Reader J.M. has an adult stepson who has been receiving treatment for schizophrenia for more than 20 years, including several hospital stays. J.M. says that his stepson has tried various support groups over the years to regain some semblance of normal life, and his stepson is losing faith in his doctor and the medical system.
Things took a more serious turn recently when his stepson tried to attack J.M., who then had to call the police. Although this stopped the fight, J.M. is now very concerned about the safety of his family. He writes:
We are getting locks installed on the bedroom doors. We have hidden the knives. We live in fear. The doctor and schizophrenic texts agree that once the violence starts there will be further bouts of it. The doctor says there have been cases where the patient’s family and the doctor agree that the patient needs to be hospitalized and the police take the patient to hospital. When I asked the police, they refused.
The doctor says we should bring him to hospital, but if we try to get him to do that, he will become angry and violent. Is there some system in Japan for the police, ambulance or hospital to take an unwilling patient to hospital?
Schizophrenia is a mental disorder in which people interpret reality in an abnormal way. It is usually characterized by disorganized speech and behavior, hallucinations and delusions, resulting in reduced social interaction. Often beginning in young adulthood, it may require ongoing treatment for the rest of the patient’s life.
Until fairly recently, schizophrenia was known as seishin bunretsu byō (split-mind disorder) in Japanese, but this was changed to tōgō shitchō shō (loss-of-coordination disorder) in 2002 by the Japanese Society of Psychiatry and Neurology. The aim was to help alleviate prejudice against those with schizophrenia.
There are two categories of involuntary hospital admission in Japan:
1) “Hospitalization for medical care and protection” (iryō hogo nyūin): In this case, the physician can admit a patient without his/her consent if deemed necessary, and provided the family consents. However, it usually requires that the family is able to convince the patient to physically go to the hospital in the first place.
2) “Compulsory admission” (sochi nyūin) aka commitment: This does not require the patient or family’s consent, but is executed on the order of the prefectural governor. It requires proof of the possibility of harm to self or others, and that two psychiatrists independently agree that hospitalization is required. In such cases, the police may transport the patient to the hospital. Due to the relatively strict criteria, however, this type of admission appears to be quite rare. Moreover, if the patient acts relatively normally when the police arrive and there does not seem to be any immediate threat of harm, they may be reluctant to get involved.
Lawyer Seiji Yamaura of the Tokyo Public Law Office writes on legal issues for The Japan Times. He provided further details on the second category and offered some advice on how it could possibly be implemented in JM’s family’s case. Sochi nyūin comes under the Act on Mental Health and Welfare of the Persons with Mental Disorders (精神保健及び精神障害者福祉に関する法律, or Seishin Hoken oyobi Seishin Shōgaisha Fukushi in kan suru Hōritsu). Specifically, Article 29 of that act stipulates that the governor of the prefecture can commit a person who is diagnosed with a mental disorder and causing self-harm or violence toward other people.
“In the reader’s case, I think he should have a consultation with the police officers at the Seikatsu Anzenka (Community Safety Department) first,” Yamaura says. “If the stepson commits violence, he should tell the officers that his stepson has a mental disorder and ask that the governor be notified of the situation through the director of the hokensho (health center).”
One major problem could be how to physically transport a reluctant patient to hospital, but there are services that can help. These are often called fukushi isō (welfare transportation) or kanja isō (patient transportation). While their main line of work is ferrying around elderly and physically disabled patients, many companies will also help out in cases like that facing J.M.’s family. Staff are trained to match the needs of clients.
One such firm is Tokyo Fukushi Unso Service, which provides transport throughout metropolitan Tokyo. A spokesperson said the family of the patient should register in advance so the firm has a clear understanding of what will be involved if and when their services are required, such as the number of personnel to send. Like a regular taxi service, distance is also factored into the costs.
While these transportation services can get the patient to hospital, it is up to the patient’s physician to find them a hospital bed in advance — you can’t just “show up.”
Worth a mention is Minna Net, which offers support and advocacy for patients and families through The National Federation of Mental Health and Welfare. Telephone counseling is available every Wednesday from 10 a.m. to 3 p.m. on 03-6907-9212 (Japanese only). See www.seishinhoken.jp/profile for more details on Minna Netto.
If you know of any helpful resources or services for families in a similar situation, please contact Lifelines. Thank you to Dr. Joe Kurosu of Primary Care Tokyo for help with information for this article. Send your queries and comments to firstname.lastname@example.org.