntary admission.

We Japanese mental disabled have no freedom of speech.

=== Article 26: Equality before the law ===

In Japan there are a lot of discriminating items for mental disabled people in many laws. For instance mental disabled people cannot get the driver's licence.

The Law of Minimum Wages are not applicable to mental disabled and physical disabled. Under the Law of Safety and Hygiene of labor (article 68) mental disabled people who are likely injure oneself or others are prohibited to go to labor. This article is interpreted unfavourably and widely, and because of this article many mental disabled people lose their job.

Under Civil Code (article 770) one of the reason of divorce is that the partner became severe mental ill and there is no hope to recover. So many mental patients are divorced against their will.

There is " special rule" in the Law of Medical Treatments. " Special rule" means that in mental hospital the number of required doctors and nurses is 1/3 and 2/3 of other hospitals respectively. Moreover this "special rule" standard is not necessary to manage mental hospitals. In fact 40 % beds of mental hospitals do not satisfy this "special rule" standard. Ministry of Health and Welfare has taken no counter measure against such condition and said that they have no plan to abolish this "special rule", when our group discussed with them on 28th of July in 1998.

The shortage of manpower under this discriminative "special rule" causes maltreatment against in-patients and high rate of locked wards (Ref. 1).

There is discrimination on fee of medical cost from medical insurance system. An average of fee of admission in mental hospitals is about 8,000 yen per one in-patient a day, but an average fee of admission in other hospitals is about 19,000 yen per one in-patient a day. This poor medical fee also causes bad circumstance and maltreatment in mental hospitals.

Mental disabled people are forbidden to live in public apartments unless they have family. Because of this discrimination mental disabled people must live in a private apartment which is expensive and under poor condition. Ref. 1 Condition of psychiatric treatments in Japan (data from Ministry of Health and Welfare)

Number of mental hospital beds per 10,000 population is about 29 in 1994. Number of in-patients in mental hospitals is about 340,000 in 1997. There is no sign that the number of in-patients decreases in Japan. The rate of beds in private mental hospitals is 88% in 1994. The rate of involuntary admission is about 33% in 1997. The rate of over 5 years admission is about 45% in 1997. The rate of locked ward for 24 hours is 58% in 1993.

Other wards includes that the ward is opened for two or three hours a day. The rate of voluntary admission patients in the locked wards for 24 hours is about 55% in 1993. The number of in-patients isolated in the locked room is 6,489 on 30th in June of 1992. The rate of manpower (1989) doctors mental hospitals 1.8 per 100 beds other hospitals over 10 per 100 beds nurses mental hospitals 20.2 per 100 beds other hospitals 38.4 per 100 beds the budget of mental health in 1980 about 84,800,000,000 yen in 1997 about 48,400,000,000 yen.

The reasons of decrease are the decrease of the number of involuntary admission and the decrease of the cost of involuntary admission which the state must pay for. Mental health workers' efforts to decrease the number of involuntary admission is the background of this budget decrease but the budget did not shift from the cost of involuntary admission to the cost for supporting system for lives of patients in the community. The budget was only cut.

=== Psychiatric Review Board (from January to December in 1996) ===

The number of complains of involuntary admission 862 PRB admitted that involuntary admission was inadequate. 43 cases The number of complaints of treatments 48 PBR admitted the treatments were inadequate 1 case Ref. 2 A quotation from "Criteria Specified by the Ministry of Health and Welfare based on the Provisions in in Par. 1 Article 28-2 of Mental Health and Welfare Law (Health and Welfare Ministerial Notification No.125 of April in 1988)" No.11.

The judgement that a person is mentally disordered and that he is liable to injure himself or others because of his mental disorder, unless he is admitted to a hospital for his mental care and custody, shall be based on the admission requirements set forth in Par. 1 of Art.29 of the Mental Health and Welfare Law (Law No.123 of 1950. Referred to as "the law" hereinafter).

This judgment made by a Designated Physician of Mental Health, as designated by the provision of Par.1 of Art. 18 of the law, shall be made only when it is deemed, in accordance with the symptoms or state of the patient shown in the following table, that the person examined ins liable to undertake an action which may result in injuries or a threat to his life, such as an attempt at suicide (referred to as "an action which injures himself" hereinafter) or an action which poses a threat to the life, the body, chastity, honor, the property, etc. of others or the social interest, etc., such as murder, injury, assault, asexual behavior, contempt, destruction or damage of property, robbery, intimidation, larceny, fraud, arson, playing with fire, etc.(referred to as "an action which injures others" hereinafter, and refers to an action which violate the Criminal Code, in principle), because of his mental disorder, unless he is admitted to a hospital. (underlined by the reporter)

== THE SITUATION OF MENTAL HEALTH IN JAPAN ==

(The presentation in WFMH Congress in 1997 at Finland)

I am Mari Yamamoto and I am a Japanese user. Today I would like to report about reorganization of mental health system neglecting users' voice. First, I would like to introduce the problems of mental hospitals in Japan.

1. There are many inpatients in mental hospitals. Number of mental hospital beds per ten thousand population is about thirty. There are about three hundred and fifty thousand inpatients in mental hospitals.

2. Many beds are in private hospitals. About eighty-nine percent beds of mental hospitals are in private hospitals. So in Japan mental health service is under the influence of mental hospitals interests. And there are many maltreatment in private hospitals. In some case nurses beat inpatients to death or in most of mental hospitals inpatients are forced to work to help the staffs.

3. High rate of closed wards fifty-eight percent of mental hospital beds are locked for twenty-four hours a day.

4. The period of admission is very long. Average admission period is about three hundred and twenty-five days and about thirty percent of inpatients are admitted over ten years.

5. Poor man power There is a discriminative standard of staffs for mental hospitals. In mental hospitals the number of necessary doctors and nurses are third and two third of those of other hospitals respectively. So in mental hospitals there are only one point eight doctors per one hundred beds and twenty point two nurses per hundred bed. On the other hand in other hospitals there are over ten doctors per hundred beds and thirty-eight point four nurses per hundred beds.

6. Psychiatric review board dose not work. The government says that this board is the psychiatric tribunal and it protects inpatients' right and prevents inadequate involuntary admission. but the window of psychiatric review board is the local government and it is not independent from local government.

In Japan, there are many inpatients in mental hospitals, nevertheless the number of complaints against involuntary admission and complaints against treatments is only thousand a year. It discloses that the right of communication is widely violated. In 1995 Mental Health Law was changed to Mental Health and Welfare Law. Mental Health Law is the system of involuntary admission and we have been appealing to abolish the Mental Health Law. But the government has been maintain this involuntary admission system and furthermore it joined "welfare" to involuntary admission system. When this bill was decided, our voice was excluded from decision making process.

The government heard the voice of only professionals and family organization. We could not get the bill until the day before the government laid the bill before the Diet. Under this new law we psychiatric users are divided from other people with disability and other people with disability is put under welfare division of the government but we psychiatric users are put under mental health and welfare division of the government.

The explanation of the government is that medical treatments and welfare cannot divide for the mental disordered. This comment means that mental hospitals can get money not only from medical treatments but also from welfare. The government wants to cut the cost of medical treatments and it wants to reduce the number of mental hospital beds. So welfare means in compensation for reduction of mental hospitals beds. Welfare is not our own interests and it is for the interests of mental hospitals. " Welfare" means to build so called "rehabilitation facilities" and many mental hospitals run "rehabilitation facilities" and long stay inpatients are moved from hospital wards to "rehabilitation facilities". These "Rehabilitation facilities" are actually terminal facilities. They are low cost shelters and in most of them there are no private rooms and inmates are living with another in one room.

Furthermore some of rehabilitation facilities are locked and inmates cannot go out freely. Communities have become the open wards of mental hospitals. In Japan there is a reporting system of the psychiatric users. Under this system policemen or citizens report the person to the public health centre when they think that the person is liable to injure oneself or others due to mental disorders. Then head of local government orders two doctors to examine the person, and if two doctors judge that the person is liable to injure oneself or others due to mental disorders, the person is forced to be admitted into the mental hospital. We all users are watched by this system.

Under this reporting system, so called "community mental health care" has been introduced. There is the system that stuffs of the public health centre, stuffs of the mental hospital, and case workers of welfare office discuss about the users who get benefit from social security system. Users in the community are controlled by this system and the reporting system. Thus communities themselves have become the open ward of mental hospital. Psychiatric users has been divided. Ones are in mental hospitals, ones are in so called "rehabilitation facilities", ones are in work shops, ones are in day care activities by mental hospitals. And all of us are controlled by the professionals. Now fee of medical cost from medical insurance system is reduced for over 3 months admission, so there is a phenomenon that inpatients are driven out of mental hospitals without their consent and without preparation of living in the community after three months admission. Or there is a phenomenon that the mental hospitals reject so called "patients difficult to look after ".

Our brothers and sisters has been killed because they are driven out of hospital too early or they are rejected to admit the hospital. Our own charge of medical treatments has become higher and higher, so we are afraid that poor users will not be able to receive necessary medical treatments. Psychiatric users have no freedom of speech and opinion. The requirement of involuntary admission is that one is liable to injure oneself or others. This "injure others" means not only to injure others' body but also to injure others' honour. In fact last year Mr. Hosokawa was reported by mental hospital's director and local government ordered to examine him. He accused maltreatment of the hospital which he had been admitted. The director reported him because he injured the hospital's honour. Fortunately he could prevent involuntary admission.

We Japanese users must overcome threaten of involuntary admission when we speak out in public. In Japan government thinks only cutting the medical cost and considers mental hospitals' interests. Psychiatric users interests are utterly neglected. It is hard and difficult struggles to get our own interests but we are not alone and our group have been fighting for our own interests for twenty-three years. We will strengthen the solidarity of users against any division of users in future. Thank you for your attention.