◆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.

◆5th Oral Argument December 6, 2021

On Monday, December 6th, the fifth oral argument in the Ito trial was held at the Tokyo District Court. This time, in response to the written rebuttal submitted by the defendant country last time (September 27), the defense team submitted ``Plaintiff Preparatory Document 2'' and presented a rebuttal. The main text alone is 50 pages long, so it is impossible to introduce all of it. In the courtroom that day, the following "summary" was read out by Attorney Hasegawa.

Plaintiff Preparation Document 2 (Summary)

1 Overview

Plaintiff Preparatory Document 2 first clarifies the plaintiff's hospitalization status based on the descriptions in the plaintiff's medical record (hospitalization medical records). We would like to draw your attention to the fact that the plaintiff, who did not require hospital treatment, continued to be forced to stay in the hospital despite repeated requests to be discharged. It is clear from the plaintiff's medical records that the plaintiff was forced to be hospitalized under the medical protection hospitalization/consent hospitalization system or the voluntary hospitalization system.

And the cause is not a problem with individual hospitals. This is the reality of Japan's mental health care. This is a flaw in laws such as the Mental Health Act, the Mental Health Act, and the Mental Health and Welfare Act, and it is also an issue of special provisions for psychiatry, which allows the minimum number of medical personnel. This is simply because the government has neglected to provide guidance and supervision to hospitals to ensure standards, and to provide relief to long-term hospitalized patients.

The history and progress of mental health care in Japan has been argued in the complaint and Plaintiff Preparatory Paper 1, but in Plaintiff Preparatory Paper 2, the actual situation is explained by citing the books of doctors and lawyers, or by the defendant's The actual situation is clarified in the refutation of the claim.

At the same time, Plaintiff Preparatory Paper 2 also alleges the unconstitutionality of the voluntary hospitalization system. The voluntary hospitalization system is not a normal hospitalization system like that used in other medical departments. In effect, it functions as a system that forces hospitalization.

The gist of this is described below.

2 Actual status of the plaintiff's hospitalization

First, plaintiff's preliminary document 2 discusses the plaintiff's type of hospitalization. In this regard, the medical records that the plaintiff received from the hospital do not clearly state the plaintiff's type of hospitalization. It is the reality of Japanese mental health care that such a situation occurs, but judging from the medical records, which emphasize the presence of guardians, the plaintiff was transferred to the hospital on September 2, 1973. It is understood that the patient was admitted as a consensual or medically protected hospitalization from April 30, 2003, and thereafter as a voluntary hospitalization.

Regarding the actual circumstances of the hospitalization, the plaintiff's condition is stable, and there is no need for hospitalization. One example of this is the following entry in the 1991 (Heisei 3) medical record:

"He is as calm as ever. He is working hard in the kitchen. He is calm and calm, without fighting with other patients in the ward. He is being treated kindly. Of course, he has not had any unusual experiences."

These plaintiffs repeatedly expressed their desire to be discharged throughout their hospitalization. However, this was completely denied. In some cases, the consent of the hospital director was given priority rather than that of the attending physician; in other cases, the family was held responsible for the lack of social resources, and that the discharge would not proceed unless the family accepted it; and even though some attending physicians were proactive about discharge, If the situation changes, discussions about discharge will not proceed at all, and not only will there be no consistency in what kind of treatment will be provided upon hospitalization, but the exact name of the disease and the condition will not be explained to the patient, and people will be told that they are not being hospitalized. I was led to believe that my condition would heal someday.'' There is little support for discharge.

Originally, in light of the plaintiff's medical condition, etc., it was fully possible for the plaintiff to continue treatment while living in the community, that is, even though there was no need for hospitalization, the plaintiff was forced to be hospitalized. This has continued to be the case.

As a result, the plaintiff lost his desire to be discharged from the hospital and was formally admitted to the hospital voluntarily, but this was not truly voluntary. In fact, because the patient was admitted voluntarily, violations of the plaintiff's rights were not checked and he was forced to stay in the hospital.

3 Japan's mental health system - national inaction

This is not a problem specific to the plaintiff or the hospital where the plaintiff was admitted. This is a problem with Japan's mental health care system.

Ryuichi Hirano, a lawyer who once served as a member of the Mental Health Subcommittee of the Public Health Council, said that when it comes to housing people with mental disorders in hospitals, it is ``easy to get in and easy to get out'', ``easy to get in and hard to get out'', ``hard to get in and easy to get out'', and ``easy to get out''. Diagrammatically there are four types: ``difficult to get in and difficult to get out''. Psychiatric care in Japan is nothing short of ``easy to get in and hard to get out.''

This kind of ``easy to get in, hard to get out'' mental health care is a policy of isolation and detention, and its human rights violations are extremely clear. Therefore, even in accordance with the Supreme Court's criteria claimed by the defendant, the legislative inaction is illegal, and the deficiency in the legal system, which does not consider hospitalization and discharge as two sides of the same coin, must be remedied by reason. Although the defendant claims that he has developed facilities and a care system in the community, mental health care in Japan remains ``easy to get in and hard to get out.''

The state must be held responsible for the infringement of rights caused to the plaintiff.

4 Problems with the voluntary hospitalization system

Additionally, as mentioned above, Plaintiff Preparation 2 further asserts that the voluntary hospitalization system is unconstitutional.

The voluntary hospitalization system was established in 1987 when the Mental Health Law was revised to the Mental Health Law.

This is different from normal hospitalization in other medical departments. "Consent" for voluntary hospitalization is interpreted to include a state in which the patient is able to refuse hospitalization, but does not actively refuse, and does not actively consent to hospitalization based on the patient's free will. This is not the only situation. Restrictions on discharge from hospital are also stipulated by law. Furthermore, under the voluntary hospitalization system, there is, in principle, no system to review the voluntary nature of hospitalization or the necessity of continued hospitalization. It is no exaggeration to say that there are many cases of closed treatment, and that compulsory hospitalization in the name of voluntary hospitalization has been established.

The plaintiffs are also victims, and the inaction of the National Diet in not amending or repealing such an unconstitutional law is illegal. The Minister of Health and Welfare's failure to correct the remuneration system and establish a system to supervise voluntary hospitalization is illegal.

Therefore, the defendant state is liable for compensation to the plaintiff even if the plaintiff's type of hospitalization is voluntary.

☆

The issue at issue in this case should be clear from the above ``gist'' alone. The plaintiff, Ms. Ito, was unjustly forced to stay in the hospital for a long period of time, even though her condition did not require hospitalization at all. This could be any hospital, not just an individual hospital. This is because it is a violation of rights caused by Japan's mental health legal system, which is ``easy to get in and hard to get out'' due to its segregation and detention policy. The defense team presented a variety of arguments and argued that the country was responsible for failing to make drastic policy changes and neglecting to provide relief to long-term hospitalized patients. Furthermore, it was argued that not only medical hospitalization but also voluntary hospitalization, which was never of the patient's free will, was unconstitutional due to its coercive nature.

The government's rebuttal to this plaintiff's argument will be presented at the 6th oral argument (February 24th). The National Institute for Mental Health Insurance has a policy of working with the defense team to search for and collect documentary evidence. We appreciate your understanding and cooperation.

Source

Ryuta Furuya, “Plaintiff Preparation for the 5th Oral Argument 2: Additional Allegation of Unconstitutionality of Voluntary Hospitalization,” Shinkokubai Tsushin, No. 20; 4-5, published December 2021

◆3rd Oral Argument June 29, 2021

We would like to report the summary of "Preparatory Document 1" submitted by the plaintiff's legal team in conjunction with the third oral argument (June 29th). Please note that the actual document is 64 pages long, so here is only a condensed summary. In response to the content of this document, the defendant country is scheduled to submit a written rebuttal on the fourth session (September 27th). The impressions of those who attended the trial are published after this report.

1. Summary of Preparatory Document 1

The defendant country's torts that the plaintiff alleges include: (1) legislative inaction in creating a medical protection hospitalization (consent hospitalization) system that violates human rights guaranteed by the Constitution and failing to amend or abolish it; and (2) a spirit that violates Article 14 of the Constitution. There is the inaction of the Minister of Health and Welfare in not abolishing the special provisions for the Department of Health and Welfare, and (3) the inaction of the Minister of Health and Welfare regarding mental health policy. In order to understand this, I will describe the historical progress regarding mental health care in Japan.

2 Facts

The plaintiff was forced to be admitted to a psychiatric hospital against his will for approximately 40 years from 1973 to 2012, but in the 1960s the defendant promoted a policy of isolated detention for mentally ill people. It was a time when In 1950, a consent hospitalization system was established in the Mental Hygiene Act, and special provisions were made for psychiatry, allowing psychiatric hospitals to be maintained with fewer medical personnel. In addition, the Medical Care Law was revised and the Medical Finance Corporation Law provided economic preferential treatment, making it easier to establish and maintain private hospitals. The defendant also issued notices and used compulsory hospitalization to lead the mentally ill to hospital. These segregation and detention policies created a situation in which psychiatric hospitals could continue to operate as long as they housed patients within the hospital.

Medically, antipsychotic drugs began to be released in 1955, and doctors began to see the prospect that patients could be discharged from hospital if treated. However, the defendant continued to ignore the findings of the mental health survey, the opinions of various councils, and the recommendations made by Clark, and instead proceeded with a policy of isolation and detention, without taking any measures to reintegrate him into society in preparation for his discharge. In Western countries, the number of psychiatric beds was reduced in the 1970s and a shift was made to community medical care, but in Japan, even after the number of required hospital beds was exceeded by the Medical Council in 1976, defendants continued to be kept in isolation. As a result, the number of psychiatric beds continued to increase until 1993.

Since the 1960s, mentally ill people who were hospitalized were unable to be discharged and remained in the hospital for a long time, and a 1983 mental health survey found that if the conditions were right, there were people who could be discharged. It turns out that there are about 100,000 people. However, facilities for reintegration into society were not developed, and tens of thousands of mentally ill people continued to be left without being able to leave the hospital, even though they did not need hospital care. The plaintiff is one of the patients who was forced to undergo such an unnecessary hospitalization.

It can be seen from the budget allocation that the defendant has not made any sincere efforts to rehabilitate mentally ill people. The national budget for people with mental disabilities continued to increase to approximately 85 billion yen from the late 1970s to around 1980, and more than 90% of this amount was for subsidized hospitalization. In 1970, social reintegration facility development was first budgeted for, but this accounted for only 0.1% of the budget for mentally ill people, and even in 1980 it accounted for 0.35%. In the 1980s, hospitalization subsidies were reduced, but the overall budget for mentally ill people continued to be reduced, and no funds were used to build facilities for reintegration into society. In addition, even now, 70% of medical expenses are inpatient medical expenses, and compared to other medical departments where the number of hospitalizations and outpatient visits are approximately equal, psychiatry is clearly focused on hospitalization.

3. Legislative inaction that did not reform or abolish medical protection hospitalization

Medical protection hospitalization has not essentially changed since it was established in the Mental Health Act as consent hospitalization. It is a system that violates important constitutional human rights such as freedom of body, freedom of movement, and the right to self-determination, and it also violates equality under the law in that it allows for forced hospitalization by private individuals only for people with mental disabilities. It is also contrary. Since the system's inception, the main purpose of consensual hospitalization has been to isolate and house mentally ill people, and it cannot be said that it has a legitimate purpose. There are only vague requirements for hospitalization, such as the need for medical care and protection, and without establishing strict screening standards, the requirements themselves are vague and unclear, allowing arbitrary implementation. In fact, there are also large regional differences.

Historically, the consent admission system, which was a free hand of hospital administrators, has been abandoned for nearly 40 years. The consent hospitalization system should have been abolished at the latest when the law was revised in 1987, but the requirements were not changed and the name was changed to medical protection hospitalization and it was preserved. Since then, there have been numerous opportunities for review, and calls for the abolition of the medical protection hospitalization system have been voiced by related organizations, but the requirements have only been slightly revised, and there has been no impact on the actual situation of medical protection hospitalization. No legislative action was taken to correct the issue. Such legislative inaction is illegal.

4 Inaction by the Minister of Health and Welfare who did not abolish the psychiatric special provisions

The defendant created a special exception for psychiatric patients and continued to leave psychiatric patients unable to receive the necessary level of medical care compared to other medical care. This is contrary to the latter part of Article 13 of the Constitution, Article 25 of the Constitution, and Article 14 of the Constitution.

5 Inaction by the Minister of Health and Welfare regarding mental health policy

The Minister of Health and Welfare's inaction regarding mental health policy includes the following:

(1) Violation of obligation to change from isolation and detention policy

Due to the country's isolation and detention policy, many people with mental disabilities are forced to remain in hospitals, depriving them of their lives. Since the defendant had personally created a state of serious human rights violation, he had an obligation to change his policy from isolated detention to community medical care in order to eliminate the situation. At the latest, after receiving the Clark Recommendation in 1968, which specifically specified the content of the duty to act, it would have been possible to proceed with the development of social reintegration facilities and the enhancement of community medical care. Despite this, the defendant did not even give any concrete consideration, and on the contrary, continued to increase the isolation and detention policy until around 1980, without setting up social rehabilitation facilities, and without providing budgetary measures or medical fees to improve community medical care. No changes were made. The Minister of Health and Welfare should have changed the quarantine policy to a regional medical care policy, but he did not do so.

(2) Violation of duty to provide guidance and supervision to psychiatric hospitals

The defendant had a duty to instruct and supervise to ensure that inpatient medical care was being provided appropriately so that hospitalization would not be prolonged longer than necessary or unnecessary hospitalizations would be avoided. There was also an obligation to ensure that the capacity was met and to supervise and correct the situation to ensure that the hospital did not become overaccommodated beyond the permitted number of beds. In addition, there was a duty to supervise compliance with health worker staffing standards. In addition, there was an obligation to establish a system to ensure appropriate medical standards, such as changing staffing standards, revising medical fees, and establishing an audit system.

Since the 1960s, improvement recommendations and Clark recommendations from the Administrative Management Agency have pointed out the institutionalization of patients due to inappropriate medical care and long-term detention, and it has become clear that many hospitals do not meet staffing standards and are overcrowded. It had become. Although this should have been corrected immediately, it continued to be neglected even into the 1980s. Furthermore, no system was established to ensure appropriate medical standards, such as changes in staffing standards or revisions to medical fees.

(3) Violation of duty to provide relief to persons who do not require hospital treatment

As a result of the defendant's policies, tens of thousands of people have been confirmed to have been forced to stay in psychiatric hospitals even though they should not have needed inpatient care and could have been discharged. Even after voluntary hospitalization was legally stipulated in the 1987 legal reform, the requirements for medically protected hospitalization remained unchanged, despite calls for clarification of operating standards. The Ministry of Health and Welfare is in breach of its duty to strictly apply such laws.

Furthermore, many patients who were forced to stay in psychiatric hospitals for long periods of time were formally switched to voluntary hospitalization, but by that time they had lost the will and ability to leave the hospital on their own. The plaintiff is one such patient. The government should proactively investigate and intervene for such patients, and has an obligation to proactively eliminate such unnecessary hospitalizations through relief measures such as policy support, revision and abolition of laws, and improvement of law enforcement. there were. However, the Minister of Health and Welfare has continued to ignore this issue since 1987.

6 Summary

Therefore, the plaintiff holds these defendants responsible for their tortious acts.

that's all

Quote source

Ryuta Furuya “Report on the 3rd Oral Argument - Outline of Plaintiff's Preparation Document -” Shinkokubai Tsushin, No. 16; 1-3, published July 2021

◆4th Oral Argument September 27, 2021

The 4th oral argument was held at the Tokyo District Court on Monday, September 27, 2021, from 4:00 p.m. This time, the defendant country presented a rebuttal to the preliminary documents submitted by the plaintiff last time.

A total of 60 people participated in the post-trial debriefing session, 35 in person and 25 via Zoom. Due to an internet glitch, some of the broadcasts were interrupted, and we apologize to those who participated via Zoom. Once again, I would like to summarize the contents of the state's rebuttal written by the defense team.

1. From start to finish on legal theory

The counterargument presented by the government this time can be broadly divided into two parts: (1) "Regarding the plaintiff's allegation regarding legislative inaction by members of the Diet," and (2) "Regarding the plaintiff's allegation regarding the Minister of Health and Welfare's inaction." In both cases, the ``premise'' at the beginning is the legal theory of what is meant by ``illegal'' in Article 1, Paragraph 1 of the National Liability Claim Procedure Law. (Hereinafter, the contents of "Preparatory Document 3" submitted by the defendant country are summarized and indicated in " ".)

(1) Regarding legislative inaction by members of the Diet, it states that ``it does not depend on whether a violation of rights has occurred as a result, but is limited to cases in which they violate legal obligations in the course of their duties.'' Citing Supreme Court precedent, it states that ``if it is clear that the content of legislation or legislative inaction violates the constitutionally guaranteed rights of the people,'' and ``the people have an opportunity to exercise their constitutionally guaranteed rights.'' It is essential to take the necessary legislative measures to ensure that the law is in place, and this is limited to exceptional cases, such as when the Diet fails to do so for a long period of time without justifiable reason, even though it is clear that this is the case.'' doing.

② Regarding the Minister of Health and Welfare's inaction, ``the act of the public servant in question was obligated as a ``legal obligation in the line of duty,'' and the public servant required to perform the act must be aware of the content of his duty of care and do his best.'' It must be clear enough that it is possible to do so." ``Determinations must be made in a manner that conforms to the principles of legal administration, and a wide variety of content, methods, and responses are required depending on the situation, in light of the underlying legal provisions, purpose, and purpose, etc. This is an administrative policy, and if the content is not univocally determined, there is no room for it to be interpreted as a legal obligation on the job." ``There must be a breach of a legal obligation owed to the person.''

For those outside the legal field, the words are difficult to understand, but in light of this ``premise,'' it cannot be said that the content of the plaintiff's complaint is illegal under the National Liability Law, and that the legislative branch (National Diet) and the executive branch The plaintiff claims that the (Ministry of Health, Labor and Welfare) is responsible for inaction (not doing anything that should have been done), but the government denies that it has any responsibility to respond. In the first place, from a legal perspective, this lawsuit is being dismissed completely as not being established.

According to one of the plaintiff's lawyers who was also involved in the former Eugenics Protection Law lawsuit, ``It feels like we are being shown the same copy-pasted text.'' Since the case is handled by the same litigation specialist, the wording is likely to be similar, but it is probably a common ``premise'' used by the government when it attempts to dismiss the case against a citizen seeking national compensation.

2. Specifics regarding legislative inaction

Regarding the legislative inaction by the Diet members, they argue that (1) ``the period of the plaintiff's consensual hospitalization or medical protection hospitalization is not clear,'' and 2) ``It cannot be said that the illegal violation of rights is obvious.''

Regarding ①, the medical records at Futaba Hospital, where Mr. Ito was hospitalized, were sloppy and there was no record of when the transition from medical protection hospitalization to voluntary hospitalization occurred. It is presumed that the patient was admitted to voluntary hospitalization upon the death of his father, who was his guardian (obligation), but it is troubling that the voluntary hospitalization document signed by the patient is no longer available.

Regarding ②, the government stated, ``Consensual hospitalization and medically protected hospitalization are different from other illnesses, in cases of mental disorders, where the person is not aware that he or she is sick, This takes into account the fact that a person may be unable to make decisions and protect his or her own interests.'' ``Restrictions on movement during hospitalization are limited to cases where the designated doctor (or the doctor in consent hospitalization) recognizes the need for hospitalization for medical and protection purposes and the consent of the person responsible for protection is obtained.'' Restrictions on sending and receiving letters, telephone calls and meetings with lawyers are prohibited, isolation and physical restraint can only be performed by a designated doctor, and standards for treatment are also established. I am claiming. ``For consensual hospitalization, notification is required to the governor, and if the governor deems it necessary after investigation, two or more expert doctors can conduct an examination.In medical protection hospitalization, along with notification, periodic "They are required to report their medical conditions, the contents of which are examined by the Mental Health Review Board, and in addition, a discharge request system is allowed." I object that I can't say it.

3. Specifics regarding administrative inaction

Regarding the Ministry of Health, Labor and Welfare's administrative inaction, we refute the following points: (1) the evaluation of the psychiatric special case, and (2) the plaintiff's allegation of legal inaction.

Regarding ①, it states that ``the Medical Care Act does not stipulate a specific standard for the number of patients by law.'' ``The special provisions for psychiatry are based on the fact that many mental illnesses are chronic diseases, or their conditions rarely change suddenly.'' It is not something that can be determined uniquely and cannot be said to be illegal under the National Liability Law." The lawsuit also argues that ``the plaintiff has not specifically asserted or proven that the plaintiff was unable to receive adequate medical care due to the existence of special psychiatric provisions.'' The plaintiffs are required to prove the causal relationship that Ms. Ito was forced to stay in the hospital for a long period of time due to the psychiatric exception.

Regarding ②, it states that since ``there is no specific legal provision for a theoretical obligation to act,'' ``there is no room for it to become a legal obligation based on the duties described in the premise.'' Therefore, ``the Minister of Health and Welfare is not guilty of any illegality,'' and ``the Minister of Health and Welfare cannot be recognized to have had any legal obligations in relation to the plaintiff.''

Furthermore, the government has (1) revised the Mental Hygiene Act (assignment of mental health counselors, establishment of mental health centers, support for counseling at home, etc.), and (2) developed social reintegration facilities (social reintegration facilities for people recovering from mental disorders). , day care facilities, mental health and social life accommodation facilities, etc.), 3. Medical fees have been revised (occupational therapy, day care, night care, group psychotherapy, visiting nursing/guidance fees, etc.), 4. Community mental health measures have been promoted. (outpatient rehabilitation projects, counseling and guidance projects for reintegration of mentally ill people into society, supplementary budget for small workshops, etc.), ⑤ Enacted the Mental Health Act (increased budget for social reintegration facilities for mentally ill people, social reintegration measures, etc.), ⑥ The Mental Health and Welfare Act has been revised (creation of mental health and welfare centers, local mental health councils, notebook system, enhancement of social reintegration facilities and projects, regional mental health and welfare measures, formulation of plans for persons with disabilities, increase in mental health and welfare-related budgets) etc.), 7) It also provides guidance to psychiatric hospitals (issues notices, etc. requesting respect for the personality of inpatients, treatment that does not violate human rights, and proper operation of the consent hospitalization system, and the Minister of Health and Welfare is providing on-the-job guidance and If requested by the Psychiatric Medical Examination Board, it would have been possible to provide guidance and supervision by exercising the above-mentioned supervisory authority, etc.).

Four. Evaluation of the defendant country's counterargument

The government maintains that it has carried out its duties according to the circumstances at the time, and has never been inactive. The various measures mentioned above have been realized little by little due to the demands and campaigns of those involved, but the Ministry of Health, Labor and Welfare's assertion that it has done everything it can gives a painful impression. Looking at the items listed, it is clear that no strong intervention measures have been taken against psychiatric hospitals. The more positively the Ministry of Health, Labor and Welfare shows its achievements to date, the more negative problems that have not been addressed, i.e., administrative inaction, will be exposed.

The central bureaucrats in Kasumigaseki are extremely talented people. It is not that the Ministry of Health, Labor and Welfare is unaware of the current state of mental health care. Despite knowing the various facts, the government has been unable to step into psychiatric hospitals. The collusion of political, financial, and public officials related to the interests of the Psychiatric Hospital Association, which has strong political power, has turned the policy-making process related to mental health care into a black box. Looking at the rebuttal written by the defendant country in this case, there is a sense of complacency based on ``adult circumstances'' that avoids touching on the ``inconvenient truth'' about psychiatric hospitals in this country. It is unfortunate that vested interests and ministerial interests that must be protected are prioritized instead of confronting the plaintiffs.

The Institute for Mental Health Insurance and the plaintiff's lawyers will not just engage in dogfights over legal theory, but will pile up concrete facts experienced by mental health care users to show the actual situation and hold the country responsible for its neglect through inaction. I would like to appeal to the authorities.

Quote source

Ryuta Furuya, “Ministry of Health, Labor and Welfare Avoiding Inconvenient Truths: Summary of Defendant State’s Rebuttal Written at the 4th Oral Argument,” Shinkokubai Tsushin, No. 18; 1-3, published October 2021.

◆2nd Oral Argument April 20, 2021

1. Situation of the trial on the day

The second oral argument in the case with Tokio Ito as the plaintiff was held at the Tokyo District Court on April 20, 2021. Members of the Mental Health Research Institute gathered at 10 o'clock in the lobby of the district court. This time, it was held in courtroom 103, which can accommodate 50 people in the audience seats, and there was no lottery for audience seats. There were 32 people in attendance, as the state of emergency was about to be declared in Tokyo due to the spread of the new coronavirus infection.

The trial was an administrative one, confirming the preliminary documents submitted by the defendant country and adjusting the next date. The defense team made a statement requesting an explanation from the government regarding the ``odds and dangers of medical protection hospitalization (hospitalization with consent),'' but to the untrained eye it was unclear what was going on, and the trial ended within about 5 minutes of the opening. it's over.

After the court closed, the group walked through the government district of Kasumigaseki and headed to a rental conference room in Nishi-Shinbashi. The debriefing session was held with a total of 49 participants, with 29 members in the conference room and 20 members connecting online via Zoom.

2. Contents of the defendant country's preliminary documents

At the debriefing session, Attorney Hasegawa explained the preliminary document (1) submitted by the defendant country to the court. This document was a document indicating whether the defendant acknowledged or disapproved of the facts stated in the complaint submitted by the plaintiff.

Generally, in a trial, one of the following three stances must be made regarding each other's claims.

・“Accept” → The assertion is not disputed as fact.

・“I don’t know” → I don’t know the claim as a fact.

・“Denial” → The claim is different from the facts and is disputed.

In this document, the government acknowledged the existence of objective legal content, notices, and recommendations regarding the content of the plaintiff's complaint, but generally showed an attitude of "ignorance" or "denial." The lawsuit also shows a stance of contesting the fact that ``the plaintiff spent time in a psychiatric hospital against his will without receiving adequate discharge support,'' stating not only ``ignorance'' but also ``denial.'' Furthermore, the defendant country has requested that the plaintiff clarify the specific details of the omission alleged by the plaintiff and the legal basis for creating the obligation to act.

In other words, although the government is showing a stance of fighting the case fully, it is not actively asserting the legitimacy of its mental health policy at this point, and is instead asking the plaintiffs to prove their claims.

3. Q&A/opinion exchange

After receiving the report and explanation from the lawyer, and taking questions from participants in the venue and via Zoom connection, as well as the press, Mr. Hasegawa provided an explanation. Here, I will write down only the main points of the questions posed that day and the content of the exchange of opinions, from Furuya's notes.

・There are several types of hospitalization, but I would like to know the basis for the doctor's decision to admit the patient in the case of compulsory hospitalization, as I am not sure.

- Decisions on hospitalization for medical protection are said to be based on the ``need for medical care and protection,'' but the definition of ``protection'' is vague and there is no written document.

・As for whether the Psychiatric Review Board is functioning, it is largely a mere document review.

・When a request for discharge is made, the Psychiatric Medical Review Board comes to the hospital where the patient is admitted to investigate, but the current situation is that it almost never leads to discharge.

・How will items that the government claims are "unknown" be handled in the future?

- ``I don't know'' means I don't know, so I ask the plaintiff who sued to provide a detailed explanation.

・Will the plaintiff be able to argue that the situation of medically protected hospitalization should have been changed but was left unconstitutional due to inaction?

・What is the government's claim that it is ``ignorant'' that Mr. Ito was originally able to be discharged from the hospital, but ended up being hospitalized for a long time without receiving sufficient discharge support?

・The government was expected to claim that it did not know about Ms. Ito's background, but it has also shown a stance of contesting the matter by denying it.

- Even after looking at the medical records, does the government deny Mr. Ito's "social hospitalization"?

・It is unclear whether the government is considering the fact that he is in a state of social hospitalization as "unknown."

・In the defendant's seat are four people who are in charge of litigation at the Ministry of Health, Labor and Welfare and the Ministry of Justice. Officials from the Ministry of Health, Labor and Welfare were also present in the audience.

・I think this trial will be quite long.

・The progress of the trial will depend on how much concrete arguments and evidence the defense team can present.

・At the next date, the plaintiff will present concrete claims and evidence to the defendant, who is demanding more specific clarification.

・Is it true that the country is taking an ``all-out fighting stance''?

・This time, we have presented in writing the content of the explanation given at the previous date. An attitude of fighting based on ``ignorance'' and ``denial.''

・We will continue to seek an explanation for the violation of the constitution.

・Many people are hospitalized for long periods of time because their families are unable to support them after they are discharged from the hospital.

・In the first place, there are major problems with the system for medically protected hospitalization. The structure in which families defending their rights consent to forced hospitalization creates a conflict of interest with patients. Medical protection hospitalization will be one of the main issues in this trial.

・Are inpatients properly informed that they can apply for discharge to the Psychiatric Medical Examination Board?

・It is not even known that such a system for requesting discharge from hospital exists. This should originally be communicated to patients, but it is unclear whether this is actually done.

・There is a possibility that the issue in this trial is whether the government is thoroughly providing guidance and supervision to ensure that patients are aware of their obligation to do so.

・Although the Psychiatric Review Board exists as a system, it hardly functions to protect the rights of patients.

・How is the necessity of hospitalization determined?

- Lawyers should be cautious about the necessity of hospitalization, but what is the current situation? Medical workers tend to be involved in a protective manner, taking into account the situation in the patient's area.

・According to the current law, ``two or more'' of the five members of the review committee must be designated mental health physicians, but as before the revision, in some local governments the majority of physicians are three, which is used in a protective manner. There is a reality.

・It is also necessary to consider specific figures such as the status of the examination committee.

・It is difficult to file a complaint alone if there is no one to follow up on your request for discharge.

- Mechanisms for lawyers and others to be involved in the defense of rights are insufficient.

・There are many long-term hospitalized patients who are reluctant to leave the hospital even if they want to because they are causing trouble for everyone, and swallow their words.

- In France, the judiciary is always involved when a patient is hospitalized, with a judge meeting directly with the patient to determine whether hospitalization is appropriate. The same applies to hospitalization.

・In many Western countries, the judiciary is involved in making decisions when a patient is hospitalized against his or her will.

・The "protection" part in the case of medical protection hospitalization is easily expanded and used as a requirement for hospitalization in Japan.

・After seeing the coverage of this trial, a patient who had been hospitalized at Futaba Hospital came forward to testify about Mr. Ito's condition at the time and the reality of his life at Futaba Hospital.

4. in conclusion

The defendant country has shown a stance of ``ignorance'' or ``denial'' of the content of the lawsuit, fully contesting the lawsuit. The preliminary document presented by the government is extremely businesslike and concise, and does not provide any details as to the reason for the "unknown" or "denial."

The next court date has been set for June 29th (Tuesday) at 11am. It will be the same as this time, Courtroom 103 of the Tokyo District Court. Up to 50 people can be seated in the auditorium, but the doors will be opened a few minutes before the court starts on a first-come, first-served basis. There will be no lottery for tickets.

In response to the defendant country's explanations of "unknown" and "denial," the plaintiff's legal team will develop a counterargument based on the content of the complaint. The actual trial is about to begin. The situation with the new coronavirus at that time is unclear, but if you can make the time, please join us. We would like to meet at the lobby of the Tokyo District Court at least 30 minutes before the meeting.

The one-coin campaign at the debriefing venue was 7,146 yen. Thank you for your cooperation. Securing a venue in the city center is expensive. Thank you for your continued support.

Quote source

Ryuta Furuya, “Defendant country's attitude to fight full-throttle with ignorance/denial - report on second oral argument”, Shinkokubai Tsushin, No. 15; 1-3, published May 2021

◆ 1st oral argument March 1 , 2021 _

We would like to report on the first oral argument held on Monday, March 1, 2021.

Thank you to everyone who rushed to the Tokyo District Court on the day of the hearing and gathered before 9 a.m. After a brief meeting in the lobby of the district court, they went outside, took a commemorative photo in front of the court, and then marched down the sidewalk with banners in hand. Members of the press also rushed to the scene, filming the event with numerous cameras and videos.

I had hoped that 20 to 30 people would come to the trial, but by the time the audience seats were drawn 20 minutes before the trial, over 50 people had come. Thank you to everyone who won the lottery and gave away their tickets. Thanks to you, I was able to witness the start of the historic trial, although it was a small courtroom No. 611.

[Status of trial]

The first trial itself ended with the same formal exchanges that take place in a normal trial. In response to the complaint filed by the plaintiff, the defendant state had already submitted a written response stating that it would fight for the dismissal of the claim, but it was a short answer stating that ``the reasons will be disclosed later.'' . In court, a representative for the defendant country pointed out that ``the basis of the obligation to act is unclear from the complaint,'' but during an exchange with the presiding judge, the defendant country first clarified its counterargument. After that, the plaintiff side decided to specifically allege the obligation to act, etc. Based on these exchanges, the next court date was set for April 20th, and the defendant country had until April 13th, one week before that date, to submit its rebuttal.

Afterwards, the presiding judge asked, ``Plaintiff, state your opinion,'' and Ms. Ito, the plaintiff, stood up and read out the document she had prepared. Ms. Ito seemed quite nervous, but she began by reading a poem she had written, and then talked about her thoughts while in the hospital, how not only herself but also her friends had committed suicide, and how she wanted to help those who were still in the hospital. , Ms. Ito expressed her stance and clear intentions in this trial. The well-spoken words of the opinion statement filled with thoughts touched the hearts of those listening, and they could not stop their eyes from heating up in the audience seats.

Afterwards, Mr. Hasegawa, the lawyer representing the defendant, stated his opinion that the plaintiff was not alone in his experience, that the reality of Japan's mental health care is that there are still tens of thousands of people in the same situation, and that the country is not treating basic human rights. He stated that he would hold the government accountable for neglecting the violations that have been committed, through the complaint of the plaintiff, who is one of the victims of this country's policies.

[Court report session]

After the court closed, members and supporters who had been waiting in the lobby moved to the adjacent Bar Association Building. We held a debriefing session in conference room 508, which was secured by Attorney Sato, and as expected, more than 50 people attended, and the room was full with some standing.

There were 20 people who accessed the Zoom broadcast of the debriefing session. Including those who left before the debriefing session and those who rushed to the debriefing session afterwards, approximately 80 people participated in the first oral argument and debriefing session. . We would like to express our sincere gratitude to everyone for their heartfelt participation.

At the debriefing session, there was a little time until the preview time for the Zoom broadcast, so at the suggestion of vice president Mr. Sugiyama, we started with the participants introducing themselves in a few words, just like in the monthly meeting. One participant said, ``I want to be a plaintiff too,'' which drew applause.

Afterwards, for those who were unable to enter the courtroom, Mr. Ito read out his statement of opinion once again, and attorney Hasegawa also read out his statement of opinion on his behalf.

This was followed by a question and answer session from the participants. Below is only the gist of the question.

・This is the first lawsuit, but are there any plans for a second or third? Which one?

・Is it because it was a psychiatric hospital in Fukushima Prefecture? Are there disparities between prefectures?

・It seems that the homepage has stopped being updated, but don't you think there is a need to disseminate more information on the internet?

・How are court costs covered?

・As mentioned in the opening question of the defendant country, on what basis is it seeking an explanation regarding the legislative inaction or the administrative obligation to act?

・Will witnesses be brought forward in future trials, although it will depend on the type of issue at issue?

・Mr. Ito, the plaintiff, how did you feel after standing in court again?

・How do you view the fact that there are 2nd and 3rd plaintiff candidates?

・Why not raise a one-coin donation here?

・Isn't the fact that the Psychiatric Review Board is not functioning being a bottleneck?

・Do judges never change?

After briefly answering each question, the lawyers who made up the defense team gave greetings and expressed their beliefs. We also received another introduction to the crowdfunding CALL4.

At the end, Deputy Representative Sugiyama and Representative Higashitani gave greetings, and the plaintiff, Mr. Ito, said, ``Thank you for coming from a far away place today.I would like to continue to fight for the people living in institutional care.'' However, I hope that you will support me.Thank you for your support,'' he said, closing the meeting.

The next court date is April 20th (Tuesday) at 11:00 a.m. However, the court has contacted lawyers and, based on the number of people wishing to attend, the courtroom has been changed to the larger courtroom No. 103. We would like to inform you that up to 50 people will be allowed in the court this time.

We would also like to inform you that we received a donation of 16,538 yen for the ``One Coin Campaign'' proposed by the participants at the debriefing session.

We know it will be a long road ahead, but we appreciate your continued support. We would also appreciate it if you would please spread the word to those who are interested in this trial to join us and support us.

Quote source

Ryuta Furuya, “Details of the 1st Oral Argument in the Shinkokokubai Litigation (First Filing),” Shinkokubai Tsushin, No. 14; 1-3, published March 2021

○Date and time: Wednesday, September 30, 2020, 3:00 p.m. to 4:00 p.m.

○Place: Ministry of Health, Labor and Welfare Press Club

○ Sponsored by: Psychiatric National Compensation Litigation Study Group

○Speakers:

Plaintiff Tokio Ito

Attorney in charge: Keisuke Hasegawa

Attorney in charge Akiko Sato

Representative Yukimasa Higashitani

Vice Representative Eriko Sugiyama

Executive Director Ryuta Furuya (Proceeding)

○th

1) Opening speech by Representative Higashitani

2) Greetings from the plaintiff: Mr. Tokio Ito

3) Lawsuit report Attorney Hasegawa + Attorney Sato

4) Q&A with reporters

5) Explanation of future campaign policy Vice Representative Sugiyama

6) Closing

7) Individual interviews/Q&A

1. In place of the opening speech, Yukimasa Higashitani, representative of the Institute for Mental Health Research

I have worked in the field of mental health and welfare for 35 years, and I have seen many people suffering from extremely severe mental health care, as well as families suffering from severe discrimination and prejudice, as well as financial burdens. Too many people are suffering.

Alexievich, a writer who won the Nobel Prize in Literature, wrote, ``War has no female face,'' and I have felt the same way in the world of mental health and welfare in Japan. "Japanese mental health care does not have a human face."

20% of the world's psychiatric beds are located in Japan. There are far too many patients hospitalized for extremely long periods of time, which is unprecedented in the world. Although the government was aware of this situation, it has continued to ignore the situation without offering any solutions. There is also a special case for psychiatry, which allows the department to have far fewer staff members than other clinical departments. Most of the psychiatric beds in our country are in private hospitals, which are dominated by profit-making. There is an abnormal world in mental health care in this country, where inhumane practices such as locking up patients and depriving them of their lives for profit are commonplace.

I have watched the current state of mental health care in Japan with anger and sadness. For this reason, we established this study group in January 2013. The purpose, of course, is to file a lawsuit for compensation from the state, but for this purpose we have conducted research and collected materials, including the history of mental health care in Japan, comparisons with international standards, and understanding of the current situation.

I am carrying the earnest feelings of many people involved, their families, and those involved in mental health and welfare. There was some hesitation about the idea of inviting plaintiffs publicly and holding a trial, but many victims of mental health care in their lives responded to our call. All of you are the people who stood up for us, not for personal gain, but to prevent any more people from becoming victims of psychiatric treatment. Together with all of you, we hope that through the trials, the people will learn about the reality of mental health care in our country and that we can change it.

This is a trial that we must win, but we do not know the outcome. However, regardless of the outcome, I hope that this court battle will serve as an opportunity to change the current situation of Japan's pathetic mental health care. Japan's psychiatric care, which had not changed despite recommendations for improvement and resolutions of condemnation from the United Nations, recommendations for improvement from the WHO, and recommendations from the ICJ (International Commission of Jurists), has changed, and people with mental disorders are now being treated in the local community. I hope to contribute to moving closer to a society where people can live in harmony.

2. Greetings from the Plaintiff (Summary) Plaintiff Tokio Ito

I have been hospitalized in a hospital in Fukushima for 39 years. The effort it took to get discharged from the hospital was no mean feat. I think it was a good thing that I was determined not to give up.

I have seen many patients suffering from institutional disease. I have seen patients (patients) who had been trying to get out of the hospital but couldn't bear it anymore and committed suicide. Some committed suicide by jumping onto the railroad tracks. There are still many patients with institutional disease. I felt sorry for them, and when I thought about what I could do, I decided to appeal to the government.

The reason why people stay in the hospital all the time is because they think that the hospital is good for long-term hospitalization, and they start to think that there is nothing they can do even after they are discharged. I also suffered from institutional illness at the hospital in Fukushima. I didn't have a driver's license, I couldn't have a social life, and I had given up, thinking there was nothing I could do.

The Great East Japan Earthquake occurred, the hospital was closed, the Fukushima Daiichi Nuclear Power Plant exploded, and the area was also a radioactive area, so I was transferred to another hospital. The last hospital I was transferred to was Ibaraki, where I was able to be discharged after a year and a half. There was no talk of him being discharged from the Fukushima hospital. I think I couldn't leave the hospital because the emphasis was on management.

My reason for filing a lawsuit is to eliminate people suffering from institutional disease. The reason I want to appeal to the government is because there are too many hospitals that are creating institutional disease, and I want them to eliminate institutional disease.

3． Keisuke Hasegawa, lawyer in charge of the complaint summary

Today, we filed a lawsuit with the Tokyo District Court demanding national compensation, alleging the illegality of our mental health policy. I would like to explain the outline as follows.

Summary of this trial

In this case, the plaintiff, who suffered from schizophrenia and was forced to stay in a psychiatric hospital for approximately 40 years, seeks damages from the state as the defendant.

This case is similar to the lawsuit against the unconstitutionality of the Leprosy Prevention Act (Hansen's disease) in the sense that the state seeks compensation for its isolation and detention policy, but the issue of mental health care is more complex. Regarding the Leprosy Prevention Act, the issues at issue in the court were both the illegality due to legislative inaction and the illegality of the policies of the Minister of Health, Labor and Welfare, but this case is a trial that only questions the illegality of the policies of the Minister of Health, Labor and Welfare or the Minister of Health, Labor and Welfare. .

The specific details of the illegality of the policy being questioned in this trial are as follows.

First of all, Japan's mental health policy was as follows: (1) Based on the positioning of people with mental disorders as dangerous to society, consensual hospitalization (currently known as medical protection hospitalization) was stipulated, and the Mental Health Act was enacted. (2) So-called psychiatry, which entrusts people with mental disorders to private hospitals with the premise of long-term incarceration, makes it easier to establish private hospitals, and allows fewer doctors and nurses than general hospitals. (3) Although Western countries have specifically considered the transition from inpatient medical care to community medical care and community welfare and have changed their policies, Japan has changed its medical policy, at least in relation to the time of the plaintiff's hospitalization. (4) Despite the fact that it is compulsory hospitalization, the substantive requirements for consensual hospitalization under the Mental Health Act are extremely vague, and the examination procedures are insufficient. 5.Despite the prejudice on the part of the local community formed by the above structure, families have been positioned as those who have consented to forced hospitalization, and families have continued to be burdened with the dilemma of protecting their own human rights. It is assumed that the justification for long-term hospitalization is that the patient's family had no choice but to request continued hospitalization. Article 13 of the Constitution, Article 14 of the Constitution, Article 22, Paragraph 1 of the Constitution, and Article 25 of the Constitution state that due to the resulting long-term hospitalization, we were deprived of the right to live in the community that we take for granted. In addition, the patient's long-term hospitalization without guaranteeing the right to due process was a violation of Article 31 of the Constitution.

It was clear at the time of the Clark Recommendation on May 30, 1961 that such a state of violation of the Constitution was occurring and that there was a need to rectify it. In December 1991, when Japan adopted the ``Principles for the Protection of People with Mental Health Care and the Improvement of Mental Health Care,'' the Minister of Health, Labor and Welfare or the Minister of Health, Labor and Welfare implemented a shift from a policy of isolation and detention to community medical care. Despite recognizing the need to take effective discharge measures for long-term hospitalized patients, it is illegal under the National Liability Act to ignore this (policy change, effective discharge measures should be taken). It is argued that the omission to act even though there was a duty to act is illegal.

4. Q&A with reporters (summary)

■Freelance

- During your 40 years in Fukushima, you must have wanted to be discharged from the hospital, but have you ever done any work outside the hospital?

(Mr. Ito) I worked outside the hospital for one year at a poultry farm, then at a factory for one and a half years, then at an equipment company for one and a half years, and then returned to the poultry farm for 10 years. Even though I worked, there was no talk of being discharged from the hospital, so I went back to work. Work in the hospital was in the kitchen for 13 and 14 years.

■Shinano Mainichi Newspaper

-What do you think your life would have been like if you had been discharged from the hospital sooner?

(Mr. Ito) If I could have been discharged from the hospital, I would have gotten a girlfriend and gotten married. There's nothing you can do at the hospital, and the relationship between men and women is noisy. After being discharged from the hospital, I am free to go to karaoke. Having children was a dream.

■Kyodo News

- Was it voluntary hospitalization for Ms. Ito, given that she was admitted with consent?

(Lawyer Hasegawa) According to the records, he was admitted for medical protection until April 2003, and then voluntarily admitted.

-Then, it becomes clear that it is difficult for Mr. Ito's family to be discharged even after voluntary admission, but did Mr. Ito's family request to be discharged but were unable to do so, or were they unable to request that he be discharged?

(Mr. Ito) His father had no intention of letting him leave the hospital. According to his father, the hospital vaguely told him that they would let him leave the hospital if it was okay for everyone to see, so his father couldn't get him to leave the hospital.

- Mr. Ito seems to be able to lead a social life, but it is difficult for the general public to understand that he was unable to leave the hospital for 40 years.

(Lawyer Hasegawa) Ms. Ito has been suffering from ``facility syndrome'' repeatedly, but she did not realize that she did not want to be discharged from the hospital or that she had switched to voluntary hospitalization.

(Attorney Sato) I recognize that this is a problem in mental health care that is difficult for the general public to understand. The psychiatry ward (closed ward) is a closed space, and the doors are locked, so you cannot go outside. A small society is formed there. If you do that, you will end up with "institutional disease." It is far removed from our daily lives. No matter how hard Ito tried, the country that created this closed society did nothing to open it up. This is where we are suing the government, and since there are still many people suffering from institutional illness, we are appealing to the government as to what it should do.

(Mr. Ito) People who are on the verge of becoming institutionalized think that they can't do anything for themselves even after being discharged from the hospital. I didn't have the financial means to pay for the hospitalization, so I thought so too. However, one day, my doctor told me that he would make sure that I received a disability pension, and then the Great East Japan Earthquake occurred and I received compensation money, so I decided to leave the hospital because I had more financial leeway.

(Lawyer Hasegawa) It is cruel to ask Mr. Ito to give this answer. What seems obvious to me is not obvious to Ms. Ito, so I would be happy if people would think of this trial as a way to ask that question once again.

■Nishinihon Shimbun

- Isn't the necessity of medical protection hospitalization a point of contention?

(Attorney Hasegawa) There is no doubt that Ms. Ito has been in the state she is in (remission) for decades, so is there a need for her to be hospitalized? I want to ask. I think this will be argued in court. The government may argue that hospitalization is unavoidable because the hospital administrator made that decision. I think we will come to call it ``social hospitalization.''

■Toyo Keizai Online

- What was the situation like when the hospital was switched to voluntary hospitalization in 2003?

(Mr. Ito) I think he worked at a poultry farm. I worked because I wanted to get out of the hospital.

(Lawyer Hasegawa) As far as I can read from Mr. Ito's records, I think that after his father passed away, Mr. Ito had been working hard for his father, so it was a time when his life stopped. It is expected that the desire to be discharged from the hospital may have waned.

-Why was there no activity at the hospital?

(Mr. Ito) Before the Great East Japan Earthquake, I was asked to go to a group home, but I had developed facility disease and had no desire to leave the hospital.

- Please tell us the similarities and differences between this lawsuit and the Hansen's disease and forced sterilization trials.

(Attorney Hasegawa) Regarding Hansen's disease, it was easy to understand that even though it was clear according to the world standard that it was medically curable, it was a result of legislative inaction left unchecked by the government. On the other hand, although it is exactly the same in terms of isolation and detention, it is not easy to standardize what will happen after mental illness is cured. Since it is not easy to do so, it may be difficult to say that it is clearly illegal. However, if we look at multiple factors, we can see that prior to Hansen's disease, advice was given regarding psychiatric care, including the Clark Recommendation. In fact, I think they should have moved in the direction of opening up sooner.

(Lawyer Sato) The major commonality is that the state has assisted in the categorization of people with disabilities and the discrimination and prejudice against that category. Or perhaps they have actively done so to justify their isolation and detention. They have created discrimination and prejudice, and they also have in common that the state has abandoned its obligation to protect the fundamental human rights of each individual, and that they are not fulfilling the fundamental requirements. This also means that discrimination and prejudice still remain deep-rooted.

■Asahi Shimbun

-If there is anything like this that you would like to see in Japan in the future, please let me know.

(Representative Higashitani) In Vancouver, Canada, there are almost no long-term hospitalizations, only short-term hospitalizations. There is outreach. Japan has group homes, but they are a stereotype. I think Japan should also take advantage of the system for living in the community and allow people to be hospitalized for a short period of time.

(Lawyer Hasegawa) In the West, there is a perception that long-term hospitalization is a violation of human rights and therefore unacceptable. We allocate a budget to the region for what the region lacks or needs. I think that setting a budget for coordination is a trend in Japan.

■Bengoshi.com

-I would like to know the age of the long-term hospitalization period.

(Mr. Ito) From the latter half of 16 years old, early 17 years old, up to 61 years old, including once discharged from the hospital. The longest of these was in Fukushima for 39 years, and he has never been discharged from the hospital.

-You mentioned earlier that a patient committed suicide, but have you ever thought about suicide, Mr. Ito?

(Mr. Ito) Yes. I once jumped when I was hospitalized in a hospital in Tokyo.

―I think 40 years is a very long time, but the length of hospitalization

I would like you to tell me.

(Mr. Ito) There are people who have longer lives. There was a person who had been hospitalized for 46 years.

(Representative Higashitani) Data from 630 surveys (mental health and welfare materials) is available.

(Secretary Director Furuya) Once discharged (transferred), the period will be reset. There are still no statistics that reveal the true situation of long-term hospitalization patients.

■Nishinihon Shimbun

―Most psychiatric hospitals in Japan are private hospitals due to management issues.

(Representative Higashitani) Countries that provide community medical care are publicly managed. Japan is privately run and this will not change, so we have no choice but to rely on the power of the judiciary.

-What do you think about the system that requires a guardian (medical protection hospitalization)?

(Attorney Hasegawa) If we look at the relationship between psychiatric care and families, the system in which family members become consenting parties and assume responsibility should be changed. Some people involved in health and welfare administration seem to wonder why it is necessary to talk about this as a ``human right'' when a family member wants to be hospitalized. Families fear that the public will wonder why they are hiding a mentally ill person, and that if they are not hospitalized, they will have no place in their community. And if the family says (if they agree), the hospital will admit them. I think this is the structure that creates long-term hospitalization. Whether it has anything to do with the court case is another matter, but this also has to change.

Five. Future activity policy - Request to journalists Eriko Sugiyama, vice representative of the Institute of Spiritual Health and Welfare

The voices of the people I've met so far, such as, ``I shouldn't have been born?'' and ``I want to live outside the hospital, just for one day,'' are echoing in my head like a running light.

This lawsuit was made possible because Mr. Ito had the great courage to become the plaintiff. Ito's desire is to somehow help the many people who are still in the hospital, whose hopes of being discharged have been dashed over and over again, who have become hopeless and institutionalized, to live as freely and freely as he does. This is a lawsuit filed by Mr. We at Kokubiken feel the same way, and we are positioning this lawsuit as the first one, and plan to file lawsuits in various locations one after another. Therefore, we would like to request that people who have experienced being forced into such unjust forced hospitalization as victims of this country's mental health administrative system become candidates as plaintiffs. Also, as a witness in the trial, I was given the chance to see inside the hospital, which is shrouded in darkness, and where the general public cannot get a glimpse into what they thought and how they lived there. We would love to hear your testimonies from your experience.

Furthermore, under the current medical protection hospitalization system, not only the patient but also their family members are victims who are forced to give consent. There you can see the family crying, saying, ``I feel so sorry for this child, how much I would like to replace him if I could replace him.'' How many family bonds have been destroyed by this system? As a matter of national policy, we would like to pursue the possibility of filing a national compensation lawsuit with the family as the plaintiff in the future.

From October 1st, we will be opening the following telephone number for inquiries. We plan to recruit plaintiff candidates, witnesses, and supporters (new members and supporters). We ask that everyone understand how we are looking for these kinds of people and help us spread the word.

Inquiry counter Tel: 03-6260-9827 (10:00-20:00, rotating staff)

The Mental Health Research Institute is a very small voluntary organization. In order to create ``psychiatric care that anyone in this country can receive with peace of mind,'' we cannot do it alone. I think it is necessary to arouse public opinion. For this reason, I would like to request the efforts of members of the media to widely report on this matter, including the progress of the trial. Our organization, Shinkokokuikeken, actively responds to requests for interviews from reporters. Thank you.

I hope that with your help we can arouse public opinion and win this lawsuit.

(14 reporters in attendance/12 members of the Mental Health Research Institute)

Quote source

Ryuta Furuya “First lawsuit filed – Press conference details” Seishinkokubai Tsushin, No. 10; 1-7, published October 2020