The health and welfare ministry has decided to allow mental hospitals to renovate some wards into residences for long-term inpatients, who would be discharged before being moved into the new residences. In this manner the ministry hopes to reduce the official number of mental inpatients. But such a step will do little to help mental patients return to a normal social life. The ministry should withdraw the plan and work out measures that will achieve real results in promoting the rehabilitation of such patients in a true community environment.
Behind the ministry’s plan is the idea of reducing the number of sickbeds in Japan’s mental hospitals, which now stands at some 344,000. This figure is the largest in the world and accounts for about 19 percent of the estimated 1.85 million beds for mental patients at institutions worldwide.
According to a 2011 survey by the ministry, 323,000 people were registered as inpatients at Japanese mental hospitals. Some 200,000 of them had been hospitalized for more than one year. The Organization for Economic Cooperation and Development says that this number is conspicuously high among its 34 industrialized member countries. In addition, some 65,000 mental patients had been hospitalized for more than 10 years.
Various factors are believed to lie behind the large numbers of long-term inpatients, including a tendency to focus on confinement of patients as a treatment for mental illness as well as lingering public prejudice that hampers their return to society. Turning some mental wards into residences is nothing other than juggling numbers to make it appear as if the number of mental patients had decreased when in reality it has not.
The ministry adopted the plan on July 1 based on a proposal by a 25-member expert panel of the ministry. The panel’s proposal does not appear to sufficiently reflect the opinions of mental patients themselves. Only two mental patients took part in the discussions as panel members.
A separate survey of mental patients taken by the ministry suggests that the latest measure runs counter to their wishes. According to the results of a recent survey of 170 patients who have been staying in mental hospitals for more than one year and 40 former long-term inpatients, 73 percent of the current inpatients wished to be released from the hospital. Asked where they would live after their discharge, the largest number mentioned their own homes, followed by group homes and rental homes.
Asked whether they would like to live in residences within hospital compounds, 60 percent replied that they would prefer continued hospitalization to that. Many patients said they would not feel they had left the hospital if their residences were inside hospital compounds. In the same survey, 60 percent of former in-patients said freedom of movement and doing things they want to do gave them the best feeling after being discharged from the hospital.
The environment of a hospital compound differs greatly from that of a real community. The ministry should pay attention to the simple fact that freedom exists in the latter, as former in-patients have pointed out. Having former in-patients live in residences inside hospital compounds will only prolong their isolation from society.
Instead of continuing to keeping former patients on hospital grounds, the ministry should take steps to help them secure residences, and improve medical and other social welfare services in real communities to help them achieve a “full and effective participation and inclusion in society” — one of the goals mentioned in the Convention on the Rights of Persons with Disabilities, to which Japan is a party.