To everyone who supports the lawsuit, "Birds in the sky, fish in the water, people in society"

My name is Furuya, and I am the representative of the Mental Health Care State Compensation Litigation Research Group.

We will report on the outcome after the verdict report meeting on July 10, 2025.

Hereinafter, the plaintiff/appellant Tokio Ito will be referred to as "Tokio-san."

◆Special Committee of the National Institute for Mental Health Compensation

On the 11th, the day after the appeal court ruling, the National Institute for Mental Health Compensation held a specialist committee meeting.

The committee, together with the legal team, has been responsible for formulating the legal theory and preparing the documents for this lawsuit.

In line with the content of the appellate court's ruling, we exchanged opinions on the significance and possibility of appealing.

We communicated the details to Tokio and confirmed his intentions as both plaintiff and appellant.

The next day, on the 12th, Furuya called Tokio and conveyed the expert committee's opinion regarding the appeal to the Supreme Court.

Tokio said, "I've had my case dismissed twice and I'm tired of it. I know I'm going to lose and I can't fight anymore. I won't appeal. I feel bad for everyone who has supported me up until now. Please tell everyone I'm sorry."

We accepted Tokio's heavy words, "I can't fight anymore," and promised to convey his words to all members.

◆July Monthly Meeting of the Institute for Mental Restitution Research

At the monthly meeting on the following day, the 13th, we once again shared the contents of the appeal court ruling, conveyed Tokio's words, and spent three hours frankly exchanging opinions.

Of the 31 participants, many called for an appeal to the Supreme Court.

On the other hand, everyone expressed sympathy for the plaintiff, Tokio, who said he was "tired."

Below are some comments taken from the minutes of the meeting.

The reasoning behind the decision states that even though the plaintiff's argument has been rejected, "assuming that the hospitalization was for medical protection," it also states that "it cannot be said that the constitution was violated" and "it cannot be said that the Minister of Health, Labour and Welfare was inaction," leaving room for rebuttal. It will be of great significance to see what the Supreme Court ultimately decides, even if the case is not won.

The first instance trial took four full years and 16 trials, causing Tokio a lot of hardship. The Supreme Court trial was a shorter process and less of a burden. It would be a shame to accept the verdict and not have a chance to argue.

○The people in the courts have no understanding of the terrible reality of psychiatric care. The district courts don't even want to look at it. We shouldn't live in a world like that. I would like this to be taken all the way to the Supreme Court. They've done a good job so far, but I would like them to make one more effort.

The first instance ruling stated that "long-term hospitalization is a publicly known fact," and it left the impression that the judges hadn't actually read the briefs. The appeal court ruling this time included a statement that was in line with the issues at issue, and I think there is considerable merit in appealing and setting a precedent. Tokio's wishes must be respected to the greatest extent possible, but I hope that after speaking with his lawyer, Tokio will change his mind.

Even if you lose again, it is still worth appealing to the Supreme Court to have it decide. The Supreme Court precedent will serve as a foundation for the next lawsuit.

In other lawsuits against the government, Tokio has repeatedly lost, but has continued to fight and has now won. He has taken a big first step. Even if he gives up on appeal, it will not be a loss that marks a step forward in the future.

Following the appeal court ruling, we would like to not just accept the decision and leave it at that, but to strike back at the last moment, but we must always follow Tokio's wishes.

I would like to fully respect Tokio's wishes as a plaintiff. However, I would like to see the matter not end here, but rather pursue the possibility of an appeal and convey this to Tokio as an opinion expressed at the monthly meeting.

Tokio-san said, "I want this to be the last time." He must be extremely tired and want to live a life without any torment. I have experienced it myself, but as a plaintiff in a lawsuit, just going through the trial is really exhausting.

I would like to convey to Tokio the words spoken at this monthly meeting and ask him to "see it through to the end." At the same time, I would like to respect Tokio's thoughts. I would also like to think about what I can do.

I think there are still some points in this lawsuit that can be fought, so I think an appeal would be better, but I want to respect Tokio's wishes. I don't want to tie him down by getting too heated.

I left the briefing session wanting to treasure the words that Tokio-san spoke. There are big problems with mental health, welfare, and medical care in this country. I want to respect Tokio-san's thoughts to the fullest extent possible.

Hearing Tokio-san's final words, "I'm tired," I think he must have been tired after a long time. The outcome of the trial was not good, but I felt he had done well, thanked him for his efforts, and wanted to give him a break.

It is painful to think that Tokio must have felt helpless when he heard the High Court's ruling. This was the first time that the Mental Health Act and current laws had been challenged in court, and it is wonderful that he was able to bring the case to the forum. The judges do not have that level of awareness.

I believe there is a deep meaning behind the appeal. However, he has already experienced the hurt he felt from being hospitalized, and going to a place where he is told about it will only add to the traumatic experience. Tokio has been through difficult times for five years. We are forcing him to endure difficult times, and I think he needs to be aware of the fact that he is being asked to do so.

Mr. Tokio must have felt that he had had enough after two dismissals. Five years have passed since the lawsuit was filed, and with his age, he seems tired. He didn't seem to have slept at all the night before the trial.

Many supporters are stating the significance and expectations of appealing to the Supreme Court, rather than letting the High Court loss be the end of the story.

On the other hand, everyone said that they would ultimately like to respect the plaintiff's wishes.

Everyone was concerned that Tokio was becoming quite fatigued due to the physical decline and psychological burden that comes with aging.

The conclusion of the monthly meeting was that "an appeal to the Supreme Court is meaningful," "we would like the members' opinions to be conveyed to Tokio," and "we will all respect Tokio's decision after that."

I conveyed this to Tokio and we decided to confirm his intentions once again.

Tokio's words

In order to give Tokio-san time to think about it carefully, we have decided to summarize the opinions expressed at the monthly meeting from the minutes of the day and convey them to him in a letter.

I put together a six-page A4 letter with a note saying, "Please call me if you have any thoughts," and sent it by express mail on July 15th.

I was hoping to get a call from Tokio, but he never called.

When I called Furuya on the evening of the 17th, he said, "I read the whole thing to the end. Everyone seems to want me to appeal, but I can't do it anymore. I've reached my limit. I've written you all letters and put them in the mailbox this morning, so I want you to express your feelings through them."

Tokio, who prides himself on his perseverance, spoke these simple words, "I can't do it anymore" and "I've reached my limit," which I took to be weighty words that express his honest feelings at the time.

Conclusion

The support group, the National Institute for Mental Health Compensation, would like to respect Tokio's decision not to appeal.

With the two-week deadline for appeal approaching, we informed our members that we would not be appealing.

We would like to express our gratitude and appreciation to Tokio for his hard work over the past four years and ten months since the lawsuit was filed in September 2020.

Although the appeal to the Supreme Court has been abandoned, the National Institute for Mental Health Compensation will continue its activities in the lawsuit "Birds in the sky, fish in the water, people in society."

We also receive opinions and suggestions regarding the future at judgment report meetings and monthly meetings.

We will pursue the possibility of filing second and third lawsuits with new plaintiffs.

The fight to change the way people with mental disabilities are viewed and the state of this country continues.

We appreciate your continued understanding, support, and cooperation.

Psychiatric State Compensation Lawsuit Research Group

Steering Committee Chairman Ryuta Furuya

To everyone who supports the lawsuit "Birds in the sky, fish in the water, people in society"

Thank you for your support through crowdfunding via CALL4.

My name is Furuya and I am a member of the Psychiatric State Compensation Lawsuit Study Group, the organization supporting this lawsuit.

The Tokyo High Court handed down its appeal decision at 10:30 a.m. on Thursday, July 10th, with Tokio Ito (hereinafter referred to as "Tokio") as the appellant.

Although it is late, we would like to inform you of the situation on the day of the verdict.

◆ Appeal decision at the Tokyo High Court

On the day of the hearing, the number of spectators exceeded the capacity of the courtroom's spectator seats, so a lottery was held and the seats were filled.

The judge read out only the following: "Judgment: The appeal is dismissed. The appellant shall bear the costs of the appeal." Without giving any reasons for his decision, the court adjourned in 30 seconds.

The results of the "unjust verdict" were reported in front of the main gate of the courthouse, watched by those who were unable to enter the courtroom.

Tokio commented, "I don't understand why the judge simply dismissed the case without giving any reason. I would like to consult with the people at the National Institute for National Compensation and Restitution to decide what to do next."

They then proceeded to the front of the Ministry of Health, Labor and Welfare and shouted in protest, "This is an unjust verdict, we will not tolerate it!"

Contents of the Appeal Court Decision

In the afternoon of the same day, a "judgment report meeting" was held at Hibiya Convention Hall.

After Furuya reported on the progress of the trial so far, Attorney Hasegawa explained the contents of the verdict.

Although the high court's ruling this time was a loss, dismissing the claim, it was still better than the district court's ruling.

The Tokyo District Court's first instance ruling was a short 11-page ruling that placed all responsibility for the long-term social hospitalization on the individual plaintiffs and made no reference to the legal system or any other issues.

The Tokyo High Court's second-instance ruling also touches on the purpose and regulations of medical protective hospitalization, as well as the responsibility of the legislative and executive branches for inaction, and is 40 pages long.

The original ruling of the first instance was an extremely sloppy verdict that did not take into account the issues at stake in the trial, but the High Court's ruling appears to have been made after a thorough examination of the preparatory documents and evidentiary documents.

However, in conclusion, in line with the defendant's argument, the court concluded that "it cannot be found that the state was under a duty to act under the State Compensation Act," and "therefore, the appellant's claim against the appellee is without merit, without even having to make a judgment on any other points. The original judgment, which was to this effect, was appropriate in its conclusion, and the present appeal is without merit, and is therefore dismissed."

The full text and summary of the judgment have been uploaded under "Litigation Materials > High Court > Court," so please check them out.

(Please note that some personal addresses and hospital names have been masked.)

◆ Plaintiff's speech at the judgment report meeting

Participants engaged in lively question and answer sessions regarding the ruling, and many voiced their opinions calling for an appeal to the Supreme Court.

Towards the end of the presentation, Tokio Ito, who had been listening silently to everyone's opinions throughout the session, gave a speech and expressed his intentions.

"I am disappointed that my appeal was rejected. I think it will be difficult to appeal. I have decided to give up. I have no intention of appealing. Please respect my feelings. Thank you everyone for everything." (From the minutes of the report meeting)

The venue was silent, and everyone was trying to guess how the plaintiff, Tokio Ito, was feeling.

Furuya stated that, based on the opinions received at the briefing session, they will further consider the possibility of an appeal and will decide on a course of action while respecting Tokio Ito's wishes.

The session concluded with the moderator, Ms. Iijima, offering words of gratitude to Mr. Ito.

The deadline for appeal is two weeks from the day after the judgment is received, which is July 24th.

We will report on subsequent developments, such as the content of discussions within the National Institute for Mental Health Compensation and the plaintiffs' expression of intent, in a separate article.

* Excerpted and revised from the 45th issue of the "National Compensation Mail" mailing list for the Mental Compensation Research Institute members (distributed on July 18, 2025)

1. Introduction

In the lawsuit seeking state compensation for mental health care (hereafter referred to as "State Compensation for Mental Health Care"), various issues related to mental health care have been put to the test in court. Here, we report on the progress from the Tokyo District Court ruling to the start of the appeal hearing.

2. Losing the case in the Tokyo District Court

The first instance ruling on the mental health compensation lawsuit was handed down by the Tokyo District Court on October 1, 2024, exactly four years after it was filed on September 30, 2020.

The district court's ruling fully accepted the defendant's arguments regarding the causal relationship between the plaintiff's hospitalization and other factual circumstances and the violation of his rights, and dismissed his claim under the State Compensation Act as being due to circumstances specific to the plaintiff. As for the other issues, the court ruled that the plaintiff's claims were without merit without even needing to be examined, and avoided any judgment on the issues at stake, namely Japan's forced hospitalization system and mental health care policy. This was an unjust ruling that was more unfair, dishonest, and unjust than we had anticipated.

163 people attended the verdict announcement meeting. Plaintiff Tokio Ito said in his opening remarks, "My lawsuit was dismissed. I believe this is an unjust verdict. People who are socially hospitalized or institutionalized are still suffering. I cannot face those people. I will hold the government responsible and fight to the end, appealing all the way to the Supreme Court."

What made the participants who attended the ruling feel the most uncomfortable and angry was the phrase "publicly known fact" in the ruling. Even a court that should strictly apply the law has declared the necessity of compulsory hospitalization of the mentally ill to be a "publicly known fact" and has dismissed it as something that should be taken for granted. This dulling of the sense of human rights towards the mentally ill in Japanese society has been created by national policy over many years. The district court ruling made it clear that those involved in the judicial system, including judges, are no exception. It also reflects the difficulty of navigating a narrow mountain path in a trial for mental health compensation.

3. Contents of the Statement of Reasons for Appeal

Although the plaintiff lost the case at the Tokyo District Court, the lawsuit is not over. In accordance with the plaintiff, Mr. Ito's wishes, he filed an appeal with the Tokyo High Court in October 2024, and the appeal was accepted.

In the appeal statement submitted on October 29, the plaintiffs listed the following five points as errors and injustices in the original Tokyo District Court ruling, which attributed all issues to the individual plaintiffs.

① The error of ignoring the Mental Health Act and other laws and not determining that the appellant's hospitalization was compulsory (consent-based hospitalization, etc.)

2) Insufficient investigation into the appellant’s hospitalization status

3) The injustice of citing the appellant's symptoms, which were only observed during a short period of time, as the cause of his long-term hospitalization

④ The injustice of attributing the appellant's long-term hospitalization to his family's reluctance to discharge him from the hospital

⑤ The injustice of the appellant's failure to seek relief measures as the cause of his long-term hospitalization

The court also cited two reasons for the appellant's prolonged hospitalization: (6) prolonged hospitalization removes the desire to leave the hospital, and (7) the appellant's own declining motivation has led to a course of hospitalization in the way that the International Commission of Jurists pointed out.

Furthermore, when submitting the statement of reasons for appeal, the expert committee of the National Institute of Mental Compensation Relief re-examined the contents of Mr. Ito's medical records and nursing records from the time of his hospitalization, and provided evidence of the process by which long-term hospitalized patients become institutionalized, as well as attaching additional opinions from experts to strengthen the evidence.

4. Government's Reply

In response to the Statement of Appeal, the appellee, the State, submitted a "Response" dated January 20, 2025. The appellee's arguments are as follows:

① The appellant's argument that the appellant was admitted by consent is without merit.

② There was no illegality in the lack of fairness in the trial regarding the appellant’s hospitalization status.

3) There is no error in the original judgment that it cannot be recognized that the appellant was forced into long-term hospitalization due to the inaction of Diet members or the Minister of Health, Labor and Welfare.

④ The original ruling that hospitalization may be necessary even without the person's consent in order to protect the person's interests is justified.

⑤ The original judgment's ruling that the appellant's family was reluctant to discharge him from the hospital and therefore it was not possible to coordinate with them regarding the appellant's discharge and that the discharge procedure may not have been carried out is not erroneous.

⑥ The appellant's argument regarding relief measures is without merit.

7) The appellant's additional argument regarding the state's responsibility for creating patients with unknown hospitalization status is without merit.

Therefore, the court concluded that "none of the appellant's arguments are meritless and the original judgment dismissing the appellant's claims is justified, and therefore the appeal should be promptly dismissed."

There are many points I would like to criticize, but there is one point in the government's argument that I find difficult to understand. Regarding Ms. Ito's statements to staff such as "I want to be discharged from the hospital," the government argues that "the medical records merely acknowledge the fact that the appellant expressed a wish to begin preparations for discharge, and it is difficult to view this as a request for discharge in accordance with the provisions of the Mental Health Act, etc." and that "it is also difficult to acknowledge that she was forcibly hospitalized."

Even in the latest "Detailed Commentary on the Mental Health and Welfare Law, 5th Edition," it says that the person making the request to leave the hospital can be any hospital staff member, and that it can be done in writing or verbally. When an inpatient says, "I want to leave the hospital," how is the line drawn to determine whether this is a "request to prepare for discharge" rather than a "request for discharge"? We fear that this arbitrary interpretation will become a bad precedent in hospitals' responses to patients who request discharge and in court cases.

5. Appellant's statement of opinion

At the first oral argument of the appeal trial on February 3rd, appellant Tokio Ito made a statement.

At the beginning of her speech, Ms. Ito said, "The judge at the Tokyo District Court said that it was inevitable that I had been hospitalized for 40 years because of my illness and my family's fault.He also said that it was inevitable that I had been hospitalized for so long because it was my own choice.It seemed like the judge was saying that it was normal for people with mental disorders to live in hospitals, and I was very shocked."

Regarding the fact that his prolonged hospitalization was due to his illness, he said, "The judge at the Tokyo District Court never mentioned the times when I was doing well, and only focused on the times when I was doing badly. When you have a mental illness, people only focus on the times when you're not doing well, and you end up looking at them with prejudice, as if they're always causing trouble. I feel that the judge at the Tokyo District Court is looking at me with the same prejudice, and I feel very disappointed."

Regarding the preconceived notion that it is inevitable that a patient cannot be discharged from hospital if their family is reluctant, she said, "Even though it is my own discharge from hospital, the decision is made based on the opinion of my family. Does the court think that such unreasonable behavior is right? I am horrified that such unreasonable behavior is allowed to continue."

Furthermore, in response to the verdict that her long-term hospitalization was of her own choice, she questioned, "Who would willingly choose to live in a psychiatric hospital like this?" and said, "After being hospitalized for decades in a psychiatric hospital, I began to feel that even if I was released, I would have no skills, no job, and no home, so I would be useless if I went out into society, and I had no confidence that I could function in society. So during the cross-examination I was asked, "At the time I was hospitalized, did you feel that staying hospitalized would be easier?" and I answered that yes, that was part of it. However, I never felt for a moment that I chose to be hospitalized." She protested against the misinterpretation of her responses to the defendant's cross-examination.

Finally, Ito appealed to the judge in court as follows: "Is it inevitable to be locked up if you have a mental illness? Does having a mental illness mean you have to listen to what your family says? Is it my fault that I lost confidence and was hospitalized for decades and unable to leave? There are many people like me. I have seen hospitalized patients who chose to commit suicide out of lamentation over not being able to leave. That is never the fault of a mental illness. I would like you to think again about how strange the system of psychiatric hospitals in this country is."

Some people in the gallery burst into applause. Silence is the rule in the courtroom, but this expressed the feelings of the many people who supported Ito.

6. Conclusion

The appeal trial has just begun on February 3, 2025, but has now entered a new stage. The appeal trial will require proof to overturn the original ruling from the first instance, and is expected to be a tough road.

As I attend the trial for mental health compensation, I can clearly see the unique logic that is unique to this country regarding mental health care. I am once again keenly aware that Wu Shuzo's "misfortune of being born in this country" is still being repeated in this country. I hope that everyone will keep an eye on the progress of the appeal trial for mental health compensation.

Ryuta Furuya, "From the Losing Judgment in the Tokyo District Court to the Appeal in the Tokyo High Court," Orifure Tsushin, No. 441; 1-3, reprinted in part from the March 2025 issue

Lawsuit for State Compensation for Mental Health Care (Tokio Ito Trial)

Statement regarding the Tokyo District Court ruling

On October 1, 2024 , the Tokyo District Court handed down a judgment in the lawsuit seeking state compensation (Reiwa 2 (Wa) No. 24587) filed by plaintiff Tokio Ito.

The ruling dismissed the plaintiffs' claim for state compensation. The reasons for the ruling did not include any evaluation of the country's mental health care legal system, which was the main point of contention in the trial. Furthermore, the ruling avoided a constitutional ruling on the historical course of the state-led segregation and confinement policy, and contained no in-depth description at all.

The court determined that the cause of Tokio's long hospitalization was due to "the plaintiff's medical condition" based on the contents of his medical records from a period when his condition was not good, and dismissed the plaintiff's argument that the government was responsible for its inaction.

In particular, the reasons for the judgment stated that "It is a well-known fact that patients with mental illnesses such as schizophrenia may experience impaired judgment, and may be unable to make appropriate decisions themselves, resulting in the need for hospitalization even without the patient's consent." This shows the court's discriminatory prejudice against mentally disabled people, who are expected to be hospitalized for long periods of time based on a temporary impairment of judgment.

The court also accepted the defendant's argument that the plaintiff's prolonged hospitalization was due to the fact that he "felt that hospitalization would be easier" and "came to the point where he chose to continue his hospitalization of his own accord," and rejected the plaintiff's argument that he was in a socially hospitalized state that made it difficult for him to express his will voluntarily due to institutionalization.

Furthermore, although "the path to relief is obviously open" through the Psychiatric Review Board and the Habeas Corpus Act, the plaintiff "never requested discharge or sought relief from a lawyer," and the long-term hospitalization "cannot be said to be a problem with the system, such as consensual hospitalization or voluntary hospitalization, nor a problem with psychiatric care policy." Without even considering the reality of psychiatric care in this country and the situation hospitalized patients find themselves in, the problem is reduced to the personal responsibility of the individual patient.

The court concluded, "Therefore, without even considering the further points, the plaintiff's claim is without merit," and dismissed the plaintiff's claim.

Considering that the ruling was handed down over four full years since the lawsuit was filed on September 30, 2020 , and that a total of 16 oral arguments had been held, this ruling can only be described as extremely unreasonable and empty of substance. One can only be stunned by the lack of insight of a court that does not know the reality inside a psychiatric hospital. How much sadness and regret must Tokio have felt, having been forced into social hospitalization for 40 years and losing precious time of his life?

The Research Group for Psychiatric State Compensation Lawsuits, together with the many people who were present on the historic day of the ruling, strongly protests this unjust ruling with anger and sadness. We also declare that, in accordance with the wishes of the plaintiff, Tokio, we will appeal to the High Court.

We hereby declare that we will continue to fight tenaciously until the day we achieve fundamental reform of mental health care in this country, until those with mental illnesses are truly and truly restored to society, and until the day when the "misfortune of being born in this country" is erased.

October 2 , 2024

Research Group on State Compensation Lawsuits for Mental Health Care

 Plaintiff Ito confidently responds to party questioning Document 2.27 

 On February 27, 2024, the 15th oral argument took place. This time, unlike the usual 10 minutes before the start of the trial, the doors to Courtroom 103 opened 30 minutes before the trial began. The gallery was soon filled to capacity. Those who arrived after the courtroom was full and were unable to enter the courtroom were moved to the Chamber of Commerce and Industry building for a mini social gathering. 

 Seven lawyers for the plaintiffs and four lawyers for the defendants were in attendance. The court opened at 3 p.m. as scheduled. The questioning of Tokio Ito began immediately. In a question-and-answer session with the head of the legal team, Mr. Hasegawa, Mr. Ito spoke about the events that led from his onset of illness to his hospitalization, his transfer to Fukushima, and his life in the psychiatric hospital. 

 After approximately 50 minutes of main questioning, the defendant's side conducted 15 minutes of cross-examination, after which the plaintiff's attorney asked additional questions. 

 The next trial date was set, and the court adjourned at 4:15 p.m. The next oral argument was scheduled for Tuesday, June 18th, at 3:10 p.m. The presiding judge also instructed that any additional preparatory documents should be submitted by June 3rd. It appears that the next oral argument will conclude the case, with both the plaintiff and defendant presenting their arguments. 

 Afterwards, the group moved to the Chamber of Commerce and Industry building, where a presentation was held. After the presentation, a publication celebration and birthday party for Tokio-san's "Kago no Tori" was held in the same venue. 

 Regarding the examination of the parties 

 Plaintiff's Examination 

 The circumstances that led to hospitalization 

 The reality of hospital life and inpatient treatment in psychiatric hospitals 

 What was Mr. Ito's own understanding of the type of hospitalization he was in? 

 How did you respond to the request to leave the hospital? 

 How was your relationship with the hospital and your family? 

 Did the change in the law not change the situation? 

 - Becoming institutionalized due to long-term hospitalization 

 ●Discharge history 

 Questions were asked along the lines of the above. 

 Cross-examination of the Defendant 

 ●Is it possible that he was able to spend his time freely while he was hospitalized? Was it possible that he was hospitalized of his own volition and was enjoying his life to the fullest? I was trying to find out this. 

 Point of issue 1: Fact-finding 

 The psychiatric hospital chart submitted as evidence does not include information about the type of hospitalization. 

 Hospitalized under medical protection from __/__/__ to __/__/__ 

 ▲▲year▲month▲day to ★★year★month★day Change of hospitalization type/voluntary hospitalization 

 There is no information such as parent's name (〇×△□). 

 Therefore, one of the points of contention had to be whether or not Mr. Ito had been forcibly hospitalized. 

 So the defendant 

 ●Even while you were hospitalized, Ito-san went out to many places. There were many events. I guess you had a certain amount of freedom. 

 ●Mr. Ito was hospitalized voluntarily. 

 ●Even if the hospitalization was compulsory, there were probably fewer restrictions on human rights. 

 It seems likely that they intended to impress upon the judge this fact. 

 On the other hand, the plaintiff 

 ●At first, it started as "consented hospitalization" under the old system, which is medical protective hospitalization. Without my knowledge, it was changed to voluntary hospitalization, but it remained a compulsory hospitalization until my father passed away. Ito testified that he was not hospitalized of his own will. 

 ●The plaintiff's legal team argues that under the Mental Health Act at the time, only "consensual hospitalization" was possible, and that even after the law was revised, the hospitalization was "medical protective hospitalization." 

 ●It is possible that the hospitalization was switched to "voluntary hospitalization" after his father's death, but Tokio testified in court that he was never informed of this. 

 Point of issue 2: Institutionalization 

 ●Mr. Ito gave up on being discharged from hospital. 

 → Plaintiff: The consciousness was brought about as a result of long-term hospitalization. It was not voluntary. 

 → Defendant: Mr. Ito was hospitalized of his own volition and enjoyed his hospital stay. He had wanted to be hospitalized himself. 

 What emerged from the interrogation 

 ●Hospitalization history: Hospitalized at a hospital in Tokyo 

 →It was clear from the outset that he was forcibly hospitalized. 

 ●Condition after transfer to Fukushima The patient's condition did not improve even after transfer 

 →Even after being transferred to another hospital, he remained hospitalized for medical protection. 

 ●Do you know the term "voluntary hospitalization"?: No. 

 I was hospitalized because my father told me to. 

 →The patient was hospitalized with the consent of the guardian. 

 ● The reality of hospitalization in a psychiatric hospital: Working inside and outside the hospital for a long period of time 

 Clearly there was no need for hospitalization. 

 Did you request to be discharged?: Yes 

 Hospital: If the family is OK with it, discharge the patient. 

 Family: If the director is OK with it, I'll discharge him. 

 → Caught between a rock and a hard place, the situation created one where the patient could not be discharged, and their desire to leave the hospital was diminished. This clarified the structure in which the situation of being caught between the hospital and the family creates institutionalization. 

 ●In order to change the situation, outside influence is essential. Was there any outside influence?: No 

 →What kind of efforts did doctors, nurses, case workers, etc. make? 

 - Were there any external audits of the hospital? Yes, but they only falsified the number of beds. 

 How often did you go out? Once or twice a year 

 Who paid the hospital bills? Family members paid for them. 

 Was there an explanation of the type of hospitalization?: No 

 - Why did you become institutionalized? Why did you give up? (No matter what you did, the situation would not change.) You felt hopeless. 

 ●Do you know about the discharge request system and have you ever used it?: I don't know. I have never used it. → Plaintiff: This is a question to make the judge understand that the discharge request system is not functioning properly. 

 → Defendant: He never used the discharge request system. He suggested that if he had used it, he might have been able to be discharged from hospital. 

 ●Background to discharge from hospital: After the Great East Japan Earthquake, the doctor at the hospital where he was transferred recommended that he live in a group home. 

 → Even if they have institutionalized conditions, they are discharged immediately if there is encouragement. 

 →The problem was that the government did not supervise it. 

 Thus, he testified about the reality that "although my condition had stabilized and I was able to work, I was unable to leave the hospital for nearly 40 years." The presiding judge rejected the plaintiff's request to call three witnesses. 

 Source: Mitsuru Arai, "Plaintiff Ito, confident in the party questioning, Document 2.27," "Spiritual Compensation Newsletter," No. 32, pp. 1-3, published June 1, 2024 

 *The original manuscript was fully written with ruby, but it has been reconstructed and some of the wording has been revised for reprinting (Furuya)

Report on the 16th oral argument (conclusion).

Despite heavy rain in Tokyo, 62 people attended in the gallery.

The trial itself concluded with the confirmation of the final documents submitted by both the plaintiff and defendant.

The next verdict was announced to be on Tuesday, October 1st at 2pm, and the court adjourned in just three minutes.

After moving through the rain, 67 people attended the trial report meeting by registering at the reception.

We had 24 people connect to Zoom, and some people watched with multiple others, so we believe the total number of people was 99.

We are grateful to the many people who are watching the progress of the trial from afar.

Attorney Hasegawa was unable to attend the report meeting due to urgent business, but Furuya gave the report by reading out the documents that had been compiled.

Below, I will summarize the contents in brackets and include Furuya's impressions.

The documents submitted in this trial were “Plaintiff’s Preparatory Brief 8” and “Defendant’s Preparatory Brief (7).”

Based on the plaintiff's previous cross-examination, the plaintiff's side has organized its arguments to date and put them in writing.

However, the defendant's arguments were very short and only contained factual contentions.

Fact-level assertions

One point of contention is the "type of hospitalization," due to sloppy (or falsified) information being recorded in the medical records.

The plaintiff's side made it clear that "the hospitalization was conducted under the Mental Health Act and was a voluntary hospitalization," and "based on the contents of the medical records and the plaintiff's understanding, he was hospitalized for medical protection until 2003."

The court then stated, "The fact that the form of hospitalization is not clear in the first place stems from flaws in the national system design," and "the reality of forced hospitalization remains unchanged, and the plaintiffs should not be made to suffer the disadvantages that result from this."

On the other hand, the defendant claims that "the plaintiff's form of hospitalization has not been proven."

The reason why the plaintiff was unable to be discharged from the hospital was a topic that was repeatedly raised during the previous cross-examination of the parties.

The plaintiffs argued that "years of inpatient treatment were unnecessary."

The reasons given for this included "I was able to objectively view my symptoms and situation," "I was able to work without any problems," "I was able to be discharged immediately after being transferred to another hospital," and "I am living without any problems since being discharged."

Furthermore, the court pointed out that "both the doctors who treated the plaintiff and the psychiatrist who examined his medical records testified that long-term inpatient treatment was unnecessary."

In response, the defendant argued that "the reason he was unable to be discharged from the hospital was not due to the government's inaction."

The court cited possible reasons for the plaintiff's inability to be discharged from hospital as "possibly due to the plaintiff's illness" and "his family not allowing him to be discharged," and stated that "the plaintiff chose to remain hospitalized, as he thought it would be easier for him to remain hospitalized."

(Regarding this last reason, Tokio also commented at the presentation, "That's a terrible thing to say.")

Regarding violations of the Constitution, such as laws

The plaintiffs argued that "the regulations governing consensual hospitalization and medical protective hospitalization are unconstitutional," "voluntary hospitalization is also unconstitutional because it does not guarantee true voluntariness," and "the psychiatric special provisions are also unconstitutional."

The defendants have not addressed this at all in their filings.

◆ Regarding "illegality" under the State Compensation Act

The plaintiffs argued that "until now, unconstitutionality of legislative inaction has been remedied under the State Compensation Act, and remedies under the State Compensation Act should not be closed in this case either."

In particular, the court stated that "this is a fundamental violation of human rights, namely personal freedom, and its infringement is clear," and that "the failure to amend or repeal the law despite recognition of this is illegal."

He also stated that "fundamental violations of human rights, such as personal freedom," "are the result of the isolation and detention policy that is the basis for this," and that this is a result of national policy.

In particular, the report stated that "medical protective hospitalization gave many private hospitals the authority to involuntarily admit patients," "allowed hospitals to operate with low medical and labor costs," and "the government approved of a policy of isolated confinement."

"If the state is not held responsible in principle no matter what policies it adopts, then it would be like giving private individuals the power by law to restrict the right to pursue happiness, personal liberty, freedom of movement, etc., and the state is not held responsible at all," he stated, stating the injustice of this, and that the Minister of Health, Labour and Welfare is "held a duty to act in principle."

The court then ruled that it was illegal for the government to have recognized the human rights violations and yet failed to shift policy toward community-based medical care, provide guidance and supervision to psychiatric hospitals, or provide relief to those forced into long-term hospitalization.

The defendants have not addressed these points at all in their written argument.

Until now, we have argued that for legislative inaction to be considered illegal, it should be limited to limited circumstances, such as when the infringement of rights is clear.

Regarding the Minister of Health, Labour and Welfare's duty to act, the court also argues that the duty and authority to act in principle are not unambiguous, and therefore does not recognize any illegality under the State Compensation Act.

◆Participants' opinions

Participants in the trial report session, both in person and via Zoom, responded:

"The defendant country is trying to avoid the issue by reducing it to factual issues."

"Does the defendant country consider that medical protective hospitalization under the current law is lawful and constitutional?"

"Where has the sincere reflection and review that has been given in advisory councils, review committees and the Diet gone?"

"Is the defendant's side not shaken by Tokio's statement?"

Various opinions were expressed.

Summary

The first instance ruling is scheduled to be handed down at 2 p.m. on Tuesday, October 1st.

I have the impression that the time it takes to reach a verdict is unusually long.

What that means is unclear at this point.

Since it is a trial, there are only two options: win or lose, but there can be a fairly wide range of outcomes between the two.

We are seeking a "victory judgment" that recognizes the illegality of the plaintiff's claims under the State Compensation Act.

However, even if a "loss judgment" does not acknowledge illegality under the State Compensation Act, unconstitutionality under the Constitution may still be acknowledged.

It is also possible that the court will not make a judgment on whether a crime is unconstitutional, or that it will decide that medical protective hospitalization is constitutional.

What the defendant country is aiming for is a judgment that dismisses the plaintiff's claim without going into the issue, on the grounds that the plaintiff has not presented any factual evidence.

The wording of the ruling will determine the extent to which it will affect future mental health care policies.

We at the National Institute for Mental Health Compensation have renewed our resolve to work hard and prepare for the verdict on October 1st.

We hope to continue to discuss how we will approach the day of the verdict at future management committee and monthly meetings.

I hope that on the day of this historic verdict, we will be able to greet each other with a smile, along with Tokio.

Source: Ryuta Furuya, "Report on the conclusion of the trial," sent to the Mental Compensation Research Association member mailing list on June 21, 2024

*We apologize for the delay in posting the trial progress report to CALL4. We will post the missing trial progress report at a later date.

◆10th, 11th, 12th oral argument February 21, May 15, July 25, 2023

There has been a delay in reporting after the 9th trial date (November 29th last year), but we will summarize the trends of the 10th to 12th Ito trials since the beginning of 2023.

In the 10th (February 21st), 11th (May 15th), and 12th (July 25th) trials, the plaintiffs submitted various documentary evidence. Specifically, it includes a report summarizing 130 testimonies submitted by members, written opinions from experts (6 psychiatrists, 3 welfare workers, and 1 constitutional scholar), and a Korean court case. Examples include recommendations from the United Nations Committee against Torture, opinions from the Osaka Mental Health and Welfare Council (1999), the Society of Psychiatry and Neurology, and statements from the plaintiff, Ms. Ito.

We will write down the plaintiff's claims by extracting some of the contents of Plaintiff's Preparatory Document 6, which was submitted in a summary form.

1. Opinions regarding the medical protection hospitalization system being unconstitutional as it is intended for isolation and detention.

・For historical reasons, emphasis has been placed on the function of social defense when it comes to hospitalization of mentally ill people in Japan.

・Decisions regarding the provision of medical care for admission and discharge are made based on circumstances unrelated to the patient's medical condition.

・Prolonged hospitalization must be avoided as it can lead to facility syndrome or loss of desire to leave the hospital.

・Psychiatric hospitals do not provide appropriate medical care

・The system that requires family members to be consenting persons (guardians) is increasing isolation and detention.

2 Opinions regarding the fact that the medical protection hospitalization system is not acceptable as a “means” for restricting human rights.

・It is not stipulated that other less restrictive measures cannot be taken (this has been pointed out by the Korean Constitutional Court, the Japanese Society of Psychiatry and Neurology, the United Nations, etc.)

・It is not stipulated that even after all support is given, the patient still cannot decide whether or not to be hospitalized.

・Requirements are vague

・Lack of judicial review (conflict of interest of designated doctor, etc.)

・A review by the United Nations Committee against Torture in 2007 expressed concern that ``private mental health doctors at private hospitals play a role in issuing restraint orders for mentally ill people.'' The original text of this "detention order" is "detention orders," which refers to forced hospitalization that restricts the person, such as internment.

・Hospitalization period should be limited

・Examinations by the Psychiatric Review Board are not functioning (questions about neutrality/independence, actual situation where written examination is not functioning, actual situation where request for discharge etc. is not reached in the first place, examination is not conducted properly)

・Family consent is not sufficient to protect patient's human rights

3 Opinions regarding the unconstitutionality of special provisions for psychiatry

・Psychiatry requires more medical personnel than general medicine.

・Psychiatric special cases have a negative impact on patient treatment

4 Opinions regarding the violation of the obligation to shift to a policy centered on community medical care, etc.

・Although it was clear that the government had to develop social rehabilitation facilities, as the Clark Recommendation and the Leconte Report clearly stated that there was an obligation to develop social rehabilitation facilities, the government did not have enough financial resources to do so. Neglected the distribution of housing, workspaces, and livelihood support, etc.

・As long as there is a prior act of entrusting inpatient medical care to private hospitals, the government is theoretically required to fulfill its ``obligation to enhance local medical care'' by giving incentives to private hospitals in local medical care. , failed to promote local medical care.

・The measures advocated by the government were not effective for reintegration into society.

5 Opinions, etc. regarding violations of the obligation to provide guidance and supervision to psychiatric hospitals

・The government has created a glut of private psychiatric hospitals that have no choice but to prioritize management, has given them the power to compulsorily admit patients, and has implemented policies that allow for fewer medical personnel (precedent actions), leading to longer hospitalizations. Although the company has a duty to provide guidance and supervision to ensure that appropriate medical care is provided, the company failed to fulfill its duty by conducting audits that were not actually functioning.

6 Violation of duty to provide relief to persons who do not require hospital treatment

・Similar to the above, despite the fact that people who did not need hospital treatment were forced to be hospitalized due to the government's prior actions, the government has not taken any measures to relieve them.

・The discharge promotion support project advocated by the government does not function as a relief for people who are forced into unnecessary hospitalizations.

7. Unconstitutionality of voluntary hospitalization

・Voluntary hospitalization is not guaranteed to be voluntary, and it is inappropriate to distinguish it from compulsory hospitalization. Some cases are treated in the same way as compulsory hospitalization, and furthermore, due to the mechanism of discharge restrictions, it can cause a feeling of pressure similar to compulsory hospitalization. is given to patients, and in reality it is being used as forced hospitalization.

8 Causation

・Social inpatients like the plaintiff are common in Japan, and they are caused by the consent hospitalization/medical protection hospitalization system and national policies.

During this time, 55 to 85 people attended the trial and debriefing session. We plan to request the court to interrogate witnesses in court, but we are at the stage where the case could be concluded in the spring of 2024 at the earliest. I would like to express my gratitude to the attorneys who have worked on this task, which has taken a considerable amount of time. I would also like to once again thank Mr. Hasegawa, Attorney General, for attending each trial report session and providing commentary.

Quote source

Ryuta Furuya “Report on trial dates (10th to 12th)” Shinkokubai Tsushin, No. 30; 1-2, August 2023

◆9th Oral Argument November 29, 2022

I would like to share with you the latest developments in the National Compensation Tribunal, as well as offer my personal opinion on future developments.

First of all, I would like to thank the large number of people who attended the hearing on the 9th trial date (November 29, 2022). A total of 73 people filled the audience seats, the largest number ever, and 78 people (65 people at the venue + 13 people connected via Zoom) participated in the subsequent trial report session. Some of the undergraduate students were aiming to become mental health workers, and they listened intently to the issues at issue in the trial and the statements of the parties and their families.

In this case, the defendant country submitted a preliminary document (5). This is a written rebuttal to Preparatory Documents 3, 4, and 5 that the plaintiff has submitted so far. I would like to briefly report on the summary explained by Attorney Hasegawa at the briefing session (below, the text in parentheses is a summary of the defendant country's argument).

1. Regarding medical protection hospitalization

(1) Purpose of consent hospitalization/medical protection hospitalization

The defendant's side stated, ``Unlike other illnesses, with mental disorders, the person is not aware that he or she is sick, so the person is unable to make an appropriate judgment regarding the need for hospitalization, and Taking into consideration that there may be cases in which it is not possible to protect the interests of such persons, cases where it is deemed necessary for such persons to be hospitalized for medical care and protection, although it cannot be said that there is a risk of harm to themselves or others. The purpose of the facility is to provide appropriate medical care to the patient and thereby benefit the patient," and is not intended to be "isolated and detained," as stated by the plaintiffs.

(2) Hospitalization requirements are vague and there are no interpretation guidelines.

In response to the plaintiff's claim that there is a violation of the Constitution, ``Article 31 of the Constitution is not directly applied in administrative procedures. ``The purpose of protecting the patient's interests is legitimate, and the patient's human rights are not unduly restricted, so the doctor or designated doctor recognizes the need for hospitalization.'' ``Hospitalization is permitted only with the consent of the guardian.'' ``Requirements for discharge, standards for treatment during hospitalization, etc. are stipulated, and in addition, the Mental Health and Welfare Act A medical review board has been established, and this does not violate the legal intent of Article 31 of the Constitution.''

In addition, in response to the plaintiff's claim that it violates the United Nations Human Rights Covenant (B Covenant), ``The Psychiatric Review Committee's review of the hospitalization notification confirmed that Article 9, Paragraph 4 of the B Covenant was satisfied'' and ``The International Covenant on Human Rights Committee ``General opinions have no legal binding effect on treaty interpretation.''

(3) To guarantee access to treatment

``Inpatient medical care at psychiatric hospitals is aimed at ensuring that patients receive appropriate inpatient medical care when they need to be hospitalized for mental illnesses in which they may not even be aware that they are sick.'' This is important from the perspective of guaranteeing access to treatment.'' This is a common recognition not only by doctors, local governments, and academics, but also by those who are involved. ``Organizing debates regarding the system''), and that remains the case.''

``There has never been a consensus on the direction of immediately abolishing medically protected hospitalization,'' and ``the legal revisions that the government has carried out will provide the best possible system, taking into account advances in medical care.'' ``As a result of the plaintiff's inability to be discharged, the medical protection hospitalization system was immediately revoked under the Constitution.'' It concludes that there is no obvious violation of rights.

(4) Comparison with medical observation method

``The two laws cannot be compared simply because their objectives are very different.''

2. Regarding the voluntary hospitalization system

In response to the plaintiff's argument that the voluntary hospitalization system includes compulsion, ``the central significance of voluntary hospitalization is to promote hospitalization in a non-compulsory manner.'' ``When being hospitalized, patients are required to submit a document stating that they will be hospitalized.They can also request discharge, etc.If a request for discharge is made, in principle, the patient must be discharged.'' Furthermore, it cannot be said that hospitalization is carried out based on the doctor's unilateral decision or that the patient's consent is not guaranteed.The provision of voluntary hospitalization is a clear violation of constitutional rights. "I can't say that," he argues.

3. Regarding special cases of psychiatry

In response to the plaintiff's claim that the special provisions for psychiatry result in discriminatory staffing compared to other medical departments, the plaintiff said, ``The special provisions for psychiatry are a relaxation of standards for the placement of doctors, nurses, etc. ``There are no regulations regarding the standards for the placement of doctors, nurses, etc.'' and ``the plaintiff's claims are not specific regarding the relationship with the standards for the placement of doctors, nurses, etc.''

Furthermore, ``In all medical fields, there are diseases that require chronic treatment.In psychiatric medical care, we strive to respond to all needs, taking into account the characteristics of most mental illnesses that are chronic or that their condition rarely changes suddenly.'' Psychiatric medical care needs to be considered.In addition, the psychiatric special provisions are only a provisional provision, and the psychiatric special provisions themselves do not determine the timing of admission or discharge." The court concluded that ``the Minister of Health and Welfare has no obligation to abolish the psychiatric special provisions in relation to the plaintiff.''

4. Regarding the obligation to change local medical policy

In response to the plaintiff's complaint, the defendant country stated, ``Based on the premise, the content of the obligation to act is not clear in light of the provisions of the law and its purpose and purpose,'' and added, ``The content of the obligation to act is not clear in light of the provisions of the law and its purpose and purpose.'' The Mental Hygiene Act was revised based on the changes in the medical system due to advances in psychiatry and psychiatry.''In 1966, the ``Guidelines for the Management of Mental Hygiene Services at Public Health Centers'' was published, and in 1966, the ``Guidelines for the Management of Mental Health Centers'' were published. In 1950, operating guidelines for ``social reintegration facilities for persons recovering from mental disorders'' and ``day care facilities'' were established, and in 1980, operating guidelines for ``mental health and social life adaptation facilities'' were established, and appropriate measures have been continued since then. ``It is clear that the Minister of Health, Labor and Welfare and the Minister of Health, Labor and Welfare have not taken any illegal action.''

5. Violation of duty to provide guidance and supervision to a mental hospital

In response to the plaintiff's claim, the defendant state did not make any further comment, stating that ``this is already stated in the defendant's preliminary document (3).''

6. Violation of duty to provide relief to social inpatients

In response to the plaintiff's argument that the defendant state had an obligation to provide relief to socially hospitalized patients, it stated, ``As a premise, the content of the obligation to act is not clear in light of the provisions of the law and its purpose and purpose.'' ``Active discharge support'' and ``obligation to proactively investigate and intervene'' have been implemented as national policies.''

7. Evaluation of this trial

As mentioned above, the defendant's rebuttal this time was merely a reiteration of what the defendant had previously stated. As you can see by reading the defendant country's argument, which has been published in the Shinkokuba Tsushin newspaper, there is nothing particularly new about it, and the content is short, less than 20 A4 pages.

In particular, there was almost no response to the plaintiff's claims regarding the liability of the legislative branch (National Diet) for inaction, and regarding the responsibility of the executive branch (Minister of Health, Labor and Welfare), ``the claims are not clear'' and ``there is no obligation to act.'' ``There was no illegal omission,'' he simply repeated. What was the point in the previous trial when they requested that the trial be held in three months, saying that ``it would take time to make a counterargument''? I still feel like I was made to wait for a prank.

Perhaps (this is just speculation in my opinion) the ``Blank Amendment Bill for the Comprehensive Support Act for Persons with Disabilities,'' which includes the ``Mental Health and Welfare Act Partial Amendment Bill'' (so-called I believe that adjustments were made within the ministry to ensure that the deliberations on the Bundled Bill were not affected. In any case, I feel like the discussion ended with "That's it!" without any new counterarguments.

By the way, there was a discussion at the monthly meeting that the Psychiatric and National Health Insurance Research Institute cannot overlook this bill, so we discussed it in the expert committee and compiled our views. It was sent by fax on December 5th to 16 members of the Health and Welfare Committee of the House of Councilors.

8. Future developments in the trial

At the end of the 9th session, the plaintiff's legal team requested the submission of testimonial materials and was granted permission by the presiding judge. In response to this, the plaintiff's legal team will submit a "testimony statement" as evidence at the next 10th hearing. During this time, through the "testimony statements" of the parties, their families, and professionals, which we received with the cooperation of our members, we were able to understand the state of mental health care in Japan, not just for the plaintiff in this case, Tokio Ito, but equally. We will be able to show the court what is being experienced in each region.

In addition, the plaintiff's legal team will seek opinions from experts such as psychiatrists regarding the historical background of the segregation and detention policy, the current hospitalization system, and the Mental Health Care Review Board, which are being questioned in this trial. A special committee has been discussing the selection of the person.

The trial is about to reach its final stage. There is a limit to what each individual can do, but if you are able, I would like you to come to the courtroom for the 10th session and watch from the audience seats.

Quote source

Ryuta Furuya, “9th Trial Date and Future Developments,” Shinkokubai Tsushin, No. 28; 3-5, published January 2023

◆7th and 8th Oral Arguments May 16, 2022, August 22, 2022

Eight trials have been held so far in the mental health compensation trial in which Tokio Ito is the plaintiff. This time, I would like to share an overview of what has happened so far in preparation for the 9th trial (opening at 1:30pm on November 19th).

1. 7th date (May 16, 2022)

Plaintiff's lawyers have submitted "Plaintiff Preparatory Documents 3 and 4." Plaintiff Preparation 3 states that forced hospitalization without the need for inpatient treatment is constitutionally unacceptable, that the plaintiff had no need for inpatient treatment, that the plaintiff was unable to be discharged due to the government's inaction, and that the plaintiff's rights It also states that the state has an obligation to eliminate infringements. In addition, Plaintiff Preparatory Document 4 adds an argument regarding the unconstitutionality of consensual hospitalization and medical protection hospitalization from the perspective of restrictions on personal freedom. We will summarize the content of the plaintiff's arguments from the trial report materials from that day.

(1) Forced hospitalization without the need for inpatient treatment

In the previous (sixth) trial, the defendant country argued that the plaintiff's type of hospitalization was not a medical protection hospitalization because there was no periodic medical report in the patient's medical record. Regarding the type of hospitalization of the plaintiff, Mr. Ito, at the time of his admission to Futaba Hospital (1973), it was the era of the Mental Hygiene Law, and "voluntary hospitalization" did not yet exist in the system, so it was "hospitalization with consent" (currently medical protection hospitalization). It's clear that there was. However, due to the medical records being sloppy, it is not written how long the patient was hospitalized with consent, but since the written contents and the consent form for voluntary hospitalization were not attached, the date of the outcome in the medical record was 2003 (2003). I can only think of April 2003. Even if there is no mention of the type of hospitalization, it is clear that the patient was forced to continue to be hospitalized, and the responsibility of the state should not be denied just because it is not possible to determine the end of the period of medical protection hospitalization. .

It is clear that Mr. Ito did not need long-term hospital treatment from his condition at the time of admission and his condition after discharge. Many psychiatrists have testified that the reason Ms. Ito was not discharged from the hospital and various rights violations occurred due to the government's inaction is a problem with Japan's mental health laws and policies. This situation has arisen because the previous Mental Health Act and Mental Health Welfare Act have introduced a medical protection hospitalization system that gives extremely wide discretionary powers to doctors, and a de facto coercion system that does not guarantee the patient's voluntariness. This is because the voluntary hospitalization system that allows hospitalization has been neglected for many years. Furthermore, this is due to the neglect of the ``psychiatry special provisions,'' which have made it commonplace to have fewer staff members and have significantly lowered the quality of mental health care, leading to low medical costs and low labor costs. Furthermore, this is because the government has neglected to shift to a regional medical policy and provide guidance and supervision to psychiatric hospitals, and has left social inpatients without any active investigation or intervention. The plaintiffs argued that the laws and policies created by the government had caused the violation of Ms. Ito's rights by requiring her to be hospitalized for an unnecessary long period of time, and that it was natural for the government to have an obligation to eliminate the violation of her rights.

(2) The need for active relief by the state

One of the reasons why the state must proactively provide relief to socially hospitalized inmates is the psychological problem of the inmates. Studies such as sociologist E. Goffman's ``Asylum'' have shown that living in a closed facility for a long period of time leaves people in a state of apathy and powerlessness. The (former) National Federation of Families of the Mentally Disabled also conducted a nationwide survey on institutionalism and social hospitalization, and found that the structure of psychiatric medical care that produces "institutionalism" exists universally throughout the country. It has been revealed that the reasons behind this are low staff standards, low open bed rate, long average length of stay in hospital, lack of efforts to reintegrate into society, and lack of local social resources. Karen Monograph No. 15 "Research on the state of facility care for long-term hospitalized patients"). The plaintiffs argued that only the state can resolve these backgrounds, and that the state has an obligation to the plaintiffs to eliminate rights infringements.

(3) Unconstitutionality of medical protection hospitalization

The plaintiff's legal team has long argued that medically protected hospitalization is unconstitutional. This time, I made an additional argument from the perspective that forced hospitalization is itself a restriction on personal freedom. The consent hospitalization system, which did not require a patient's lack of decision-making capacity as a requirement for compulsory hospitalization, is clearly unconstitutional, and the medical protection hospitalization system, to which this requirement was later added, has left ambiguous hospitalization requirements and is still poorly processed. This remains sufficient and violates Article 31 (guarantee of due process) of the Constitution. In fact, since 1983, there have been more than 50,000 hospitalized patients with a condition called social hospitalization, and it is clear that medical protection hospitalization is not strictly implemented. In addition, the limited constitutional interpretation* has not been implemented, and it can be said that medically protected hospitalization is unconstitutional.

*Limited interpretation of constitutionality: Although there is room for a law to be judged unconstitutional, the court interprets it as constitutional by restricting the meaning of the provision, which is one way to avoid a judgment of unconstitutionality.

2. 8th date (August 22, 2022)

Last time (7th session), the plaintiff claimed inaction on the part of the executive branch (Minister of Health, Labor and Welfare), but this time, the plaintiff once again presented "Plaintiff Preparation Document 5" and evidence showing inaction on the part of the legislative branch (National Diet). Materials have been submitted. The defendant in this case is the government, and it is not only holding the Ministry of Health, Labor and Welfare responsible for its inaction, but also the Diet, which has not amended or repealed the law.

In order to enumerate the inaction of mental health policy in the legislative branch, the defense team examined a huge amount of parliamentary minutes spanning approximately 0 years from 1965 to 2005. Although the expert committee of the National Institute of Mental Health and Physical Education is assisting in the search for materials, the presentation of evidence was the result of the steady search work of the defense team. This is an extract of questions asked by members of the Diet (ruling and opposition parties) in the Diet (House of Representatives and House of Councilors), answers by the Minister of Health, Labor and Welfare (Labor) and government members, and opinion statements by witnesses. This work revealed that ministers and parliamentarians recognized and discussed the various issues surrounding psychiatric care at an early stage.

The main points of discussion in the Diet are: (1) the issue of social hospitalization (including social reintegration measures), (2) the issue of psychiatric special provisions, (3) the issue of psychiatric medical review boards, (4) conversion to community mental health care, and (5) medical protection. These include problems with the hospitalization system, (6) problems with the voluntary hospitalization system, and (7) problems with the isolation and detention policy similar to Hansen's disease. Issues surrounding psychiatric care have been repeatedly debated in the Diet, and it is clear that both the Diet members and the government were aware of the many issues, and that, despite being obligated to act, they have postponed fundamental reforms rather than embarking on them. We are holding the legislature accountable for its inaction.

In the preliminary document, the president of the Japan Psychiatric Hospital Association also criticized that ``so-called social hospitalization is a product of the government's inaction,'' and ``the government should apologize to the mentally ill, the mental health care workers, and the public.'' I also add that there are.

Until now, trials have been held roughly every two months, but the defendant state requested that the trial date be set three months later, saying that it would take some time to make a counterargument, and the ninth trial date was set on November 11. It was set as the 29th (Tuesday) of the month.

3. Towards the 9th date

At the 9th oral argument, the defendant country will submit a brief presenting its rebuttal. It will be interesting to see what kind of argument will be made against the evidence presented by the plaintiff's defense team.

Since the second session, the largest courtroom in the Tokyo District Court (Courtroom No. 103: 100 seats) has been used, but the restriction on the number of seats (1/2 = 50 seats) due to coronavirus measures has been lifted. Because of this, there were noticeable empty seats among the 30 to 40 spectators, and there was a possibility that the court would be changed to a smaller courtroom. If you have time, please come to the Tokyo District Court.

Quote source

Ryuta Furuya, “Summary of the 7th and 8th Oral Arguments: Pursuing the Responsibility of the Executive and Legislative Branches for Inaction,” Shinkokubai Tsushin, No. 26; 1-3, published October 2022.

◆6th Oral Argument February 24, 2022

1. Unprecedented trial and debriefing session

The 6th oral argument was held at the Tokyo District Court on Thursday, February 24, 2022. This time, something a little unusual happened, so I would like to report it in some detail.

From 11 a.m., I was standing in the lobby of the district court, forming a circle with the members who had gathered, and applauding Tokio Ito, who celebrated his 71st birthday on the 22nd, saying, "Congratulations!" when I heard a security guard say, We were warned that "gatherings are prohibited."

There were 37 people in the audience seats in Courtroom 103, and a total of 42 people including the plaintiffs and their lawyers. Even though both the plaintiff and defendant were present, the judge did not appear and the trial was delayed. The presiding judge finally appeared, unlike the previous judges, and simply greeted him by saying, ``I have been replaced.'' At the beginning of the trial, the judge asked those in the audience who were not wearing masks to wear them, but they refused, so he alerted those around them to be careful.

The trial itself only consisted of confirming the preliminary documents submitted by the defendant country and adjusting the next date, and was over in about 5 minutes after the court opened.

Afterwards, the debriefing session was held with the participants taking taxis to an inexpensive rental conference room near Shinbashi Station (all taxi costs were covered by the association's expenses, but it was still in the vicinity of Kasumigaseki). It was much cheaper than renting an expensive conference room.)

The debriefing session turned into a luncheon meeting. There were 53 participants in total, 36 in-person and 17 via Zoom. During the lawyer's report scene, Zoom crashed once, so I asked Mr. Hasegawa again to talk about the contents of the defendant's prepared statement (rebuttal). We also apologize for the inconvenience that the "debriefing materials" distributed at the venue could not be shared on screen for some reason, making it difficult for everyone participating on Zoom to understand.

The content of the counterargument in the "preparatory document (4)" submitted by the defendant country in this trial can be summarized as shown in the brackets below.

2. Regarding the plaintiff's hospitalization type

Regarding whether Ms. Ito was admitted with her consent/medically protected, the defendant state stated, ``Since there is no regular medical condition report written in the medical record, it was not a medically protected hospitalization.'' ``The guardian's notes were present regardless of the type of hospitalization, and the guardian's notes are not related to the type of hospitalization, and the record of the outcome date is also not related to the change in the type of hospitalization.'' .

It's hard to understand, so I'd like to add that this is a point of contention because the medical records were sloppy. Normally, the period of hospitalization and type of hospitalization are written at the beginning of the medical record at any hospital, but this information was missing. Also, whether it is voluntary hospitalization or medically protected hospitalization, there are documents related to the type of hospitalization that are bound in the patient's medical record, but I cannot find them. One of the issues at issue in this case is the ``medical protection hospitalization'' system. The defendant country argues that since there is no evidence in the medical records that Ms. Ito was admitted for medical protection, the plaintiff is not entitled to complain about the unfairness of her hospitalization.

3. Regarding legislative inaction

(1) Regarding the necessity of hospitalization

In response to the plaintiff's argument that ``there is no legal fact that there are cases in which the patient is unable to make an appropriate judgment regarding the necessity of hospitalization and is unable to protect his or her own interests.'' The defendant state stated, ``It is possible that a patient with schizophrenia may be unable to seek treatment voluntarily due to the effects of their symptoms and medical condition.There are cases where compulsory hospitalization may be necessary to protect the patient's interests.'' Yes," he argues.

(2) Regarding the determination of medical protection hospitalization

In response to the plaintiff's argument that ``according to the legal text of medical protection hospitalization, it is not limited to cases where the ability to make decisions has deteriorated, and it cannot be understood that there is a legitimate purpose.''

The defendant country states, ``We have issued ``Guidelines for Handling Hospitalization for Mentally Disabled Persons and Consent Hospitalization,'' and allow voluntary hospitalization.'' Furthermore, ``a judgment by a ``designated mental health physician'' whose quality is ensured and legitimacy is ensured through rigorous screening and regular training is required, and hospitalization is not permitted indefinitely.'' No,” he argues.

(3) Regarding the ambiguity of “protection” in medical protection hospitalization

In response to the plaintiff's argument that ``the requirements for ``medical care and protection'' for medical protection hospitalization are ambiguous.''

The defendant state stated, ``As the uniqueness of mental illness means that each patient is treated differently, decisions regarding medically protected hospitalization should not be regulated by uniform standards, and doctors' discretion should basically be respected.'' "It should be done." ``Similar discussions were held when the law was revised in 1999, and it was decided that it was inappropriate to uniformly stipulate it as a standard based on the law,'' according to the study committee's discussion at the time. On the other hand, the above-mentioned notice of ``Guidelines for Handling Hospitalization for Mentally Disabled Persons and Consent Hospitalization'' indicates the standard for requiring hospitalization according to the condition of each disease, and furthermore, it requires the judgment of a designated physician. However, it is not left entirely to the discretion of the doctor."

(4)Requirements for parental consent and long-term hospitalization

According to the plaintiff's statement, ``The requirement of consent from parents, etc. cannot be considered as a justification for forced hospitalization; it obscures who is responsible for forced hospitalization, and on the contrary, it is the cause of long-term hospitalization like the plaintiff.'' Regarding that claim.

The defendant's side counters by saying, ``The requirement for parental consent has nothing to do with the cause of long-term hospitalization because the judgment is made by a designated mental health physician.''

(5)About the Psychiatric Review Board

In response to the plaintiff's claim that the ``Psychiatric Review Board is not functioning.''

The defendant country states, ``The actual circumstances of each case and problems in practical implementation do not meet the requirement of ``obvious infringement of rights,'' which is a requirement for illegality under the National Liability Law.'' Furthermore, the statement argues, ``The patient's medical records include entries such as overnight stays and outings, and it is difficult to say that there was actual treatment in the hospital that violated constitutional rights.''

4. Regarding the illegality of mental health policy

(1) Regarding special cases for psychiatry

The defendant country states, ``The content is not uniquely determined, and due to its nature, it cannot be said that it should be determined, and the Minister of Health and Welfare is not obligated to act.'' The lawsuit also argues that ``the plaintiff's claim is not specific regarding the causal relationship between the existence of the special psychiatric exception and the plaintiff's inability to be discharged from hospital.''

(2) Regarding the obligation to shift from isolation and detention policy to community medical care policy

The defendant country states, ``Depending on the plaintiff's argument, the Minister of Health and Welfare's obligation to act based on the article cannot be recognized.'' He also countered by saying, ``Based on the recommendations, the government has taken certain measures.''

5. Regarding the illegality of voluntary hospitalization

(1) Legislative inaction regarding the revision and abolition of voluntary hospitalization

The defendant country stated, ``In view of the purpose of the voluntary hospitalization system, the requirements and procedures for admission and discharge, etc., the provisions of the Mental Health Act and the Mental Health and Welfare Act that establish the voluntary hospitalization system do not ``clearly violate rights.'' ”. ``The idea that the meaning of ``voluntary'' includes not only the patient's request but also a condition in which the patient does not actively refuse is based on the idea that the central purpose of voluntary hospitalization is to promote hospitalization in a non-compulsory manner. In addition, given that the patient's intention is confirmed in writing, restrictions on discharge are limited, and requests for discharge are possible, long-term hospitalization is possible without unlimited voluntary hospitalization. "I can't say that there is," he argues.

(2) Regarding the inaction of the Minister of Health and Welfare

The defendant country states, ``Depending on the plaintiff's argument, the Minister of Health and Welfare's obligation to act based on the article cannot be recognized.'' The lawsuit also argues that ``there is no specific allegation or proof that the plaintiff was unable to be discharged from voluntary hospitalization, and there is no record of this in the plaintiff's medical record.''

6. Discussion at the debriefing session

As mentioned above, the defendant country is trying to dismiss the plaintiff's question of inaction by the Legislature and the Minister of Health and Welfare using legal theory, stating that there is no obligation to act. In response to the defendant country's counterargument, those who participated in the debriefing session expressed various opinions. I would like to highlight some of the following:

① The existence and historical background of so-called ``voluntary hospitalization,'' which is not stipulated in the current law; ② Ambiguity in the procedures for compulsory hospitalization such as medical protection hospitalization and the criteria for determining ``protection;'' ③ Doctors' discretionary authority in the case of psychiatric hospitalization. (4) The need to evaluate the contents of the current Mental Health and Welfare Act in light of the Constitution, (5) The rapidly increasing number of isolated detentions that the Ministry of Health, Labor and Welfare should be aware of, etc. (6) The issue of in-hospital work such as in-hospital and out-of-hospital work that Ms. Ito was also engaged in, etc.

At the debriefing session, Mr. Ito also revealed a surprising fact about his stay at Futaba Hospital. Many questions and discussions and opinions were exchanged over an hour and a half.

7. next trial

The next 7th trial date is Monday, May 16th at 10am. This time, the plaintiff's defense team will make a second argument against the defendant country. Now that we have a new presiding judge, we need to show that many people are paying close attention to how this trial will proceed. If you are available, please include this in your schedule and participate in the court viewing activities.

Source

Ryuta Furuya, “Defendant State Denies ``Obligation to Act'' - Report on the 6th Trial Date,'' Shinkokubai Tsushin, No. 22; 1-3, published March 2022.