Development of forensic mental health services in Japan: working towards the reintegration of offenders with mental disorders

International Journal of Mental Health Systems

Takayuki Okada²  Akiko Kikuchi²  Kumiko Ando²  Yusuke Fukuda¹  Chiyo Fujii² 

[1] National Institute of Mental Health, National Centre of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo 1878553, Japan;Department of Forensic Psychiatry, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo 1878553, Japan

关键词: Treatability;    Social reintegration;    Rehabilitation;    Mentally disordered offenders;    Forensic psychiatry;   

Others  :  800926
DOI  :  10.1186/1752-4458-8-21

 received in 2014-04-17, accepted in 2014-05-29,  发布年份 2014

【 摘 要 】

Background

Until the recent enactment of the Medical Treatment and Supervision Act (MTSA) in 2005, neither legislations nor facilities for mentally disordered offenders were available in Japan. The aim of the country’s forensic mental health services, based on this new law, is to improve the social reintegration of mentally disordered offenders. In order to provide optimal psychiatric care to these individuals, specialised court proceedings, treatment facilities, and concrete guidelines have been established. The aim of this study was to review the current status of the new system and to clarify future challenges for improving services.

Methods

The authors collected official statistics regarding the new system published separately by the Ministry of Health, Labour and Welfare, the Ministry of Justice, and the Supreme Court of Japan. We aggregated the data and examined the system’s current implementation status, nationwide.

Results

There were 2,750 requests for enrolment in the MTSA system between its initiation in 2005 and 31 December 2012. Of those requests, 2,724 cases had been concluded in court. In 63.1% of the cases, an inpatient treatment order had been made; 82.4% of those inpatients were diagnosed with schizophrenia. By the end of March 2012, two patients completing treatment under the MTSA had re-committed a serious offense. While overall designated inpatient and outpatient treatment facilities have reached national targets in terms of resources and beds available, a regional gap in MTSA designated facilities remains and the number of patients under inpatient treatment order is on the increase.

Conclusions

Overall, the MTSA system has been running smoothly without encountering any serious problems. However, several concerns have emerged, such as the accumulation of patients under inpatient treatment order and insufficient regional resources. To more successfully promote the reintegration of mentally disordered offenders, improvements in outpatient treatment and welfare services are crucial. In order to install effective measures to help improve the system, a nationwide database of patients being treated under order of the MTSA should be properly built and maintained.

【 授权许可】

   
2014 Fujii et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Nakatani Y: Psychiatry and the Law in Japan. Int J Law Psychiatry 2000, 23:589-604.
• [2]Department of Mental Health Policy and Evaluation, National Institute of Mental Health, National Center of Neurology and Psychiatry: Report on Mental Health and Welfare. [http://www.ncnp.go.jp/nimh/keikaku/vision/pdf/medemiru7.pdf webcite] Tokyo: Japan. (in Japanese)
• [3]Ministry of Health, Labour and Welfare: The Guidelines for the Inpatient Treatment of the Medical Treatment and Supervision Act. [http://www.ncnp.go.jp/nimh/shihou/guideline_nyuin_shogu2012.pdf webcite] Tokyo: Japan. (in Japanese)
• [4]Ministry of Justice: White Paper on Crime. [http://hakusyo1.moj.go.jp/jp/nendo_nfm.html webcite] Tokyo: Japan. (in Japanese)
• [5]Ministry of Health, Labour and Welfare: Clinical Diagnosis of Patients under Inpatient Treatment Order. [http://www.mhlw.go.jp/bunya/shougaihoken/sinsin/nyuin.html webcite] Tokyo: Japan. (in Japanese)
• [6]Ministry of Justice: Annual Report of Statistics on Rehabilitation. [http://www.moj.go.jp/housei/toukei/toukei_ichiran_hogo.html webcite] Tokyo: Japan. (in Japanese)
• [7]Supreme Court in Japan: Judicial Statistics. [http://www.courts.go.jp/search/jtsp0010 webcite] Tokyo: Japan. (in Japanese)
• [8]Ministry of Justice, Ministry of Health, Labour and Welfare: Report on The Implementation Status of The Act for The Medical Treatment And Supervision of Persons With Mental Disorders Who Caused Serious Harm. Tokyo; 2012. (in Japanese)
• [9]Ministry of Health, Labour and Welfare: Number of MTSA Designated Facilities. [http://www.mhlw.go.jp/bunya/shougaihoken/sinsin/shikou.html webcite] Tokyo: Japan. (in Japanese)
• [10]Ministry of Health, Labour and Welfare: Population Survey Report. [http://www.e-stat.go.jp/SG1/estat/List.do?lid=000001112823 webcite] Tokyo: Japan. (in Japanese)
• [11]Ministry of Health, Labour and Welfare: Review of Administrative Project in 2013, Project No.769. [http://www.mhlw.go.jp/jigyo_shiwake/gyousei_review_sheet/2013/h24_pdf/769.pdf webcite] Tokyo: Japan. (in Japanese)
• [12]Ministry of Education, Culture, Sports, Science and Technology, Ministry of Health, Labour and Welfare: The Ethical Guideline of Epidemiological Research. Tokyo; 2013. (in Japanese)
• [13]Nakatani Y, Kojimoto M, Matsubara S, Takayanagi I: New legislation for offenders with mental disorders in Japan. Int J Law Psychiatry 2010, 33:7-12.
• [14]Konrad N, Lau S: Dealing with the mentally ill in the criminal justice system in Germany. Int J Law Psychiatry 2010, 33:236-240.
• [15]Protais C: Psychiatric care or social defense? The origins of a controversy over the responsibility of the mentally ill in French forensic psychiatry. Int J Law Psychiatry 2014, 37:17-24.
• [16]Salize HJ, Schanda H, Dressing H: From the hospital into the community and back again – a trend towards re-institutionalisation in mental health care? Int Rev Psychiatry 2008, 20:527-534.
• [17]National Center of Neurology and Psychiatry: Shift from Hospitalized Medical Treatment to Living in the Community. “Visions in Reform of Mental and Medical Welfare” Research Page. [http://www.ncnp.go.jp/nimh/keikaku/vision/index_e.html webcite] Tokyo: Japan.
• [18]Sado M, Inagaki A, Koreki A, Knapp M, Kissane LA, Mimura M, Yoshimura K: The cost of schizophrenia in Japan. Neuropsychiatr Dis Treat 2013, 9:787-798.
• [19]Müller-Isberner R, Freese R, Jöckel D, Gonzalez CS: Forensic psychiatric assessment and treatment in Germany. Legal framework, recent developments, and current practice. Int J Law Psychiatry 2000, 23:467-480.
• [20]Okae A: Takuma Mamoru Seishinkanteisyo―Seishiniryo to Keijishiho no Hazama de [Report on Psychiatric Evaluation of Mamoru Takuma―a tension between Psychiatry and Criminal Justice]. Tokyo: Aki Magazine; 2013. (in Japanese)
• [21]Nakatani Y: Challenges in interfacing between forensic and general mental health: a Japanese perspective. Int J Law Psychiatry 2012, 35:406-411.
• [22]Ministry of Justice: Statistics of Mentally Disordered Offenders 2008 England and Wales. [https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/218001/mentally-disordered-offenders-2008.pdf webcite] London: UK
• [23]Kikuchi A: A Monitoring Survey of Designated Inpatient Facilities. Report for the Health and Labour Sciences Research Grants, Comprehensive Research on Disability Health and Welfare, from the Ministry of Health, Labour and Welfare 2014, 93-106. (in Japanese)
• [24]Ando K, Nagata T, Hirabayashi N: Current status and challenges on the medical treatment and supervision act. J Jpn Psychiatr Hosp Assoc 2013, 31:36-41.
• [25]Ando K: A Monitoring Survey Of Designated Outpatient Facilities. Report for the Health and Labour Sciences Research Grants, Comprehensive Research on Disability Health and Welfare, from the Ministry of Health, Labour and Welfare 2014, 109-131. (in Japanese)
• [26]Ito H, Frank RG, Nakatani Y, Fukuda Y: The regionalhealth care strategic plan: the growing impact of mental disorders in Japan. Psychiatr Serv 2013, 64:617-619.
• [27]Nomura T: Current situation and future tasks for psychiatric services in Japanese prisons. J Nippon Med Sch 2009, 76:182-187.
• [28]Nakajima S, Shirai A: Mental health and utilization of mental health services among victims of crime in Japan. Nihon Arukoru Yakubutsu Igakkai Zasshi 2007, 42:21-31. (in Japanese)