Thursday, May 9, 2013

Reform of Mental health act in Japan

The Japanese government introduced a bill for reforming of Mental Health and Welfare Act into Parliament on April 19, 2013.

Ministry of Health, Labour and Welfare: The bills introduced into 183rd Parliament (in Japanese)

A topic on this reform is guardianship. Mental Health and Welfare Act regulates guardianship for patients with mental disorders. When a patient was sent to a mental hospital involuntarily, the spouse or other one of family members will be elected as a guardian for the patient. A psychiatrist with designated physician license is able to force the patient who needs to be protected to be hospitalized if the guardian agrees with the hospitalization. This scheme is called “admission for medical care and protection”. This form of hospitalization is adapted for one-third of all inpatients with mental disorders.

Guardians have some legal obligations. Historically, they were responsible for making the patient go to the hospital regularly and avoiding the patient from harming self or others. Even now, they have to accept the patient when discharged from the mental hospital. These obligations burdened the family member who had elected as a guardian. Some associations of family members of the patients with mental disorders were being opposed to this scheme of guardianship.

Therefore, Ministry of Health, Labour and Welfare tried to reform the mental health law.

According to the bill, Regulation of guardianship no more exist. The new “admission for medical care and protection” is approved when one of the family members, if not a guardian, agreed with the opinion of a licensed psychiatrist.

This reform includes some controversy.
What happens if another person of the family members were opposed to the involuntary hospitalization? Formerly, other family members than the guardian had no right to be opposed to the decision of involuntary hospitalization. For a guardian, the power of supporting involuntary hospitalization coincided with the responsibility for protecting. The new bill equips a regulation about a request for discharge by some family members. Mental health practitioners would experience hard time when there is a quarrel among family members.

From the beginning, I think that the scheme of admission for medical care and protection is problematic. It is strange that an agreement of a family member, who are not an expert of psychiatry or law, is mandatory for forced hospitalization. This scheme originated in traditional Japanese culture. However, the relationship of the family is not so close nowadays in Japan. We have to reconsider the regulation about involuntary hospitalization.

Nonetheless, too radical reform will be confusing for the patients. I understand this reform as only a transitional measure.


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