In 2020, Tokyo will host the Olympic Games, and the Tokyo Metropolitan government is already abuzz with preparations. The eight Metropolitan Hospitals, including Matsuzawa Hospital, are also bracing for an influx of patients from abroad.
Setting aside the upsurge in the number of outpatients and inpatients that is expected to attend the Olympic Games, Matsuzawa Hospital has for years been experiencing a very difficult problem related to the treatment of foreign patients: the protection of the human rights of psychiatric patients who don’t understand Japanese. A serious case of human rights violation at a psychiatric hospital in Japan in the ‘80’s led to the amendment to the Mental Health Act. Under the newly amended act, due legal process in cases of involuntary admission or other treatments requiring physical restriction in psychiatric hospitals was established for the first time in the history of Japanese mental health. However, the procedure for handling foreign patients has been neglected.
Between May 5, 2012 and January 21, 2014, 123 foreign patients visited Matsuzawa Hospital for consultation; 31 patients from China, 14 from the US, 12 from Korea, 5 from the Philippines, 5 from the UK, 4 from France, 4 from Nepal, and the remaining 48 from miscellaneous other countries the world over. 15% of these patients understood Japanese, but 35% spoke mainly English, 29% only Chinese, 7% only Korean, and 17% other languages. Only 4.1% were tourists; 78.8% lived and worked in the Tokyo Metropolitan area and neighboring regions, and 13.8% had no fixed abode. About half the patients were diagnosed schizophrenics or suffered from acute psychotic syndromes, and about 10% were addicted to psychoactive substances. Unlike their Japanese counterparts, these foreign patients experience many difficulties accessing psychiatric services in Japan. As a result, most of these patients are already in a very severe or agitated state by the time they come to us, voluntarily or involuntarily.
Of the 123 foreign patients I mentioned previously, 78 were admitted our hospital, 65 of whom (83.3%) were admitted on an involuntary basis. Some were placed in isolation rooms, and some were physically restrained. It is sometimes very difficult for psychiatric patients, especially when they are agitated, to have any insight into their own mental state or understand why they need medication or hospitalization. Thus, the due process of law in cases of involuntary psychiatric treatment is especially important to safeguard their rights. For Japanese patients, the due process of law in the handling of such cases was enforced only in 1987 following the ratification of the Mental Health Amendment Act. But for foreign patients who do not understand Japanese, the Act has proved to be of little value. A few months ago, a patient from the UK was admitted to our hospital on an involuntary basis. She spent a few days in an isolation room due to severe psychomotor excitation. When she was moved to the general psychiatric ward, she was heard to murmur, “Oh, it is a hospital, not a jail!” Whether or not she meant this humorously, I was very shocked when a nurse told me the story. Can you imagine how you would feel if you were taken to psychiatric hospital during a trip abroad and secreted away in a small room like a jail cell, and if you could not understand the language that other people around you were speaking?
In 2014, we translated our policy on involuntary admission in English, French, Spanish, Chinese, Korean, and Tagalog. Before making these publicly available, I plan to have them vetted by the embassy of each nation represented by these languages in the hope that patients who are admitted on an involuntary basis will feel a little easier when they realize that their embassy representatives are aware of, and have approved, the procedures concerned. The embassy of the Republic of Korea approved our Korean translation (we express our special thanks to Ms. Eunhye Oh of Waseda University for her efforts in this matter), and the embassy of France and Spain have reviewed the translations prepared for them. We have yet to receive a response from the embassy of the other countries. Some of these countries are often too eager to complain about human rights elsewhere but seem completely indifferent to those of their own mentally ill citizens.
More than 2 million foreigners live in Japan today. Of late, the number of foreign tourists has also been rapidly increasing. More and more workers will come to Japan to supply the construction labor pool until the Olympic Games begin in the summer of 2020. Some are already mentally ill before they arrive here, and some show transient mental confusion after their arrival. All these people have the right to be treated with their own consent, but for some who cannot understand why they need to be treated, a humane procedure for involuntary treatment and reliable safeguards against malpractice need to be firmly in place. These procedures are equally important to Japanese citizens and foreigners who visit our shores.