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Treatment for mentally ill elusive at Japan’s medical prisons

Chunichi Shimbun

When a 21-year-old woman was sentenced to life in prison on March 24 for killing an elderly woman, the Nagoya District Court acknowledged that the defendant’s mental illness — a developmental and bipolar disorder — was part of the reason for the heinous crime and that she should be treated in a medical prison.

The woman, who was a minor at the time of the offense, was also found guilty of the attempted murder of two people by poisoning them with thallium sulfate, a highly toxic substance, when she was a high school student. She told the court that she simply “wanted to see a person die.”

“We should let her be aware of her responsibilities, so that she can atone for her crimes while serving her sentence. To do so, authorities need to come up with the most suitable rehabilitation and treatment for her disability,” the court said.

In a rare move, the court also said “treatment can be provided through (existing) frameworks, including medical prisons.”

But is that true?

Okazaki Medical Prison in Aichi Prefecture, one of four medical prisons in Japan, currently houses 135 male offenders, including those with serious mental disabilities.

On a day at the prison, one inmate was singing a cheery song in a deep voice from behind the locked prison doors. Next to him, another man sat staring into space, while another drew pictures furiously of a bus with a red pencil.

“They don’t really understand what they are going through. They can’t communicate with each other either,” a prison guard explained.

Karaoke and picture books are part of the treatment, along with other methods, including medication, counseling and art therapy such as pottery. With two psychiatrists on hand, inmates are well taken care of.

But of the four medical prisons, only two — Okazaki and Kitakyushu — accept offenders with mental disabilities, and women are only accepted at the latter.

“Only those who cannot communicate at all or participate in communal life are sent to medical prisons,” a correctional officer said, adding that such prisons are “difficult to enter.”

The officer also said the woman who was convicted on March 24 is likely to be sent to a regular prison, not a medical one.

At Kasamatsu Women’s Prison in Gifu Prefecture, 167 out of 445 inmates, or close to 40 percent, have mental disabilities, even though it’s not a medical prison.

The inmates are treated only by part-time psychiatrists through medical examinations and medication.

“We have many inmates here, so it is impossible to provide sufficient treatment individually,” another correctional officer said, pointing out the limitations of treating such inmates in a regular prison.

Koichi Hamai, a professor at Ryukoku University Graduate School of Law who is well-versed in treatments in prisons, said the convicted woman could learn how to deal with her disorder if she is placed in a medical reformatory for minors, which provides correctional education and treatment via a teacher, doctor and nurse assigned to each inmate.

“In Japan, the purpose of prison is first and foremost to punish the offender. It is important to understand the unique characteristics of the offender’s disability and come up with a way (to rehabilitate them) with family members and doctors,” Hamai said. “It is time for us to review our penal system.”

This section, appearing Tuesdays, features topics and issues from the Chubu region covered by the Chunichi Shimbun. The original article was published March 27.