Psychiatric Commitment in Japan: International Concern and Domestic Reform

Abstract

PSYCHIATRIC COMMITMENT IN JAPAN: INTERNATIONAL CONCERN AND DOMESTIC REFORM Pamela Schwartz Cohent I. INTRODUCTION A. OVERVIEW Psychiatric commitment is one of the most sensitive and complex policy issues confronting any government. Legislating or adjudicating in this area is like juggling on a tightrope; the acrobat must balance the interests and realities of law, psychia- try, politics, and culture, while walking a precarious line between protecting human rights and safeguarding against the potentially devastating effects of mental illness. The manner in which this balancing act is accomplished will depend on the characteristics of the juggler and the nature of the issues being juggled. A suc- cessful performance in one setting may be unpopular or unwork- able in another. In promulgating the Mental Health Act of 1987 ( 1987 Act ),' the Japanese government overhauled its approach toward the balancing act of psychiatric commitment. The 1987 Act pro- vided for the first time in Japan's history a legislative scheme for t Consultant in mental health law. Formerly, Staff Attorney, Judge David L. Bazelon Center for Mental Health Law, Washington, D.C. Visiting Scholar, Sophia University, Tokyo 1990-1992. Member, 1992 International Commission of Jurists Mission to Study the Human Rights of Psychiatric Patients in Japan. This article was written under a grant from the Japan Society for the Promotion of Science ( J.S.P.S. ). In addition to J.S.P.S. and Sophia University, the author thanks the many individuals in Japan and the United States whose help and guidance were crucial to this work. Special appreciation goes to Professor Saku Machino of Sophia University, Professor Stephan Salzberg of the University of British Columbia, Nobuko Kobayashi of the Tokyo Center for Mental Health and Human Rights, and the members of the preparatory committee for the 1992 International Court of Jus- tice ( I.C.J. ) mission to Japan. 1. English translations of provisions of the 1987 Act and regulations promul- gated thereunder (including the Psychiatric Review Board Manual) are from the unofficial translation published by the Mental Health Division of the Health Service Bureau of the Ministry of Health and Welfare of Japan (1988).