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More than a month after the mass slaying at a care home for people with disabilities in Sagamihara, Kanagawa Prefecture, we are still struggling to understand what prompted the alleged killer to commit such a horrific act, while authorities explore why the crime was allowed to happen — despite all the signs that the 26-year-old suspect himself had provided about his intentions — and what can be done to stop a similar lapse from happening again.

Satoshi Uematsu, who surrendered to police in the early hours of July 26 after allegedly killing 19 residents and injuring 27 others at the facility where he had previously worked, has been quoted as telling investigators that he thought people with disabilities “had better disappear.” In a letter he delivered to the official residence of the speaker of the Lower House in Tokyo in February, he wrote of his plan to “massacre 470 disabled people” and to “create a world where people with multiple disabilities can die in peace.” He had also reportedly suggested that he had been influenced by the ideology of Nazi leader Adolf Hitler.

These reported remarks have led to speculation that Uematsu was driven to the stabbing spree out of a belief in eugenics. But such theorizing should not lead us to see the crime as an isolated case of someone with a peculiar way of thinking. The effort to prevent such hate crimes must explore the background to how the suspect, who was in daily contact with people with disabilities while he worked at the care home for more than three years until this spring, came to harbor such views.

Since his arrest, Uematsu is reported to have reiterated the argument that his massacre of the residents with severe disabilities was intended to “save” the victims, whose presence was making both their families and care facility workers unhappy and doing no good for the country. According to media reports quoting investigators, he continues to justify his acts and insist that there must be many people who support his views. Unfortunately, his remarks seem to mirror the concerns expressed by people with disabilities, their families and supporters that Uematsu may not be alone in holding such views. If that is the case, we must get to the bottom of what lies behind such twisted ways of thinking.

While Uematsu is not believed to have acted violently against residents of the care home when he was working there, violent and sometimes deadly abuse by care workers of elderly residents in nursing homes has been widely reported across the country in recent years. This problem is often blamed on severe working conditions and chronic manpower shortages at care facilities, which leave many care workers exhausted and frustrated. Although the situations and consequences seem to widely differ between the Sagamihara case and abuses at care facilities for the elderly, it may be worth investigating whether they share a root cause.

While the criminal investigation of the killings continues, including the interrogation of the suspect, authorities are looking into whether there were problems in the way relevant parties acted after Uematsu revealed his plan to kill people with disabilities — even naming the Sagamihara care home as one of his targets and mentioning specific plans that he actually carried out during the crime — in the letter he brought to the Lower House speaker’s official residence. Particularly under scrutiny is the period when he was admitted to a mental hospital in February — and his discharge shortly after.

The information about the letter was communicated to the police and then relayed to the Sagamihara facility, Uematsu’s employer at the time, which proceeded to interview him. When Uematsu repeated his remarks about his intention to kill people with disabilities, officials of the care home alerted the city of Sagamihara via the local police, and the municipal government used its power to commit him to the mental hospital on the grounds that in his state of mind he could harm others. He was diagnosed as having a marijuana-induced mental illness and a delusional disorder, but was released within 12 days after the doctors concluded his condition had improved and he no longer posed a danger.

His release — along with the fact that he tested positive for marijuana during his hospitalization — was not made known to the police. He visited the mental hospital twice for additional treatment, then both the municipal government and the police lost contact with him. Under the current system, people committed to a mental hospital under such conditions cannot be forced to receive additional treatment once they are released.

The Health, Labor and Welfare Ministry has set up a team of experts on mental treatment and others to review the sequence of events. Its discussions are expected to include whether the decision to release Uematsu had been appropriate, whether sufficient follow-up treatment had been provided or whether there was enough communication among relevant authorities to keep tabs on the situation. Behind the panel’s creation are fears that the system for committing people under the power of municipal authorities may not ensure that those people get sufficient treatment and follow-up care.

The system should be reformed if its shortcoming are exposed as a result of the review. The government must tread carefully, however, so that it doesn’t deviate from the purpose of this system as a medical step, not as a deterrence against potential crimes. It needs to heed the concern raised by certain groups that the review could result in tightening surveillance or invite discrimination or prejudice against people with mental problems. Reaction to this horrific crime should not be an excuse for distorting the purpose of the system.

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