Human rights of the psychiatric patients from abroad

2015.07.13

Human rights of the psychiatric patients from abroad

In 2020, we are going to have the Olympic Games in Tokyo. In Tokyo Metropolitan government, the preparation for the games is already under way. The 8 Metropolitan Hospitals include us are also busy in preparation for the patients from abroad.

Besides the Olympic Games, The Tokyo Metropolitan Matsuzawa Hospital has a very difficult problem about the treatment of foreign patients for years. It is the protection of human rights of the psychiatric patients who can neither speak nor read Japanese. In early 1980th, a serious human rights violation case happened in a psychiatric hospital in Japan. This incident triggered an amendment to the Mental Health Act of Japan. In this new amendment act, the due process of laws in involuntary admission and other physical restriction in psychiatric hospitals established for the first time in a history of Japanese mental health. However, the procedure for the foreign patients had left behind ever since.

Between 5th May 2012 to 21st January 2014, 123 foreign patients consulted the Matsuzawa Hospital. There are 31 patients from China, 14 from US, 12 from Koria, 5 from Philippine, UK, 4 from France, Nepal and 48 from other countries all over the world. 15% of these patients understand Japanese language, but 35% of patients speak mainly English, 29% Chinese, 7% Korian and 17% other languages. Only 4.1% were tourists, 78.8% had home and job in Tokyo Metropolitan and neighboring, and 13.8% were of no fixed abode. About a half of the patients were diagnosed schizophrenic disorder or acute psychotic syndrome, about 10% were psychoactive substance abuse. Compared with Japanese patients, these foreign patients have a lots of difficulties to access to psychiatric services in Japan. Because of that, most of these patients are too severely disorganized or excited to understand what happened on them when they were taken to the hospital.

78 of 123 foreign patients were admitted our hospital, and 65 of 78(83.3%) were involuntary admission. Some were isolated in secretion rooms and some of them were physically restricted. It is sometimes very difficult for psychiatric patients especially in their excitement to have an insight for their own mental state. So, they often cannot understand why they need medication or hospitalization. This is the reason why the due process of laws in involuntary psychiatric medicine is exclusively important. For Japanese patients, this kinds of due process of laws have been established since Mental Health Amendment Act in 1987. But for the foreign patients who cannot understand Japanese Language, the Act decided nothing. A few months ago, a patient form UK was admitted our hospital involuntarily. She spent a few days in a secretion room because of her severe psychomotor excitement. When she moved to general psychiatric word, she murmured “Oh, it is a hospital, not a jail!?” Is it a joke or black joke, anyway, I was very shocked when a nurse told me about the story. Can you imagine how you should felt if you were taken to psychiatric hospital during your travel abroad and secreted in a small jail like room, and if you could not understand the language that other people spoke.

We have translated our official papers about involuntary admission into English, French, Spanish, Chinese, Korian and Tagalog in 2014. Before we use these translation, I would like to authorize the translation by Embassy of each countries because the patients who are forced to admission to the hospital will feel easier if they realize the embassy of their own country authorize the law procedures. The embassy of Korea republic only authorize the translation (we express our special thanks to Ms. Eunhye Oh of Waseda University for her efforts on this matter), the embassy of France and Spain reviewed the translation, but we have not received any responses from embassy of other countries. They are often too eager to speak about the situation of human rights in other countries but completely indifferent to the human rights of their own mentally ill people.

There are more than 2million foreigners in Japan today. The number of tourists from abroad has been rapidly increasing recently. More and more workers will come to Japan for the constructions until Olympic Games in 2020. Some are already mentally ill before they come, and some show transient mental confusion after they come to Japan. All of these people have rights to be treated with their own consent, but for some who cannot understand their need to be treated, we have to prepare the procedure for involuntary treatment and reliable safe guard for mal practices. The importance of these procedures is unchanged both in Japanese and foreigners.