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Aim: In Japan, a new comprehensive forensic mental health service was established and enforced in 2005. However, the shortage of psychiatrists dedicated to this service is a problem. Therefore, we investigated the attitudes of general psychiatrists in Japan toward this field in order to develop measures for dealing with this issue.
Methods: Questionnaires were sent to 3205 psychiatric facilities in Japan in January 2007. The questions explored the experience of the respondents with forensic evaluations; the respondents' recognition of, experience with, and attitude toward the Medical Treatment and Supervision (MTS) Act; and attitudes toward forensic mental health in general.
Results: The data of 1770 respondents were analyzed in this study. Three main findings were obtained: psychiatrists generally had little experience with criminal responsibility evaluations, and a small percentage of psychiatrists tended to have conducted the majority of these evaluations; although psychiatrists widely recognized the enactment of the MTS Act, they were not sufficiently familiar with the details of the MTS Act; and in spite of a reluctance to address forensic mental health issues, the respondents harbored a general interest in these topics.
Conclusions: Despite a general interest, general psychiatrists in Japan tend to possess insufficient knowledge of this subspecialty and lack experience in and opportunities to work in this subspecialty. The reluctance of psychiatrists to work in forensic mental health might be partly responsible for this situation. These results suggest that the enrichment of education systems for forensic psychiatry is necessary for the development of forensic psychiatry in Japan.
IN 2004, THE JAPANESE government published a report entitled, ‘Visions for the Reform of Mental Health and Medical Welfare.’ This report reflected a shift in the basic policy regarding the medical treatment and care of patients with mental disorders from treatment in psychiatric hospitals to treatment in the community involving a reduction of approximately 70 000 hospital beds over a period of 10 years. Deinstitutionalization reportedly increases the need for forensic mental health services,1 suggesting that these services should be improved in Japan.
In light of this background and the many forensic problems in psychiatric services, Japan enforced a new law in 2005 called the ‘Act on Medical Care and Treatment for Persons Who Have Caused Serious Cases under the Condition of Insanity’ (the Medical Treatment and Supervision [MTS] Act). The MTS Act provides a hybrid solution that straddles the judicial and medical systems, with the District Court serving as a gatekeeper, composed of a judge and a specially qualified psychiatrist (seishin-hoken-shinpan-in or ‘reviewer’ hereafter). The reviewer is selected from a group of mental health examiners (seishin-hoken-hanteii or ‘examiner’ hereafter) who have completed specialized training concerning the MTS Act. A comprehensive forensic mental health system was subsequently established in Japan as a result of the MTS Act.2–4
Although an urgent need for an increase in forensic mental health services exists, the number of psychiatrists who are dedicated to the forensic mental health service in Japan remains scarce.5 There are three main types of criminal responsibility evaluations in Japan: (i) a preliminary pre-trial evaluation entrusted by a public prosecutor (kan-i-kanntei); (ii) a standard pre-trial evaluation entrusted by a public prosecutor (shokutaku-kanntei); and (iii) a public trial evaluation ordered by a judge (kouhann-kanntei). Preliminary pre-trial evaluations are usually completed after an interview that typically requires a few hours to complete, whereas the other two evaluations require a few months to complete and are regarded as formal criminal responsibility evaluations. Criminal responsibility evaluations have traditionally been considered the most important focus of forensic psychiatry in Japan6 and are the procedural starting point for the MTS Act. However, the number and demographic characteristics of psychiatrists qualified to perform such evaluations have not been studied.
As part of the new law, an internal panel of the District Court orders psychiatric evaluations for medical necessity following the public prosecutor's decision not to proceed with prosecution by reason of insanity or diminished responsibility. These evaluations and assessments are performed with the aim of determining whether involuntary inpatient care in a designated inpatient facility or compulsory outpatient management at a designated outpatient facility is needed. Until now, few studies have investigated the attitudes of Japanese general psychiatrists toward forensic mental health services, including this new law. Therefore, we investigated the experiences and attitudes of general psychiatrists toward forensic mental health services in Japan.