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

Abstract

BackgroundUntil the recent enactment of the Medical Treatment and Supervision Act (MTSA) in 2005, neither legislations nor facilities for mentally disordered offenders were available in Japan. The aim of the country’s forensic mental health services, based on this new law, is to improve the social reintegration of mentally disordered offenders. In order to provide optimal psychiatric care to these individuals, specialised court proceedings, treatment facilities, and concrete guidelines have been established. The aim of this study was to review the current status of the new system and to clarify future challenges for improving services.MethodsThe authors collected official statistics regarding the new system published separately by the Ministry of Health, Labour and Welfare, the Ministry of Justice, and the Supreme Court of Japan. We aggregated the data and examined the system’s current implementation status, nationwide.ResultsThere were 2,750 requests for enrolment in the MTSA system between its initiation in 2005 and 31 December 2012. Of those requests, 2,724 cases had been concluded in court. In 63.1% of the cases, an inpatient treatment order had been made; 82.4% of those inpatients were diagnosed with schizophrenia. By the end of March 2012, two patients completing treatment under the MTSA had re-committed a serious offense. While overall designated inpatient and outpatient treatment facilities have reached national targets in terms of resources and beds available, a regional gap in MTSA designated facilities remains and the number of patients under inpatient treatment order is on the increase.ConclusionsOverall, the MTSA system has been running smoothly without encountering any serious problems. However, several concerns have emerged, such as the accumulation of patients under inpatient treatment order and insufficient regional resources. To more successfully promote the reintegration of mentally disordered offenders, improvements in outpatient treatment and welfare services are crucial. In order to install effective measures to help improve the system, a nationwide database of patients being treated under order of the MTSA should be properly built and maintained.

Differences between British and Japanese perspectives on forensic mental health systems: A preliminary study

“…Consequently, in Japan, offenders with schizophrenia are inevitably dominant in the FMH setting[9]. Since forensic psychiatrists in Japan devote most of their expertise and energy to the treatment of schizophrenic patients, they hardly deal with psychopathic patients who may be incarcerated in prison[10]. Additionally, Japanese forensic psychiatrists do not have a very strong sense of responsibility with regard to contributing to public safety.…”

“…However, this fact should be interpreted cautiously because some patients discharged from an MSU are transferred to a low secure unit, HSU, or prison. In contrast, Japanese legislation has no provision for discharged patients to be recalled to prison[10]; moreover, there are no facilities equivalent to HSUs in Japan.…”

Defining outcome measures of hospitalization for assessment in the Japanese forensic mental health scheme: a Delphi study

“…However, many factors including recidivism were probably shown likely to be invalid as outcome measures [ 27 ]. Furthermore, recidivism may not be available as an outcome measure for HfA because the rates of recidivism of the crimes associated with the MTS act are usually too low to be statistically examined [ 8 ]. Therefore, we had to develop an original series of HfA outcome measures.…”

“…The offender is then obligated to accept the special psychiatric care provided by the designated medical facilities and to submit to continuous supervision by a Rehabilitation Coordinator working in a probation office. Thus, for the first time, courts and officers of the Ministry of Justice are involved in the treatment of patients with mental disorders, signaling the beginning of a new era for forensic mental health services in Japan [ 8 ].…”

Web-Based Violence Risk Monitoring Tool in Psychoses: Pilot Study in Community Forensic Patients

“…The majority of patients treated in such a setting would have a primary psychotic diagnosis with or without comorbid personality disorder and substance misuse. Similar services designed for mentally disordered offenders exist in other jurisdictions including the United States, Northern Europe, Australia, and Japan (Fuji, Fukuda, Ando, Kikuchi, & Okada, 2014 ; Hayes, Kemp, Large, & Niellsen, 2013 ; Pinals, 2014 ), but rates of patients per head of population vary widely (Priebe et al, 2008 ).…”