Filed a lawsuit demanding an apology from the government

We, the Psychiatric National Compensation Litigation Study Group (abbreviated as Psychiatric Compensation Research Institute), filed a lawsuit against the government with Mr. Tokio Ito as the plaintiff.

He spent over 40 years in psychiatric hospitals in Tokyo and Fukushima. There were almost no episodes that appeared to be psychiatric symptoms, except at the beginning of the illness. Even when he was hospitalized, he worked outside the hospital every day and worked to help with school lunches inside the hospital, with the aim of being discharged. However, there were no active efforts to reintegrate him back into society, and precious time in his life was taken away by his stay in the hospital.

Ms. Ito is not the only person whose life was taken away from her life by being admitted to a psychiatric hospital.

Japanese mental health care where human rights are not respected

Even now, a national survey shows that there are over 70,000 people who continue to be hospitalized in psychiatric hospitals, even though their illness has disappeared. There are tens of thousands of people. With proper social resources, such as various types of group homes and community health care teams, they could live as citizens in their communities, but they remain isolated from society in hospital wards. This is outrageous. Psychiatric medicine in our country continues to commit unforgivable human rights violations in the name of medical care. we denounce this.

The number of compulsory hospitalizations, isolation and restraint, and their prolongation; frequent cases of patient abuse; a hospitalization system that places responsibility on family members and ignores public responsibility; and a bias towards drug therapy called multi-drug therapy. There are countless problems with psychiatric care in Japan, such as poor medical care.

◆Recommendation from WHO (1968)
Didn't the country know why this situation had been ignored for so many years? There's no way I didn't know. The Clark Recommendation in 1968 first raised the alarm that psychiatric care in Japan was biased toward hospitalization, and that mentally ill people were being deprived of their right to live in the community. Mr. DH Clark, a British psychiatrist who visited Japan as an advisor to the WHO and investigated the actual state of psychiatric care in Japan and made recommendations, had already pointed out problems at that time and recommended seven points for Japan to improve. The following recommendations are being made.

However, Japan ignored this recommendation for improvement. Community mental health care has become the norm around the world, and even after normalization meant that people with disabilities were no longer isolated from the local community based on the ideals of "full participation and equality," in Japan, medical financing was established by the government. They continued to build psychiatric hospitals with low-interest loans from the public finance corporation.

◆Long hospitalization period <br>While the world's major developed countries have reduced the number of psychiatric beds, the number of psychiatric beds in Japan has continued to increase, and now accounts for 20% of the total number of hospital beds in Japan. They now account for 20% of the world's psychiatric beds. The average length of hospitalization in Japan is 280 days, which is 10 times longer than the OECD average of 28 days. Furthermore, the hospitalization system, which lacks judicial oversight, is behind the increase in forced hospitalizations. Forced hospitalization without the person's consent severely restricts human rights, so in Europe and the United States it is common for courts to monitor the length of hospitalization, but in Japan there is no judicial involvement at all. The system is designed to allow a patient's hospitalization to be extended as long as they wish at the discretion of the psychiatrist.

From the perspective of human rights protection, this is an incredibly messed up system. It has to change.

◆Utsunomiya Hospital Incident (1984)
The Utsunomiya Hospital incident in Tochigi Prefecture, which was discovered in 1984, became a social issue and triggered the change from the Mental Health Act to the Mental Health Act. In 1985, the Japanese government announced at the United Nations that it would make improvements. The plan calls for the transition of long-term psychiatric hospital patients to the local community, and a certain number of community facilities such as group homes and workshops have been prepared. However, the number of psychiatric beds did not decrease, and the situation in which socially hospitalized patients were unable to return to the community remained unchanged.

Why hasn't it changed?

90% of Japan's psychiatric hospitals are private hospitals. Emphasis is placed on business management, and it is more likely that disabled people will be kept hospitalized to stabilize business rather than reintegrating them into society. It is outrageous to profit from stealing a patient's life, but the reality is that it has become commonplace.

Why do we need a trial? Is it not possible to form a consensus?

In order to change the current situation, we need to form a bipartisan parliamentary group, bring together psychiatry-related professional organizations, academic societies, family associations, etc., and, with support from the media, create a temporary special measures law that will require the dismantling of psychiatric hospitals and their relocation to local communities. There is a path forward.

However, this is met with fierce opposition from some politicians, and can be said to be impossible to implement. Until now, the idea of switching to community mental health care has been repeatedly raised in various councils and study groups, including the Public Health Council. However, if we look at history, which has not changed at all, it is clear that it is virtually impossible to dismantle psychiatric hospitals through consensus building.

purpose of trial

The purpose of this trial was to clarify in court Japan's responsibility for its inaction in implementing its mental health policy, which has been repeatedly pointed out both by the international community and by internal council reports, but has not changed. be. Of course, we aim to win the case, but winning is not the only goal.

Through the trial, it will be revealed how many people have been, and still are, victims of the country's mental health policies. The voices of not only the plaintiff but also many other parties and their families will be delivered to the judiciary as testimony.

The only way to prevent more victims from happening is for a court to find the government responsible for its years of inaction, force the government to apologize, and change its policies.

Plan from now on

Our immediate goal is to hear the voices of many of the parties involved and their families as testimony in preparation for Tokio Ito's trial at the Tokyo District Court, which is the first stage of the lawsuit. The first trial has been set for March 1, 2021, and preparations are continuing.

Our legal battles do not end at the Tokyo District Court. People who have come forward as plaintiffs in Kagoshima are also waiting. We plan to file secondary and tertiary lawsuits across the country.

Following the litigation by the parties, the goal is to pursue a family lawsuit, in which the family becomes the plaintiff . Japan's mental health and welfare law system has, and still is, placed a lot of responsibility on families. It is an abdication of public responsibility.

◆The burden on families The system of ``medical protection hospitalization'' is forced hospitalization without the patient's consent. (In the old mental health law system, it was called "consent hospitalization," but in principle, this "consent" came from the family, not the patient.) This system does not require consent from the patient and does not require a treatment contract. It is a messed-up system in which medical expenses are not covered by public funds, and the patient and his or her family are responsible for paying the medical expenses.

For mental health care, voluntary hospitalization based on the patient's will and forced hospitalization in situations where forced hospitalization is unavoidable are sufficient. Voluntary hospitalization is based on the individual's will, so it makes sense for it to be covered by insurance, and voluntary hospitalization is compulsory hospitalization based on the assumption that there is no medical contract, so the entire amount is borne by public funds.

In addition, because forced hospitalization severely limits human rights, in other countries the judiciary intervenes to monitor medical care, but in Japan there is no judicial involvement at all. The reason that Japan's psychiatric care has an abnormally high rate of forced hospitalization is precisely because this system of medically protected hospitalization is being abused. Families have been forced to bear heavy emotional and financial burdens for many years.

In the future, we will appeal the unfairness of this medical protection hospitalization system through mental health and national compensation lawsuits and psychiatric and national compensation family lawsuits, and aim to abolish it.

We hope that through this trial, mental health care in our country will become a medical care that everyone can use with peace of mind.
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