Presentation on Forensic Psychiatry went well

Today, 26 July 2015, I gave a presentation on the situation of Forensic Psychiatry in the Netherlands. It was my last presentation of this trip in Japan, and it went well.

At 10 AM Ryugan came to pick me up at my hotel, and we had a nice breakfast together (I traded my raw egg for a sausage). Then, after going to Nakano, we had coffee with cake and walked across Nakano Broadway, where we visited Mandarake (the famous manga store). That was nice. Then around noon we went to the venue of the meeting again. It was in the same building as yesterday, but this time we were in a bigger room in the basement. I saw several people who had also been to yesterday’s meeting and the seminar on Family Group Conferencing, and also several people from Kyoto had come (users-survivors as well as professors and professional care-givers). There were about 90 to 100 people.

At 1300 the session started. The goal of the conference was to compare the Japanese situation to the situation in other countries. I was not the only speaker this time. Kirihara opened the conference with a welcoming word, and then Yoshi was supposed to speak, but he was late, so I went first. I presented the situation in forensic psychiatry in the Netherlands, and especially the inhumanities. (see next blog post for my presentation text, http://punkertje.waarbenjij.nu/reisverslag/4852276/presentation-text-forensic-psychiatry-netherlands , which you may want to read before continuing to read this post). In my presentation I explained the incredibly high stigma attached to forensic psychiatry in the Netherlands, and how the system fails to bring relief for the person subjected as well as for the community. Many people found it helpful information.

After my presentation, Yoshi spoke about the Japanese situation. In Japan, the system of forensic psychiatry is now less than 10 years old, and the Japan National Group of Mentally Disabled People (http://www.jngmdp.org/ ) has been advocating against it even before its start, and they are still continuing to fight against it, because the forensic system only seems to bring more fear to the public, and more stigma and suffering to the users, and more government control under the name “protection”. In Japan there are about 3000 to 4000 persons subjected to forensic psychiatry, and there are some worrying data. A survey shows that more and more people are detained, and that the number of people leaving the system is decreasing, and also the number of suicides is higher than before the law on forensic psychiatry. There are no data which show a positive effect of the forensic psychiatry. And in Japan the number of forced hospitalization is already 4 times higher than in other OECD countries. So we can say that tax money is wasted. The court procedure is merely a rubber stamp policy, and the judge follow the psychiatrists advise almost blindly, and also the review board is not effective, because there are hardly an releases. It is a fact that the person has to become obedient and compliant to avoid prolongation of the forensic psychiatric placement. There is no cure for intellectual disabilities or personality disorders, so these people never move out. And the system is mainly about control, and not focussing on support. So forensic psychiatry in Japan is not a solution, but a problem.

There was a small break, and again Mari collected the questions on my presentation from the participants on forms, and read them out afterwards. Questions were about whether persons with psychosocial disabilities in the Netherlands have to pay for mental health care (yes there is a fixed contribution for voluntary care which is (too) high, and in institutions, generally the income of persons is confiscated and persons only get weekly allowances). Why do 14% of people die in forensic psychiatry in the Netherlands (this is total number of mixed causes, including by suicide, medical reasons, abuse and also violence from other inmates). Which types of crimes can lead to forensic psychiatry in the Netherlands (these are only the severe crimes with generally high social impact, such as violence, sexual crimes, fire and property crimes. And there has to be a psychiatric diagnosis, which can also be in the history of the person). Is the number of suicides in the Netherlands also high? Yes it is much higher than the number of persons who die in traffic accidents, almost twice as high, and the number is on the rise, and has roughly doubled since 2007. Yet the government does invest in safer traffic, but not really in preventing suicide). Are there forms of peer support in the Netherlands and does Mind Rights provide peer support? Yes peer support is generally provided by smaller local organizations, mostly NGOs and persons who disagree with the system. Mind Rights is an advocacy organization, but I think advocacy is also a form of peer support, to let people know they are not alone. (there came some applause). And also there is a growing number of user-run houses as a shelter for persons in distress, where they can get peer support. Another question was on what the biggest problem is in forced treatments in the Netherlands. I answered that people can be called “incapable of will” or “incapable of judging” and that this can affect all choices in their life, which is absolutely very harmful. I cannot say what is the worst violation, because there is no ranking, all violations damage people and need to be banned. On the question whether forensic psychiatry is also used for political dissidents, I could say no. Forensic psychiatry is a severe measure and only applies to the more severe crimes, BUT political actions can be sanctioned by forced mental health care, such as a famous case in the Netherlands, of a man who threw a small candlelight holder to the Queens vehicle and had to spend 1 year in a mental health institution and since then he is taken into preventive detention on the days that the Queen is in public, based on accused mental disorder and preventing rehearsal. Note that he did not hurt anyone, but only caused a shock. The last question was on the law reforms in the Netherlands, and whether it would make a positive difference for forensic psychiatry, but I don’t think so, since the general public sees the forensic care as monsters, and also we see a trend that also persons without a criminal sentence can be placed into these high secured settings, such as persons diagnosed with Borderline personality disorder who cause a lot of incidents. Since the focus of the system is on control, and not on support, I see no positive in it.

After my contribution, a psychiatrist Mr. Kurokawa spoke about his visit to Italy (Rome, Napoli, Trieste) and the lessons he had learned there. Firstly, it is said that all the mental health institutions have been closed down in Italy, but in fact this is not really true, since there are still some private psychiatric hospitals there. But there has been a significant change towards community based care. This is partly because in Trieste for example, there used to be a nazi-camp in World war 2, and people found the psychiatric institution resembled this practice (personal sidenote: sadly there is no such awareness in the Netherlands, I have been severely abuse in psychiatry in Vught, where also one of the biggest Dutch nazi-camp sites was located in World war 2). Back to the presentation of Mr. Kurokawa from Osaka. In Trieste there is now an open care centre, Salude Mentale, which is open 24/7, and they have 8 beds in every location, total of 32, but the doors are all open. The maximum stay is 4 weeks, and they have many forms of services for the service users, such as occupational activities. The change was initiated by a labour union, which was comprising many professors, who opposed the OPG (psychiatric institutions), see http://www.stopopg.it/ and they are of opinion that psychiatric problems are mainly social problems, and that the culture of society causes so-called “mental illness”. So they have de-institutionalized the persons and made special services in the community. According to the doctors in Trieste and also Mr. Kurokawa, applying the label of dangerousness to psychiatric disabilities is rubbish, and the biggest problem are the psychiatrists who still promote that.

Now in Italy, and they want to close the forensic psychiatric institutions as well. When somebody needs treatment, the doctor visits the person at the location where he/she is, and they don’t see a need for institutionalization. Also Italian criminal law dated from 1930, and was associated with fascism, and so there was also growing support to eliminate these remnants of that horrible past, and by now the first of 6 forensic psychiatric institutions was closed in June 2015. There are no new admissions in forensic psychiatry in Italy.
Studies show that when there is a rich local outpatient care system, there are less people in psychiatric institutions. In the past years in Trieste nobody was placed in a psychiatric institution.

The doctors from Italy also visited Osaka, to help Mr. Kurokawa, who will open a “Salude Mentale”, community based mental health care centre in Osaka, Japan. It was very nice that Mr. Kurokawa also mentioned that he was inspired by the method of Family Group Conferencing for persons with psychosocial disabilities, especially in the light of changing the society.
There were some questions to further clarify the experiences in Italy. It all sounded quite positive. I really regret that I still haven’t had a chance to visit Trieste and see it with my own eyes, because I somehow find it hard to believe that it is really so positive as it is said, but it could be….

Around 5.30 the session ended, and we had a break. I went outside, but was chased away again by the nasty mosquito’s, who seemed to like a fresh European meal. The relief-medicin is pretty good, but I prefer prevention, which is better than curing so to say.
Quite some participants stayed for “the party” at the third floor of the building, where a meal was waiting for us, combined with a meeting from 6 to 7, where the present participants shared their views. There were about 15-20 people. Most of the time there was no interpretation to English, but I still liked to be present and witness the interaction. There was also a psychiatrist with lived experience, and a progressive nurse. It was nice to see that the JNGMDP is having these allies. It was a pleasant atmosphere, very respectful towards all experiences and views. But also very tiring, especially because of the heat today (36 degrees and again very humid).

After 7, I didn’t have much energy left and decided to go back to my hotel. Ryugan accompanied me in the taxi. Then I did some emails, booked the additional luggage for my trip back to Europe, and made a phone call home to my mother and brother, who were both very delighted with this surprise call. That was nice. After a little stroll outside to buy something to drink, I returned to my room and worked a bit more. Tomorrow I will dive into Tokyo as a tourist, and my mind is now free, because I don’t have anymore presentations to do. Only the hospital visits, but that is a different activity, where I mainly need to perceive. So all I have to do is open my mind, and be receptive, and I can train that skill tomorrow when I am a tourist :) That sounds like a good plan to me. So now I am off to bed. Good night!