Japan mass killing sparks debate: why didn’t the system prevent it?

TOKYO — A day after the mass murder of 19 people at a facility for the disabled, many shocked Japanese were questioning why the only suspect was discharged after just two weeks from a hospital to which he’d been forcibly committed under mental health laws. Some are also wondering why the suspect, who had written letters in February saying he would kill hundreds of handicapped people, was not kept under surveillance after he left hospital. “Involuntary commitment is done forcefully by the authorities...If the time period drags on longer than necessary, it becomes a serious violation of human rights,” Asahi newspaper said in an editorial on Tuesday. “However, there were warning signs before the incident,” said the Asahi, one of Japan’s two biggest newspapers. “Was the treatment and monitoring of the man sufficient“? Experts said there were no legal limits on the length of involuntary hospitalization but a discharge was required once the patient was no longer deemed a danger to himself or others. The decision is up to the doctors, so it’s difficult to second guess. “The general public might think, ‘Why was such a person let loose?’ but forcible commitment is against the person’s will so the conditions should be strict,” said Fumie Kyo, a lawyer specializing in mental health patients’ rights. Nevertheless, Kyo added, it might have been possible to keep Uematsu in hospital longer under protective care even if he was no longer judged a threat to others. The goal of Japan’s hospital commitment system, however, is to provide medical treatment, not prevent crime, experts said. “If medical treatment is deemed no longer necessary, then the doctor must discharge the patient,” said Seijo University professor Teruyuki Yamamoto. “The law is for the purpose of medical treatment, not for the prevention of crime, so there are limits.” Authorities have not disclosed the hospital where Uematsu was treated or identified the doctor who approved his discharge. The experts said there was no legal requirement to keep a discharged mental patient under surveillance and indeed, doing so without permission would risk violating his rights unless the patient had previously committed a serious crime. Still, most agreed the incident had exposed weaknesses in Japan’s community support system for discharged mental patients. “Japan’s regional support system for the mentally ill is weak,” Kyo, the lawyer, said. “All we have been doing is institutionalize the mentally ill.” What sort of system should be put in place could be a delicate problem in a society where mental illness carries a stigma. “What is needed from now on is to create a soft system where officials from the department of health ask how the patient is doing,” said Toshihiko Matsumoto, a physician who specializes in drug dependence at the National Institute of Mental Health. “Most mentally ill patients do not do such a thing,” Matsumoto added, referring to the killings. “It’s an extremely exceptional case. I’m worried that because of such an exceptional case, the rights of people who are trying to get better will be restricted.”