Risk Factors for Problematic Behaviors among Forensic Outpatients under the Medical Treatment and Supervision Act in Japan

Abstract

The Medical Treatment and Supervision Act (MTSA) was enacted in 2005 in Japan to promote the reintegration of clinical offenders with mental disorders into society. Under the MTSA, individuals who committed serious crimes in a state of insanity or diminished responsibility are diverted from the criminal justice system to the mental health system. Based on court decisions about MTSA-based treatment, clinical offenders have an obligation to engage in rehabilitation within their local community under the guidance of mental health professionals. However, patients under MTSA-based clinical treatments have faced various problems in the course of treatment, because of psychiatric as well as other static or dynamic factors, and sometimes have committed problematic behaviors, such as violence and medical non-compliance. Hence, this study aimed to clarify factors related to patients’ inclusion in MTSA-based outpatient treatment and additionally, their commitment of problematic behaviors, based on confidential data acquired during a four-year government survey period (National Center of Neurology and Psychiatry) from MTSA enactment (July 15, 2005) to December 31, 2009. In total, we recruited 441 clinical offenders receiving MTSA-based outpatient treatment from 158 nationwide facilities. To evaluate related factors, we collected demographic, psychiatric, forensic, clinical treatment, and social service information. Statistical analyses demonstrated that predominant profiles of patients included male gender, younger age, low school history, psychiatric diagnoses (F1, F2, and F3), and no correctional or outpatient history before MTSA-based treatment. F1 or substance use diagnosis, in particular, was increasingly correlated with other factors, such as male gender, older age, and correctional history before MTSA treatment. Among the 441 patients, 189 (43%) committed problematic behaviors in the course of the MTSA-based outpatient treatment. Risk factors for patients’ commitment of problematic behaviors comprised F1 diagnosis and inpatient history before MTSA-based treatment inclusion. In summary, reduction of overall problematic behaviors under the MTSA outpatient likely makes progress by focal attention to patients with psychiatric disorders caused by substance use and/or a past inpatient history for more severe psychiatric symptoms. This work is of ongoing and future importance in the domain of forensic community treatment, to connect risk-enhancing factors with risk management.

Validity of Short-Term Assessment of Risk and Treatability in the Japanese Forensic Probation Service

“…At Time 1, the average length of MTSA outpatient treatment was 14.46 months [standard deviation (SD) = 8.66 months]. Overall, the study sample did not significantly differ from the national MTSA sample in terms of distributions of gender, age at Time 1, diagnosis, or index offense ( 25 ).…”

Assessing attribution in the criminal behavior of mentally disordered offenders: Developing a Japanese version of the Gudjonsson Blame Attribution Inventory‐Revised

“…Only if intensive psychiatric treatment is deemed to be necessary is the inmate transferred to a medical prison. The second falls under the Medical Treatment and Supervision Act (MTSA), passed in 2003 and enacted in 2005, which implements patient care for individuals whose criminal charges have been dismissed due to their psychological incompetence, who have been found not guilty by reason of insanity, or who have been given a suspended sentence and not been imprisoned because of diminished responsibility for their offenses 2,3 . The aims of psychiatric care in correctional institutions for guilty persons and forensic psychiatric units for those not guilty are the same, that is, to assist the individuals to preserve their health and stimulate their participation in society consequent with their abilities and preferences while preventing recidivism.…”

The Perspective of Forensic Inpatients With Psychotic Disorders on Protective Factors Against Risk of Violent Behavior

“…In Japan, legislation to provide specialized treatment to forensic service users with mental disorders, along with the Medical Treatment and Supervision Act (MTSA), have been enforced since 2005, symbolizing the beginning of fully fledged forensic psychiatry (1)(2)(3)(4)(5). According to the Medical Treatment and Supervision Act Hospitalization Guidelines, developed by the Ministry of Health, Labor and Welfare, service users are required to seek necessary medical care autonomously and be willing to work proactively on their issues (6).…”