Questions and Replies on Japan at CAT-committee
Door: Jolijn
Blijf op de hoogte en volg Jolijn
22 Mei 2013 | Nederland, Eindhoven
Today it’s Wednesday 22 May 2013. I’m back home in the Netherlands since Saturday night, 18 May, but the process with the CAT-committee is not fully over yet. During this week the CAT-committee was asking Questions and receiving Replies from the Japanese government-delegation, and in a few weeks there should be Concluding Observations on the State reviews by the CAT-committee. The Concluding Observations are a final report by the CAT-committee, containing recommendations for a better protection of human rights in that particular State (in our case: the Netherlands and Japan). So these recommendations will show whether our shadow report submissions and efforts to raise awareness made a difference.
Last weekend I travelled back home, and took a day of rest on Sunday. Then on Monday I first I went home to visit my mother for celebrating a belated Mothers-day (I was travelling last week). So on Tuesday 21 May 2013 I resumed the work by listening to the CAT-committee asking Questions to the Japanese government-delegation.
I was only able to watch the second hour of the session, starting at when Mr. Tugushi was speaking. It appeared I tuned in right on time. It was very positive that he addressed several mental health issues.
Mr. Tugushi has been asking about mental health care and forced institutionalization. There are many involuntary patients in mental health centers, and Mr. Tugushi asked for information about why out-patients services are not well-developed. Are there any steps to develop out-patients services and reducing the number of ones hospitalized? Japan is one of the countries with more involuntary emplacements, what is the role of the Courts in these cases? Are there any options to appeal or file complaints? He asked about the changes in the new mental health law, and about the monitoring of psychiatric institutions, and asked for information about the measures taken to ensure judicial control over the public and private hospitals.
He also asked for data about solitary confinement, and about any other restrictions of a person’s activities. Physical restraint is said to be used only as a last resort in case of risk of suicide or harm. Is there any statutory time limit to physically restraint in mental health centers? Are there alternatives, and safeguards to ensure solitary confinement and restraints are not used wrongfully?
Mr. Bruni quoted the Special Rapporteur on Torture, Mr. Juan Mendez, who had issued a report in 2011 on solitary confinement in detention, number A/66/268. The Special Rapporteur considers solitary confinement a harsh measure, which is contrary to rehabilitation. For this he bases himself on scientific, medical evidence, which says that in the first few days of solitary confinement psychological and mental damage appears, which can have a lasting impact. So for this reason, solitary confinement for a period longer than 15 days should be subject to an absolute prohibition. What is the state position on this, what are they doing with this knowledge?
Then Ms. Sveaass came up and asked thorough questions on mental health care.
She expressed concerns about the fact that 97% of the state budget for mental health care goes to psychiatric hospitals, and there are virtually no alternatives although the Japanese government promised to make efforts for community based services before. This seems to need more priority. Japan is nr. 1 of OECD-countries in the amount of beds per population-rate (followed by Belgium and the Netherlands), and Japan is also nr. 1 in length of stay, which is very alarming. This is 300 days, and it is huge compared to number 2 : 108 days. The global OECD average of stay is about 25-30 days. Many psychiatric beds are inside private care, which is also falling under the state duty to monitor and ensure its obligations.
It seems also that 43% of the persons in institutions are involuntary placed in hospitals by article 29 and art. 33, and that the possibilities of complaining are really limited. The Psychiatric Review Board does not work independently. It’s necessary to review the law in order to reduce involuntary emplacements and the time of hospitalization too, and to enable appeal and complaint mechanisms, where patients can go into court if necessary.
Also the number of restraints seems to be growing. The solitary confinement seems to be doubled in the last years from 2004-2009, and the use of restraints is rising too, but not at the same speed. Ms. Sveaass asked for more information about these problems and what will be done, because it is really worrying.
This was a powerful round of questions. The submission on Japanese mental health care by Mari Yamamoto and Yoshikaze Ikehara clearly made an impact here, and we are all very happy that the subject is taken on by the CAT-committee. This appears quite promising.
Today, Wednesday 22 May 2013, the Japanese government delegation gave its Replies to the CAT-committee. This was again a 3-hour session, where the government-delegation first presented the answers to yesterday’s questions of the CAT-committee. Basically, the government delegation of Japan elaborated on how well everything was organized in Japan, about prisons, and interrogation and health care before execution of death penalty. At the very end of their presentation they mentioned some information about mental health care.
They stated that the court is involved in the decision for involuntary hospitalization, under the law for medical care and observation for mentally incompetent persons. Based on filing by the prosecutor, the judge and mental health tribunal judge will decide whether hospitalization is necessary or not or whether the person will be provided treatment as an outpatient.
The use of restriction and restraints in hospitals is based upon the condition of person, based on the necessary minimum, and the psychiatrist must conduct the examination before restraints or restriction of behavior is decided.
In Japan, hospital-based medical care has importance, and compared to other countries, the period of hospitalization may be too long. In order to solve the lengthy hospitalization of mentally disabled, measures have been taken, and as a result, both length and number of patients in hospital are declining in numbers.
The revision of the Law on mental health and welfare has been put forward to the Diet by the ministry of health and welfare. In this revised law, there is a duty to take measures to promote transfer of mentally disabled into the community, this duty is to be imposed on mental health hospital managers.
There is a system is available to file objections for treatment of hospitalization, also for involuntary hospitalization. Based on the administrative appeal act the request can be made for review to the superior head agencies. Requests for release from the hospital and requests for improvement of treatment can be filed to the Psychiatric Review Board which is a collegiate of psychiatrist, jurist and others.
Then there was another round for clarifying questions by the CAT-committee.
Mr. Tugushi said it was a pity that the Japanese government left mental health issues as a last issue, and does not take much time for such an important issue. (It was great to see him being so firm).
He said a detailed answer was not given regarding mental health. There has been mentioned a movement in Japan towards deinstitutionalization and to drop the number of patients who spent long time in institutions. However, this doesn’t correspond with the data which Committee received on development of outpatient services – only 3% of budget is spent on outpatient services and the rest (97%) is spent on private and public mental health hospitals. Are there any changes foreseen?
He repeated his question on whether there is maximum time limit for the application of means of restraint, and if he could receive information on statutory time limits on restraint on patients, and information on effective and thorough judicial control and monitoring of detention in public and private institutions.
The Committee is informed that in accordance to changes to new legislation – it will become easier to detain someone against his or her will, so instead of ensuring safeguards, the safeguards are weakened. Are there any plans to strengthen safeguards and to strengthen further monitoring of places where mentally disabled people are held?
Mr. Bruni said he hadn’t had a response to his remark on the day before, and referred again to the report of 2011 on solitary confinement in detention, number A/66/268 from the Special Rapporteur on Torture, Mr. Juan Mendez. The Special Rapporteur considers solitary confinement a harsh measure, which is contrary to rehabilitation. For this he bases himself on scientific, medical evidence, which says that in the first few days of solitary confinement psychological and mental damage appears, which can have a lasting impact. So for this reason, solitary confinement for a period longer than 15 days should be subject to an absolute prohibition.
The government recognizes the harmful effects of solitary confinement in their own papers, but they still apply it. So what is their response to the paper of the Special Rapporteur, A/66/268. Will they study it?
Ms. Sveaass was also again very powerful.
About psychiatric care and mentally ill patients she stated: It is important to remind that generally persons are psychiatrically ill for a short period of time in their life, and it’s rare to be chronically ill, but it’s easy to become a chronic patient when subjected to a prolonged stay in hospital, such as 300 days or even 20 years. These persons become chronic patients just by staying in there so long.
There has been mentioned a reduction in time and number of hospitalization, but the statistics we’ve seen so far do not show such tendency. 43% of inpatients today are involuntary patients, and over 300.000 persons are hospitalized in psychiatric hospitals, which means there is a high number of people involuntarily detained in hospitals. There seems to be an option to keep people back for 72 hours even on voluntary admission and this may then become an involuntary placement.
The use of restraints and solitary confinement is increasing. And at the psychiatric review board only very few decisions are reviewed. How can this be made a judicial and competent instance to review these things?
Ms. Belmir raised a question that was also raised by many other members: Is it not possible to stop executions of mentally disabled persons? It is quite illogical in my view.
The Japanese government delegation had a little bit of time left for Replies, and the Japanese government responded:
In case that death row inmate has mental issues, the execution of death penalty is prolonged, suspended. In general, the mental condition of a death row inmate and other inmates general health is checked with the doctors from a professional point of view. The minister of justice will make final judgment on that. Currently, there is a shortage of doctors and personnel. In order to provide good medical service in prisons, we try to hire outside doctors as well.
About involuntary hospitalization: unfortunately at this juncture, there are no representatives of the Ministry of health and welfare here, so it’s impossible to give more information as to what was given earlier, so if you could give us kind understanding, thank you.
Regarding solitary confinement – in law there are 2 types of confinement but as was explained these are 2 of different nature. Isolation is to avoid contact with other inmates, and category 4 is to provide opportunities for the inmate to come into contact with other inmates. For category 4 there is a system for filing complaints. If the inmate considers that category 4 is inappropriate filing a complaint is allowed according to the law.
At the end the Japanese head of delegation had a final say. He was referring to a remark about the Japanese justice system (based on confessions), when he firmly said "Japan does not live in middle ages". People laughed, but then he raised his voice: Do not laugh! Shut up! I'm serious, we are an advanced country, we are proud. He was very serious and everybody turned silent. It was quite an awkward moment, but I heard this situation is uncommon in Japanese politics, and it’s probably the nerves of this man who probably did his best, and just snapped. That can happen. At least it woke everybody up.
This Japanese session before the CAT-committee was an interesting session to follow, and it is very positive to see how mental health issues are included in the questions asked by the CAT-commitee.
I’m looking back at my trip to Geneva now. I met so many interesting persons. I had the great opportunity to become friends with Mari and Yoshi from Japan, and Vicky.
And I feel very positive about the trip. It was exhausting, but also very inspiring and refreshing. When I came back home, I realized how re-energized I was. In Geneva I had felt recognition, understanding, peer support, peer philosophy, it was somehow a smooth comfortable surroundings. It’s different from the daily struggle against the system. It was like a hot bath. Like I had a chance to offload some stress there, and find mutual grounds, common understanding. I didn’t expect such an impact personally, but it feels good. I liked the entire experience in Geneva this time. It was great and re-energizing.
And my visit to Geneva had quite some side-results. I gained so many useful contacts in my network, and new tools in my toolbox, such as even a possibility to give lectures at a Dutch University of Law. That would be even more efficient that studying law myself (which was about to be my last resort).
I gained many NGO-contacts, which can be allies, which can strengthen us all.
And I think we managed to raise awareness in contact with several UN-officials on the seriousness of human rights violations in psychiatry. In the Netherlands, in Japan, and all over the world: we also spread a horrible article from Rwanda, http://www.panusp.org/torture-of-person-with-mental-disability-in-rwanda/ And regarding the questions asked by the CAT-committee members, I think we can only be proud. There was substantial attention for mental health care issues in the framework of the Convention Against Torture. Our mission was to bring the practices of torture and ill-treatment in mental health care onto the agenda of the CAT-committee. I think we can say we succeeded. And we had a very pleasant time together, and everything was organized so well and it was very comfortable. It was a pleasure. So Mari, Yoshi, Vicky and I somehow feel like we are a dream team together. I have great memories of this week together in Geneva. Big smile.
Now we can only wait for the Concluding Observations (the final report of the CAT-committee), and sincerely hope the recommendations will be firm and useful for improving the situation in mental health care.
Last weekend I travelled back home, and took a day of rest on Sunday. Then on Monday I first I went home to visit my mother for celebrating a belated Mothers-day (I was travelling last week). So on Tuesday 21 May 2013 I resumed the work by listening to the CAT-committee asking Questions to the Japanese government-delegation.
I was only able to watch the second hour of the session, starting at when Mr. Tugushi was speaking. It appeared I tuned in right on time. It was very positive that he addressed several mental health issues.
Mr. Tugushi has been asking about mental health care and forced institutionalization. There are many involuntary patients in mental health centers, and Mr. Tugushi asked for information about why out-patients services are not well-developed. Are there any steps to develop out-patients services and reducing the number of ones hospitalized? Japan is one of the countries with more involuntary emplacements, what is the role of the Courts in these cases? Are there any options to appeal or file complaints? He asked about the changes in the new mental health law, and about the monitoring of psychiatric institutions, and asked for information about the measures taken to ensure judicial control over the public and private hospitals.
He also asked for data about solitary confinement, and about any other restrictions of a person’s activities. Physical restraint is said to be used only as a last resort in case of risk of suicide or harm. Is there any statutory time limit to physically restraint in mental health centers? Are there alternatives, and safeguards to ensure solitary confinement and restraints are not used wrongfully?
Mr. Bruni quoted the Special Rapporteur on Torture, Mr. Juan Mendez, who had issued a report in 2011 on solitary confinement in detention, number A/66/268. The Special Rapporteur considers solitary confinement a harsh measure, which is contrary to rehabilitation. For this he bases himself on scientific, medical evidence, which says that in the first few days of solitary confinement psychological and mental damage appears, which can have a lasting impact. So for this reason, solitary confinement for a period longer than 15 days should be subject to an absolute prohibition. What is the state position on this, what are they doing with this knowledge?
Then Ms. Sveaass came up and asked thorough questions on mental health care.
She expressed concerns about the fact that 97% of the state budget for mental health care goes to psychiatric hospitals, and there are virtually no alternatives although the Japanese government promised to make efforts for community based services before. This seems to need more priority. Japan is nr. 1 of OECD-countries in the amount of beds per population-rate (followed by Belgium and the Netherlands), and Japan is also nr. 1 in length of stay, which is very alarming. This is 300 days, and it is huge compared to number 2 : 108 days. The global OECD average of stay is about 25-30 days. Many psychiatric beds are inside private care, which is also falling under the state duty to monitor and ensure its obligations.
It seems also that 43% of the persons in institutions are involuntary placed in hospitals by article 29 and art. 33, and that the possibilities of complaining are really limited. The Psychiatric Review Board does not work independently. It’s necessary to review the law in order to reduce involuntary emplacements and the time of hospitalization too, and to enable appeal and complaint mechanisms, where patients can go into court if necessary.
Also the number of restraints seems to be growing. The solitary confinement seems to be doubled in the last years from 2004-2009, and the use of restraints is rising too, but not at the same speed. Ms. Sveaass asked for more information about these problems and what will be done, because it is really worrying.
This was a powerful round of questions. The submission on Japanese mental health care by Mari Yamamoto and Yoshikaze Ikehara clearly made an impact here, and we are all very happy that the subject is taken on by the CAT-committee. This appears quite promising.
Today, Wednesday 22 May 2013, the Japanese government delegation gave its Replies to the CAT-committee. This was again a 3-hour session, where the government-delegation first presented the answers to yesterday’s questions of the CAT-committee. Basically, the government delegation of Japan elaborated on how well everything was organized in Japan, about prisons, and interrogation and health care before execution of death penalty. At the very end of their presentation they mentioned some information about mental health care.
They stated that the court is involved in the decision for involuntary hospitalization, under the law for medical care and observation for mentally incompetent persons. Based on filing by the prosecutor, the judge and mental health tribunal judge will decide whether hospitalization is necessary or not or whether the person will be provided treatment as an outpatient.
The use of restriction and restraints in hospitals is based upon the condition of person, based on the necessary minimum, and the psychiatrist must conduct the examination before restraints or restriction of behavior is decided.
In Japan, hospital-based medical care has importance, and compared to other countries, the period of hospitalization may be too long. In order to solve the lengthy hospitalization of mentally disabled, measures have been taken, and as a result, both length and number of patients in hospital are declining in numbers.
The revision of the Law on mental health and welfare has been put forward to the Diet by the ministry of health and welfare. In this revised law, there is a duty to take measures to promote transfer of mentally disabled into the community, this duty is to be imposed on mental health hospital managers.
There is a system is available to file objections for treatment of hospitalization, also for involuntary hospitalization. Based on the administrative appeal act the request can be made for review to the superior head agencies. Requests for release from the hospital and requests for improvement of treatment can be filed to the Psychiatric Review Board which is a collegiate of psychiatrist, jurist and others.
Then there was another round for clarifying questions by the CAT-committee.
Mr. Tugushi said it was a pity that the Japanese government left mental health issues as a last issue, and does not take much time for such an important issue. (It was great to see him being so firm).
He said a detailed answer was not given regarding mental health. There has been mentioned a movement in Japan towards deinstitutionalization and to drop the number of patients who spent long time in institutions. However, this doesn’t correspond with the data which Committee received on development of outpatient services – only 3% of budget is spent on outpatient services and the rest (97%) is spent on private and public mental health hospitals. Are there any changes foreseen?
He repeated his question on whether there is maximum time limit for the application of means of restraint, and if he could receive information on statutory time limits on restraint on patients, and information on effective and thorough judicial control and monitoring of detention in public and private institutions.
The Committee is informed that in accordance to changes to new legislation – it will become easier to detain someone against his or her will, so instead of ensuring safeguards, the safeguards are weakened. Are there any plans to strengthen safeguards and to strengthen further monitoring of places where mentally disabled people are held?
Mr. Bruni said he hadn’t had a response to his remark on the day before, and referred again to the report of 2011 on solitary confinement in detention, number A/66/268 from the Special Rapporteur on Torture, Mr. Juan Mendez. The Special Rapporteur considers solitary confinement a harsh measure, which is contrary to rehabilitation. For this he bases himself on scientific, medical evidence, which says that in the first few days of solitary confinement psychological and mental damage appears, which can have a lasting impact. So for this reason, solitary confinement for a period longer than 15 days should be subject to an absolute prohibition.
The government recognizes the harmful effects of solitary confinement in their own papers, but they still apply it. So what is their response to the paper of the Special Rapporteur, A/66/268. Will they study it?
Ms. Sveaass was also again very powerful.
About psychiatric care and mentally ill patients she stated: It is important to remind that generally persons are psychiatrically ill for a short period of time in their life, and it’s rare to be chronically ill, but it’s easy to become a chronic patient when subjected to a prolonged stay in hospital, such as 300 days or even 20 years. These persons become chronic patients just by staying in there so long.
There has been mentioned a reduction in time and number of hospitalization, but the statistics we’ve seen so far do not show such tendency. 43% of inpatients today are involuntary patients, and over 300.000 persons are hospitalized in psychiatric hospitals, which means there is a high number of people involuntarily detained in hospitals. There seems to be an option to keep people back for 72 hours even on voluntary admission and this may then become an involuntary placement.
The use of restraints and solitary confinement is increasing. And at the psychiatric review board only very few decisions are reviewed. How can this be made a judicial and competent instance to review these things?
Ms. Belmir raised a question that was also raised by many other members: Is it not possible to stop executions of mentally disabled persons? It is quite illogical in my view.
The Japanese government delegation had a little bit of time left for Replies, and the Japanese government responded:
In case that death row inmate has mental issues, the execution of death penalty is prolonged, suspended. In general, the mental condition of a death row inmate and other inmates general health is checked with the doctors from a professional point of view. The minister of justice will make final judgment on that. Currently, there is a shortage of doctors and personnel. In order to provide good medical service in prisons, we try to hire outside doctors as well.
About involuntary hospitalization: unfortunately at this juncture, there are no representatives of the Ministry of health and welfare here, so it’s impossible to give more information as to what was given earlier, so if you could give us kind understanding, thank you.
Regarding solitary confinement – in law there are 2 types of confinement but as was explained these are 2 of different nature. Isolation is to avoid contact with other inmates, and category 4 is to provide opportunities for the inmate to come into contact with other inmates. For category 4 there is a system for filing complaints. If the inmate considers that category 4 is inappropriate filing a complaint is allowed according to the law.
At the end the Japanese head of delegation had a final say. He was referring to a remark about the Japanese justice system (based on confessions), when he firmly said "Japan does not live in middle ages". People laughed, but then he raised his voice: Do not laugh! Shut up! I'm serious, we are an advanced country, we are proud. He was very serious and everybody turned silent. It was quite an awkward moment, but I heard this situation is uncommon in Japanese politics, and it’s probably the nerves of this man who probably did his best, and just snapped. That can happen. At least it woke everybody up.
This Japanese session before the CAT-committee was an interesting session to follow, and it is very positive to see how mental health issues are included in the questions asked by the CAT-commitee.
I’m looking back at my trip to Geneva now. I met so many interesting persons. I had the great opportunity to become friends with Mari and Yoshi from Japan, and Vicky.
And I feel very positive about the trip. It was exhausting, but also very inspiring and refreshing. When I came back home, I realized how re-energized I was. In Geneva I had felt recognition, understanding, peer support, peer philosophy, it was somehow a smooth comfortable surroundings. It’s different from the daily struggle against the system. It was like a hot bath. Like I had a chance to offload some stress there, and find mutual grounds, common understanding. I didn’t expect such an impact personally, but it feels good. I liked the entire experience in Geneva this time. It was great and re-energizing.
And my visit to Geneva had quite some side-results. I gained so many useful contacts in my network, and new tools in my toolbox, such as even a possibility to give lectures at a Dutch University of Law. That would be even more efficient that studying law myself (which was about to be my last resort).
I gained many NGO-contacts, which can be allies, which can strengthen us all.
And I think we managed to raise awareness in contact with several UN-officials on the seriousness of human rights violations in psychiatry. In the Netherlands, in Japan, and all over the world: we also spread a horrible article from Rwanda, http://www.panusp.org/torture-of-person-with-mental-disability-in-rwanda/ And regarding the questions asked by the CAT-committee members, I think we can only be proud. There was substantial attention for mental health care issues in the framework of the Convention Against Torture. Our mission was to bring the practices of torture and ill-treatment in mental health care onto the agenda of the CAT-committee. I think we can say we succeeded. And we had a very pleasant time together, and everything was organized so well and it was very comfortable. It was a pleasure. So Mari, Yoshi, Vicky and I somehow feel like we are a dream team together. I have great memories of this week together in Geneva. Big smile.
Now we can only wait for the Concluding Observations (the final report of the CAT-committee), and sincerely hope the recommendations will be firm and useful for improving the situation in mental health care.
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Je kunt nu ook Smileys gebruiken. Via de toolbar, toetsenbord of door eerst : te typen en dan een woord bijvoorbeeld :smiley
