The June 8 killing of eight children by a knife-wielding man at an Osaka elementary school has inevitably rekindled the old debate about whether — and how much — judicial authorities should be able to intervene when dealing with mental patients accused of committing serious crimes.
It is a debate that has gone nowhere for decades. While advocates of judicial involvement say it’s an overdue protection of public safety, opponents argue it would be impossible to graft an effective and just program of judicial psychiatry on top of a psychiatric system that has for so long been neglected and ineffective.
The suspect in the massacre, Mamoru Takuma, 37, avoided indictment due to mental disorder in a 1999 case in which he was accused of poisoning the tea of his coworkers.
He had since been in and out of a mental hospital, and had last been hospitalized for about two weeks before he reportedly stormed into the Osaka Kyoiku University Ikeda Elementary School, committing one of the most horrible crimes in Japan’s recent history.
It is not clear whether he will escape criminal responsibility this time, as investigative authorities reportedly suspect he was aware that he might be able to dodge criminal charges because of his record of mental illness.
Five months ago, before this latest shocking crime brought the issue back into the public spotlight, the Justice Ministry and the Health, Welfare and Labor Ministry launched a joint panel to discuss treatment for mentally ill people accused of heinous crimes.
“Crimes that are unimaginable in Europe and the United States, where judicial psychiatry systems are established, often take place in Japan,” Akira Yamagami, a professor at Tokyo Medical and Dental University, said at the panel’s first meeting Jan. 29.
“Innocent citizens die and their families suffer deep scars that cannot be healed . . . due to crimes that, if proper measures had been taken, could well have been prevented.”
The current law on mental health welfare empowers prefectural governors, at the advice of more than one doctor, to send to mental hospitals criminal suspects who were not tried because of their psychiatric problems.
However, Yamagami pointed out that such criminals often return to society and repeat heinous behavior without receiving either judicial punishment or sufficient medical treatment. Under the law, those people can be released from mental institutions mainly on the prerogative of the doctors treating them.
Yamagami told the panel that a judicial facility capable of providing, based on court orders, special medical treatment for such people should be created in Japan, citing the existence of such facilities in most Western countries as well as some Asian nations.
He also said that violent mental patients often cause problems at conventional mental institutions where they are housed together with other patients, prompting hospital operators in turn to excessively restrict their freedom through physical confinement and other steps.
Such arguments for a judicial facility for the mentally ill have been advanced time and again each time a brutal crime has been committed by someone with mental problems, but a consensus on a fundamental solution has been elusive.
In the 1960s, the government launched a study on legal measures to enable courts to send mental patients accused of heinous crimes — but shielded from criminal responsibility because of their illnesses — to a special judicial facility to give them treatment and prevent them from repeating wrongdoing.
But the idea met with fierce opposition from organizations representing the rights of psychiatric patients. The Japan Federation of Bar Associations and the Japanese Society of Psychiatry and Neurology argued that such a step might lead the public to ostracize mental patients as “potential criminals” and would encourage prejudice and discrimination against them.
The idea resurfaced in 1980 after a bus was firebombed in front of Shinjuku Station in Tokyo and six passengers were killed — and again met with strong opposition.
“(Since then,) it has been like a taboo to openly discuss the issue until recently,” said a health ministry official.
The JSPN, comprising more than 8,000 academic members nationwide, took up the issue of judicial psychiatry as the theme of a symposium for its annual convention held in Sendai in May 2000.
But the event was called off after several people from organizations advocating the rights of mental patients stormed the stage and spoke with megaphones just before the conference was to begin, according to JSPN members.
Although such debate may no longer be taboo in the wake of the Ikeda school massacre and other recent crimes involving suspects with mental problems, resistance remains strong, especially among people who are familiar with the poor state of psychiatric treatment in this country.
“I wonder what kind of a facility it would be if those people (who have long advocated judicial psychiatry) create one,” said Makiko Kato, who runs a self-supporting group home for mental patients in Tokyo’s Taito Ward.
Although she admits the issue should be widely debated, she said she cannot let go of her long-harbored distrust of the government and medical establishment’s policies toward mental patients.
“(The state of) psychiatric treatment in Japan is just terrible,” said Masaaki Noda, professor at Kyoto Women’s University. The government’s basic policy on psychiatric patients, which was hastily decided after a 1964 assault on then U.S. Ambassador to Japan Edwin Reischauer by a 19-year-old man, was only to build mental institutions nationwide to accommodate mental patients, he said.
The number of such institutions has increased little over the past decade, from 1,648 in 1989 to 1,663 in 1999, according to the health ministry. The roughly 340,000 mental patients who are now hospitalized in Japan are currently looked after by fewer than 10,000 working psychiatrists.
Psychiatric studies are not given due respect and consideration by Japan’s medical establishment, Noda said, adding that education programs are also poor in the field.
As a result, inhumane treatment of patients by insufficient staff, as well as long-term hospitalization of patients by doctors exploiting them for profit, prevail at some private mental hospitals. Such practices once drew widespread criticism and were taken up in 1984 by a subpanel of the United Nations Human Rights Commission.
Lawyer Hiroaki Jin opposes the idea of creating a special judicial facility given the current atmosphere surrounding mental patients in Japan.
Although he said such a system may work in Europe, for example, because people and society show understanding toward mental patients, “If we have such a facility in Japan, inmates would only be branded as ‘dangerous’ and would be further isolated upon their release.”
Yoshikazu Ikehara, a lawyer who serves a national organization for families of mental patients, said he is also skeptical about such a facility if it is intended to maintain public safety by locking away the mentally ill, instead of offering them effective treatment.
“The graveness of crimes (committed by mentally ill people) and their mental disorders are not necessarily related,” he said.
Kato said that, in reality, people with psychiatric problems are invisible to society most of the time. “Most mental patients live quietly on the bottom layers of society, unable to get satisfactory jobs or discuss their troubles with others.” More efforts should be made to teach the general public about mental patients and understand their problems as something that could happen to anybody, she added.
Noda said any new measures would not be effective unless the government drastically improves the current conditions of psychiatric treatment in this country, including boosting the number of expert staff.
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