Abstract
To include people with disabilities as equal citizens, CRPD (Convention on the Rights of Persons with Disabilities) promotes direct or supported decision-making by people with disabilities. However, involuntary psychiatry admission is considered in many countries to be necessary for people with psychosocial disabilities. To overcome the tension and implement CRPD, it is essential to understand the experiences and concerns of service users, family members, and medical professionals in each country. To understand the process and the factors that make psychiatrists decide involuntary psychiatric admission in Japan, and explore their attitudes toward direct or supported decision-making by people with psychosocial disabilities. Psychiatrists who had authorized involuntary admission and who were in charge of the service users were recruited at hospitals in Japan. The interviews were individual, peer to peer, and semi-structured. The interviews were audio-recorded, transcribed verbatim, and the analysis followed reflexive thematic analysis using NVIVO 12. Six psychiatrists (five designated psychiatrists and one psychiatric resident) participated in the study at two hospitals in urban Japan. The study found that the psychiatrists assessed symptoms, behaviors, and perceptions of the service users together with supports and wishes of their families. The psychiatrists decided on involuntary admission when they saw self-harm or violence, weak insights and judgment abilities, family’s wishes, or when they wanted to avoid the service users leaving the hospital with incomplete treatment. The psychiatrists felt that the service users would not understand any explanations, which made their communications minimal. The psychiatrists thought it was hard to imagine a system other than the current involuntary admission mechanism. If it was to change, they felt the essential things were to avoid abuse, clarify who is responsible, make plans medically valid and feasible, and assess and plan through everyday life, not just in crisis. During a crisis, the psychiatrists were most careful about complying with the Mental Health Act and responded to the family’s wish. The psychiatrists justified involuntary admission as they believed that people in a psychiatric crisis cannot decide or understand and need protection. Related protocols, laws, and expectations from family members shapes the values and practices of psychiatrists in Japan. The paper concludes with several recommendations to regard people with psychosocial disabilities as equal citizens, and promoting the aim of reducing or ending involuntary admission.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Barbui, C., Purgato, M., Abdulmalik, J., Caldas-de-almeida, J. M., Eaton, J., Gureje, O., Hanlon, C., Nosè, M., Ostuzzi, G., Saraceno, B., & Saxena, S. (2020). Efficacy of interventions to reduce coercive treatment in mental health services: Umbrella review of randomised evidence. The British Journal of Psychiatry. https://doi.org/10.1192/bjp.2020.144
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa
Braun, V. & Clarke, V. (2020). One size fits all? What counts as quality practice in (reflexive) thematic analysis? Qualitative Research in Psychology, 1–25.
Carney, T. (2010). Involuntary mental health treatment laws: The ‘rights’ and the wrongs of competing models? In B. McSherry & P. Weller (Eds.), Rethinking rights-based mental health laws (pp. 257–274). Hart Publishing.
dos Santos Mesquita, C., & da Costa Maia, Â. (2016). When the safe place does not protect: Reports of victimisation and adverse experiences in psychiatric institutions. Scandinavian Journal of Caring Sciences, 30(4), 741–748. https://doi.org/10.1111/scs.12300
Freeman, M. C., Kolappa, K., de Almeida, J. M. C., Kleinman, A., Makhashvili, N., Phakathi, S., Saraceno, B., & Thornicroft, G. (2015). Reversing hard won victories in the name of human rights: A critique of the General Comment on Article 12 of the UN Convention on the Rights of Persons with Disabilities. The Lancet Psychiatry, 2(9), 844–850. https://doi.org/10.1016/S2215-0366(15)00218-7
Gooding, P. (2015). Psychiatrists’ perceptions of supported decision-making: A Victorian empirical study. Psychiatry, Psychology and Law, 22(5), 701–722. https://doi.org/10.1080/13218719.2014.983217
Gooding, P., McSherry, B., & Roper, C. (2018). Alternatives to coercion in mental health settings: A literature review. Melbourne Social Equity Institute. Melbourne. Retrieved from https://www.researchgate.net/profile/Piers_Gooding/publication/329984750_Alternatives_to_Compulsory_Detention_and_Treatment_and_Coercive_Practices_in_Mental_Health_Settings/links/5c33ec6ea6fdccd6b59aea78/Alternatives-to-Compulsory-Detention-and-Treatment-
Huber, C. G., Schneeberger, A. R., Kowalinski, E., Fröhlich, D., von Felten, S., Walter, M., Zinkler, M., Beine, K., Heinz, A., Borgwardt, S., & Lang, U.E. (2016). Suicide risk and absconding in psychiatric hospitals with and without open door policies: A 15 year, observational study. The Lancet Psychiatry, 3(9), 842–849. https://doi.org/10.1016/S2215-0366(16)30168-7
Kanata, T. (2015). Japanese mental health care in historical context: Why did Japan become a country with so many psychiatric beds? Social Work, 51(1)
Martin, W., & Gurbai, S. (2019). Surveying the Geneva impasse: Coercive care and human rights. International Journal of Law and Psychiatry, 64, 117–128. https://doi.org/10.1016/j.ijlp.2019.03.001
McSherry, B., & Wilson, K. (2015). The concept of capacity in Australian mental health law reform: Going in the wrong direction? International Journal of Law and Psychiatry, 40, 60–69. https://doi.org/10.1016/j.ijlp.2015.04.006
Ministry of Health Labour and Welfare. (2021). Report on Public Health Administration and Services. Retrieved from https://www.mhlw.go.jp/toukei/list/36-19.html
Newton-Howes, G., Savage, M. K., Arnold, R., Hasegawa, T., Staggs, V., & Kisely, S. (2020). The use of mechanical restraint in Pacific Rim countries : An international epidemiological study. Epidemiology and Psychiatric Sciences 29, 29(e190), 1–7. https://doi.org/10.1017/S2045796020001031
Okayama, T., Usuda, K., Okazaki, E., & Yamanouchi, Y. (2020). Number of long-term inpatients in Japanese psychiatric care beds: Trend analysis from the patient survey and the 630 survey. BMC Psychiatry, 20(522), 1–8. https://doi.org/10.1186/s12888-020-02927-z
Saya, A., Brugnoli, C., Piazzi, G., Liberato, D., Ciaccia, G. Di, Niolu, C., & Siracusano, A. (2019). Criteria, procedures, and future prospects of involuntary treatment in psychiatry around the world: A narrative review. Frontiers in Psychiatry, 10(APR). https://doi.org/10.3389/fpsyt.2019.00271
Schneeberger, A. R., Kowalinski, E., Fröhlich, D., Schröder, K., von Felten, S., Zinkler, M., Beine, K. H., Heinz, A., Borgwardt, S., Lang, U. E., & Bux, D.A. (2017). Aggression and violence in psychiatric hospitals with and without open door policies: A 15-year naturalistic observational study. Journal of Psychiatric Research, 95(August 2017), 189–195. https://doi.org/10.1016/j.jpsychires.2017.08.017
Sugiura, K. (2021). Users’ involvement in decision-making: Lessons from primary research in India and Japan. In M. A. Stein, V. Patel, C. Sunkel, & F. Mahomed (Eds.), Mental health, human rights, and legal capacity (1st ed.). Oxford: Cambridge University Press.
Sugiura, K., Mahomed, F., Saxena, S., & Patel, V. (2020a). An end to coercion: Rights and decision-making in mental health care. Bulletin of the World Health Organization, 98(1), 52–58. https://doi.org/10.2471/BLT.19.234906
Sugiura, K., Pertega, E., & Holmberg, C. (2020b). Experiences of involuntary psychiatric admission decision-making: A systematic review and meta-synthesis of the perspectives of service users, informal carers, and professionals. International Journal of Law and Psychiatry, 73, 1–14. https://doi.org/10.1016/j.ijlp.2020.101645
Szmukler, G. (2015). Compulsion and “coercion” in mental health care. World Psychiatry, 14(3), 259–261. https://doi.org/10.1002/wps.20264
The World Bank. (2022). Population growth (annual %) - Japan. Retrieved from https://data.worldbank.org/indicator/SP.POP.GROW?locations=JP&start=2004&end=2019
United Nations. (2007). Convention on the rights of persons with disabilities. Treaty Series. https://doi.org/UN Doc. A/61/611
van Voren, R. (2002). Comparing Soviet and Chinese political psychiatry. Journal of the American Academy of Psychiatry and the Law, 30(1), 131–135.
World Health Organisation (WHO). (2018). Mental Health Atlas 2017. Retrieved from https://www.who.int/mental_health/evidence/atlasmnh/en/
Acknowledgements
We thank Professor Vikram Patel and Professor Diana Rose for their advice on the study’s early stage. We would also like to thank Mr. Kenjiro Horiai for providing feedback on the analysis from the service user’s perspective.
Funding
Funding was provided by Kobayashi International Scholarship Foundation and University of Tokyo.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All authors declare that we have no conflicts of interest.
Ethical Approval
Tokyo University Ethics Committee and the ethics committee of the two participating hospitals assessed and approved the study (No. 11615-(5)). All the participants provided written informed consent. This work was supported by Kobayashi Foundation and the University of Tokyo, which was used to compensate the interviewer’s and participants’ transportation, recording, and transcription.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Appendices
Appendix
Interview Guide
The interview guide’s questions were:
-
(1)
What made you consider admission regarding the specific patient?
-
(2)
Why did you choose involuntary admission for the patient?
-
(3)
How should the patients participate in the decision-making?
-
(4)
How is the relationship with the patients during and after hospitalization?
-
(5)
If they need admission again, should it be decided differently?
-
(6)
Thoughts on supported decision-making, including Advance Directives (when the medical condition is stable, the person chooses what kind of medical care they want to use or does not want to use in crisis and registers it), Circle of Friends (people designated by the person to gather support information and decide what kind of medical services the person wants to use in a crisis), and Open Dialogue (mainly in the event of a psychiatric emergency, people who know the person well and medical professionals gather to discuss with the person to help the person choose a solution).
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Sugiura, K., Morita, Y., Kawakami, N. et al. How Do Psychiatrists in Japan Choose Involuntary Admission, and What Do They Think of Supported Decision Making? A Thematic Analysis of Peer to Peer Interviews. Community Ment Health J 59, 654–663 (2023). https://doi.org/10.1007/s10597-022-01046-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10597-022-01046-1