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Schizophrenia sufferer challenges Japan's isolation of mentally ill

Tokio Ito poses alongside his art in Ota, Gunma Prefecture, on Oct. 26, 2020. (Kyodo)

TOKYO (Kyodo) -- A schizophrenic man who says he was forced to spend roughly 40 years in mental hospitals despite an improvement in his condition is urging the Japanese government to do more to overhaul its policies regarding long-stay hospitalization at such institutions.

    Tokio Ito, 69, filed a lawsuit against the central government at the Tokyo District Court on Sept. 30, demanding 33 million yen ($318,000) in damages for being denied discharges over the years.

    The resident of Ota, Gunma Prefecture, criticized the government for a policy that he said left him "in a state of limbo" and "stole the better part of my life."

    The lawsuit states that the hospitalizations were, in effect, enforced and violated equal protection under the law and the right to the pursuit of happiness guaranteed by the Constitution.

    Ito, born in Sendai, northeast Japan, was diagnosed with schizophrenia when he was 16 and admitted to a Tokyo hospital in 1968. He was finally released after spending years in various mental hospitals in October 2012. Although happy to be out, he regrets the life he missed, such as not having a family of his own.

    After repeatedly going in and out of two mental institutions in Tokyo, Ito was transferred to another in Fukushima Prefecture in 1973. What followed was an uninterrupted life of psychiatric hospitalization, though his sickness progressively improved, he says.

    Determined to show that he was "a model patient who could leave the hospital as quickly as possible," Ito worked from morning till evening at a chicken farm and factory outside the Fukushima hospital during his time at the facility.

    His take-home pay was just 350 yen a day -- most of which he used purchasing cassette tapes of Japanese traditional enka music. "Even after 10 or 20 years went by, there was never any talk of me being released," Ito said.

    In the 1960s and 1970s, health departments in North America and Europe reviewed long-term mental hospitalization from a human rights perspective and overhauled their systems to emphasize community-based care as opposed to hospital-based settings.

    But during the same period, Japan doubled down on long-term hospitalization, seeing a rise in the number of psychiatric beds at private institutions.

    According to health ministry data as of the end of June 2017, there were an estimated 280,000 psychiatric inpatients -- about 60 percent hospitalized for more than one year, considered "long-term stays," and 55,000 for more than 10 years.

    Roughly 60 percent of the inpatients suffer from auditory hallucinations or delusions, typically witnessed in schizophrenia.

    In 2014, Japan still had a very high ratio of psychiatric care beds per capita among member countries of the Organization for Economic Cooperation and Development, with 269 beds per 100,000 people compared with the average of 68, based on a 2014 OECD report.

    The average length of hospital stay, meanwhile, was about 290 days, which is exceptionally long compared with other countries.

    Long-term hospitalization appears to reflect the influence of past isolation policies, in particular for leprosy patients, and concerns have been raised over human rights abuses. But while the government has set itself a target of reducing hospitalizations, it has failed to meet it. What is needed, experts say, is to secure financial resources, cooperate with medical personnel, and eliminate prejudice in the community towards those with mental illness.

    Parallels between what experts deem the stigmatization of mental disorders can be drawn with Japan's erstwhile draconian policy toward leprosy patients.

    Last year, Japan enacted a law to enable compensation payments of up to 1.8 million yen to be made to family members of leprosy sufferers who experienced discrimination and prejudice under the country's past regime of segregation.

    The law states that the government and the Diet "deeply apologize" and show remorse to the family members for their hardship. Leprosy, also known as Hansen's disease, is now curable, but many patients were forced into isolation in sanatoriums under a law that was in place between 1907 and 1996.

    In Ito's trial, he argues that priority was given to the hospital bottom line of filling beds rather than treating individuals with mental disorders, leading to long-term hospitalizations. When he lived at the mental hospital in Fukushima, many patients had been there for decades, he said.

    While many countries made the shift from such isolation policies to community-based care for psychiatric patients, Japan continued the practice of "abandoning long-term patients," he argues.

    "When you insisted on leaving a hospital, you became a target for the doctors. So everyone ended up keeping their hopes concealed deep in their hearts," said Ito.

    One indication that Japan might now be moving toward community-based care for psychiatric patients and away from long-term hospitalization is an effort to adopt the so-called Open Dialogue program developed in Finland's Western Lapland in the 1980s.

    It involves a family-social network approach to care in which primary treatment is carried out with the patient in meetings together with family members and experts. With the introduction of this surprisingly simple method, the length of hospital stay for schizophrenia patients and the proportion of patients who needed to take medication were significantly reduced in the Western Lapland region compared to conventional treatment.

    Ito's mother died when he was just a child, and his father would visit him at the mental hospital several times a year. But his father died in 2000.

    Having been cut off from the outside world for so long, Ito possessed no cellphone or driver's license and had all but written off being discharged after a life of institutionalization. "I felt that it would be impossible for me to return to society."

    But a turning point came with the March 2011 Great East Japan Earthquake and tsunami.

    Patients at the Fukushima hospital were evacuated to various areas due to the devastation, and Ito stayed at several mental hospitals in Ibaraki Prefecture. Suggesting that Ito's condition had improved, a doctor asked him if he would like to leave the hospital and move into a group home about a year and a half after the disaster.

    Confused about the reason -- or lack thereof -- for his release since no one had recognized a change in his condition for years, Ito nevertheless left the hospital in October 2012 at the age of 61. After staying in a group home, he moved into an apartment by himself in Ota where he currently resides.

    Ito, who does art drawings and writes poetry as a hobby, realized a long-held dream of opening a solo exhibition. He is also engaged in activities to support schizophrenia sufferers. Although he leads a fulfilling life today, he dreams of what might have been.

    "I wanted to marry and have children," he said.

    Although he cannot turn back the clock, he hopes that his decision to sue the government will help people like him who have been cast away in mental hospitals but wish to reintegrate into society. "I want people not to hold prejudices but see our reality."

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