Japan: shock report on mental hospitals

Press, 29 May 1985, Page 19

Japan: shock report on mental hospitals

From

PETER McGILL,

in Tokyo

The International Commission of Jurists is to call on Japan to make sweeping reforms in the way the country treats mental patients. In a report, shortly to be published, the Geneva-based commission is presenting evidence of “widespread and gross abuses.” The major scandal — but one which the I.C.J. calls only “the tip of the iceberg” — is the deaths of 222 mental patients in three years at the private Utsunomiya hospital, north of Tokyo. Two of the patients, it is alleged, were clubbed to death with iron pipes and sticks. The hospital afterwards explained these deaths as being due to “natural causes.”

Corpses of more than 40 patients, it is said, were illegally dissected and anatomical parts kept as “specimens.” The hospital director, Bunnoshin

Ishikawa (eventually found by the Government to be unqualified), allegedly beat unruly patients with a golf club on his nightly rounds.

Ishikawa is now in prison, sentenced for having forced some patients to work as staff and conduct tests on other patients, including the injection of drugs. Health inspectors found that many patients at Utsunomiya did not require hospitalisation at all. These included alcoholics, drug addicts, and vagrants. The hospital had kept them merely to increase its profits. One of the major I.C.J. findings is that bad conditions in this and other hospitals are largely due to the “extreme privatisation" and lack of Government control of mental health care in Japan.

Mental health has become of one Japan's growth industries, with

330,000 patients in hospitals, 87 per cent owned by the private sector. Treatment, however, is still largely funded from national insurance.

Two-thirds of these patients are kept in “locked wards," according to the 1.C.J., and length of stay is far higher than in other advanced countries. The average is 560 days but in many cases it runs into 5 to 15 years. “Treatment" consists largely of “control in locked wards and chemotherapy, it doesn't do any good in the long term," says an I.C.J. team member, Dr Timothy Harding.

Admission controls are so slack that, in the words of a Japanese human rights lawver, Etsuro Totsuka, the hospital?’'have degener-

ated into a “dumping ground for the unwanted.”

A staggering 93 per cent of all Japanese mental patients have been involuntarily confined: a few are “dangerous” cases committed on orders from local governors, but the vast majority are put inside by a simple form of “consent” from parents or guardians.

Because of what the Health and Welfare Ministry likes to call “Japan’s unique culture, which stresses the family,” once such consent is obtained all that is needed is a test by the hospital admitting the patient. No independent psychiatric diagnosis is required. \ Japan has no restrictions on

setting up in psychiatric practice, and one of the “minimum” recommendations the I.C.J. will make in its report is a licensing system. At present, Japanese mental hospitals have a financial incentive to have “more patients and fewer staff” and to hold on to their patients as long as possible as a form of “fixed asset," Mr Totsuka points out. There is no right of automatic psychiatric review of patients once confined, as the Ministry of Health and Welfare claims it “lacks enough money" to carry it out.

Private management of hospitals in Japan frequently deny their inpatients access to a lawyer or even a telephone.

"We asked the Government what human rights mental patients have in Japan, and the reply was 'habeas corpus,' ” says one I.C.J. team member. “But in. the pas

five years only two cases have reached the courts.”

Last year, there was a mass escape by patients. On another occasion ' a 37-year-old patient packed his bags, announced he was leaving, and was kicked by a male nurse and suffered a broken rib. When the I.C.J. team tried to visit the Tanak Hospital this month they were “refused entry.”

One member of the I.C.J. team thinks the situation in Japan is so bad as to require condemnation by the world psychiatric community. Japan was one of the leading delegations to condemn the Soviet Union at the World Psychiatric Association in 1977 for the silencing of dissidents in mental hospitals, yet the majority of Japanese psychiatrists overlook the abuses of patients in their own hospitals. Copyright—London Observer Service.