A proposed revision to the law on mental health and welfare seeks to provide continued medical treatment and support for people who are discharged after being ordered hospitalized by local government heads due to mental disorders. The government drew criticism for characterizing it as a legislative effort to prevent crimes like the July 2016 massacre of 19 residents at a care home for disabled people in Sagamihara, Kanagawa Prefecture, whose accused perpetrator had been hospitalized under such a program several months before the attack. Critics charge that it is irrelevant to expect psychiatric treatment to serve the purpose of preventing crimes. Mental patients and their families express concern that the involvement of the police in the rehabilitation efforts of hospitalized patients could lead to tightened surveillance of the patients.

The ruling coalition passed the amendment in the Upper House last week and sent it to the Lower House after the government denied that the proposed measure is aimed at crime prevention or surveillance of mental patients — and deleted the reference to the amendment as a legislative response to the Sagamihara killings in a document distributed to Diet members explaining the gist of the revision. The government needs to make more efforts to win the understanding of patients, their families and other parties, without which the program’s effective implementation will be difficult.

The mental health and welfare law gives prefectural governors and mayors of major cities the power to commit people with mental disorders to hospitals for treatment when their conditions are deemed to pose a risk of harming either themselves or others. Satoshi Uematsu, who has been indicted on charges of murdering 19 people and injuring 24 others in the stabbing spree at the Sagamihara facility, was hospitalized briefly in February last year under this program after he disclosed plans to mass murder people with disabilities in a letter he delivered to the official residence of the Lower House speaker. But he dropped off the authorities’ radar after he was discharged from the hospital until the killing spree in late July. It was exposed that information about Uematsu’s problematic behavior and remarks, including statements that smacked of eugenics, had not been adequately shared among relevant authorities, including local governments and the police.

In December, a team of experts at the Health, Labor and Welfare Ministry reported that authorities might have been able to prevent the massacre had there been a scheme to give Uematsu treatment and support after he was released from the hospital. Under the legislation proposed by the health ministry, a local government that orders a mental patient to be hospitalized will be required to set up a local council to support the patient and devise a rehabilitation program. The municipality in which the patient will live after being discharged will provide counseling and guidance based on the program. If the patient moves to a different municipality during the period of follow-up care, the program will be passed on to the local office of the patient’s new place of abode. The police — along with officials of the relevant local government, medical institutions and organizations of people with mental disorders — will take part in the local council.

Concern voiced by organizations supporting mental patients and other parties that the proposed scheme could result in tightening authorities’ surveillance of patients was amplified by government officials’s explanations that the measure is intended to prevent crimes like the Sagamihara case. Opponents of the legislation, including doctors and lawyers, said the government should not use psychiatric treatment as a tool for public safety, and that it is inappropriate to introduce the new scheme when the causal link between the current scheme and the Sagamihara killings has not been established. Such concerns have not died down even after health minister Yasuhisa Shiozaki apologized for the “confusion” over the bill and said the amendment is not aimed at preventing crimes.

It is appropriate to beef up the system of care for hospitalized mental patients so continued treatment and support after their discharge will facilitate their social rehabilitation. Still, the concerns of patients and their families that the treatment program will put them under surveillance must be addressed. Effective support for the patients will be difficult if they and their families shun such treatment out of fear they are being watched. The government needs to make further efforts to win the trust of relevant parties in the proposed scheme.

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