Observational Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. Jun 22, 2015; 5(2): 234-242
Published online Jun 22, 2015. doi: 10.5498/wjp.v5.i2.234
Audit study of the new hospitalization for assessment scheme for forensic mental health in Japan
Akihiro Shiina, Masaomi Iyo, Toyoaki Hirata, Yoshito Igarashi
Akihiro Shiina, Masaomi Iyo, Department of Psychiatry, Chiba University Hospital, Inohana, Chuoh-ku, Chiba 260-8670, Japan
Toyoaki Hirata, Chiba Psychiatric Medical Center, Toyosuna, Mihama-ku, Chiba 261-0024, Japan
Yoshito Igarashi, Center for Forensic Mental Health, Chiba University, Inohana, Chuoh-ku, Chiba 260-8670, Japan
Author contributions: All authors contributed to the creation of the questionnaire; Hirata T collected the data; Shiina A analyzed the data and wrote the manuscript; Iyo M supervised the procedure of this study; Igarashi Y is the administrator of this study; all of the authors critically assessed the manuscript and finally approved this article.
Ethics approval: We did not gather any personally identifiable patient information in this study. No studies described in this paper were interventional. We reported the contents of this survey to the Ethical Council of the Graduate School of Medicine, Chiba University in advance, and the council has confirmed that each survey posed no ethical problems.
Informed consent: This study is a service evaluation study. The ethics council has approved that it is not required to obtain the informed consent of each patient in this study.
Conflict-of-interest: This study was supported by a Grant-in-Aid for Scientific Research from the Ministry of Health, Labour and Welfare of Japan, entitled “Iryo-kansatsu-ho seido no kantei-nyuin to senmonteki-iryo no tekiseika to kojo ni kansuru kenkyu [A research for optimization and improvement of Hospitalization for Assessment and Special Treatments in the MTS Act.].” We declare that we have no other conflict of interests related to this research.
Data sharing: There is no additional data available other than in this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Akihiro Shiina, MD, PhD, Department of Psychiatry, Chiba University Hospital, Inohana, Chuoh-ku, Chiba 260-8670, Japan. shiina-akihiro@faculty.chiba-u.jp
Telephone: +81-43-2227171 Fax: +81-43-2262297
Received: December 20, 2014
Peer-review started: December 21, 2014
First decision: January 20, 2015
Revised: February 6, 2015
Accepted: March 30, 2015
Article in press: April 2, 2015
Published online: June 22, 2015
Processing time: 180 Days and 15.1 Hours
Abstract

AIM: To clarify the components of hospitalization for assessment (HfA) and the management changes from the beginning of the scheme to the present.

METHODS: This study is composed of two surveys. In 2013 survey, we created two paper questionnaires (facility and case questionnaires) for psychiatrists working in psychiatric hospitals accepting HfA patients. Questionnaires were sent to 205 hospitals that were identified as accepting the HfA cases, and responses were requested via mail. The facility questionnaire was designed to clarify the following specifications and characteristics of each facility: the facility organizer (public sector or private hospital), and the number of beds, psychiatrists, psychiatric nurses, occupational therapists, psychiatric social workers, psychotherapists, public health nurses, and patients treated through HfA during the survey period. The case questionnaire was then used to collect data of the patients under HfA based on the Medical Treatment and Supervision (MTS) Act who were discharged between July 1, 2012 and June 30, 2013. Gathered information included: legal information of each case, demographic data, past history of the offenders, issued offense and the relationship to the victim, information regarding past psychiatric testimonies, psychiatric diagnoses, contents of the treatment during HfA, information regarding seclusion and restraint during the HfA, the verdict of the District Court panel, and so forth. Next, we compared those results with relevant data obtained in 2007. The 2007 survey comprised data of HfA patients from July 15, 2005 (the date the MTS Act was enforced) to January 15, 2007.

RESULTS: We obtained 171 cases, approximately a half of whole contemporary cases of HfA, from 134 facilities, of which 46 were national, prefectural, or semi-official hospitals, and 88 were private hospitals, in 2013 survey. The majority of subjects were male, schizophrenic, and experienced previous psychiatric treatment. The most frequent type of the offense was injury, followed by arson. Most of the subjects were medicated, and a few cases took psychotropic injection during the HfA. The frequency of injection was decreased in 2013 (χ2 = 7.54, df = 1, P = 0.006) than in 2007. Psychiatric testimony was more likely to be conducted in 2013 (χ2 = 8.56, df = 1, P = 0.004). The examiner psychiatrist was more likely to belong to the HfA facility to which the patient was hospitalized (χ2 = 5.32, df = 1, P = 0.02). Hospitalization orders were more frequently selected in 2013 (χ2 = 19.76, df = 3, P < 0.001), although the characteristics of the subjects had not changed.

CONCLUSION: Although the management of HfA has improved in recent years, structural problems remain.

Keywords: Medical treatment and supervision act; Hospitalization for assessment; Forensic mental health; Audit study

Core tip: In 2005, the Medical Treatment and Supervision Act was enforced in Japan. In this scheme, offenders with mental disorders are hospitalized for assessment (HfA) to determine their treatment. We aimed to clarify the components of HfA and the management changes from the beginning of the scheme to the present. We obtained approximately a half of whole contemporary cases of HfA in the 2013 survey, and then compared the data to those in the 2007 study. The comparison revealed some changes in the HfA cases. This study clarified the improvement of HfA management, and remained some structural problems as well.