Mental patients who are voluntarily hospitalized for treatment should in principle not be locked up, according to a report submitted Tuesday to a subcommittee of an advisory council to Health and Welfare Minister Yuya Niwa.

Although currently about half of such patients are kept behind locked doors, the report recommends new standards that would allow patients to be kept in a freer and more open environment unless they pose a risk of suicide or harm to others. In that case, doctors would be obliged to notify the patient in writing.

The health minister will make changes to specific rules by April, when a revised law on mental health welfare takes effect. Patients currently receiving isolated treatment or who are in physical confinement must be overseen by mental health specialists.

But in other cases, there are no clear rules on whether mental patients should be locked up, leaving the decision up to doctors.

Because confinement means less trouble and care, many patients end up in locked facilities.

To end that trend, the report says patients who voluntarily stay in mental hospitals must be “treated basically in an open environment” and be notified of the conditions of the treatment at the time they are admitted.

The report also calls on doctors to not isolate or physically confine a patient as a means of punishment.

But the report sets the following conditions for restrictive treatment:

1) When it is difficult to continue treatment in an open facility;

2) When there is a possibility of self-destructive behavior or suicide;

3) When one’s verbal or physical actions may pose harm to other people.

In such cases, doctors must notify the patient, write the date and reason for the treatment on the medical record, and have a designated mental health specialist examine the patient within 72 hours, it said.

As for patients who are sent to mental hospitals at the order of prefectural governors or through the family’s request, the report says physical restrictions on them should be kept to the minimum necessary level.

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