Situation

== 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.