TOKYO -- Tokio Ito hopes that, when his day in court comes, he'll be able to say his piece with eloquence. He will do his best.
That day in court he's looking forward to will be in a lawsuit the 69-year-old filed at the Tokyo District Court against the government of Japan in September this year, seeking 33 million yen (about $317,000) in damages. His grievance: the 40 years of his life spent being held in psychiatric institutions after being diagnosed with schizophrenia; decades robbed from him by national mental health policy far behind the times.
Ito was born in Sendai in northeast Japan, and was a 16-year-old trainee cook at a restaurant in Kawasaki, Kanagawa Prefecture, south of Tokyo when he began to show symptoms of schizophrenia. He was admitted to two Tokyo hospitals before, in 1973, he began what turned out to be nearly four decades at a psychiatric institution in Fukushima Prefecture, northeastern Japan.
While he was institutionalized, he did several jobs, including working at a nearby chicken farm and helping serve food to the hospital's in-patients. At the time, he thought that, if he showed he could work seriously, he might be allowed to leave the hospital. However, his hopes were dashed. There was no release.
"I thought about dying many times," Ito says. "I'd wanted to get married, to have kids. But I lost more than half of my life (in the hospital)."
The event that finally saw him get free of the Fukushima Prefecture psychiatric institution was the March 2011 Great East Japan Earthquake. All the patients were evacuated, and Ito was transferred to a hospital in Ibaraki Prefecture, north of Tokyo. His attending doctor there asked if he would like to move into a group home. Taking advantage of the suggestion, Ito finally got his long hoped-for release the following year. He spent two years living at the group home before moving out on his own. About eight years ago, he settled in Ota, Gunma Prefecture, and has been living there alone ever since.
As long as Ito takes his medication, he doesn't have any trouble in his daily life from his illness. He lives in a one-bedroom apartment and does all his own cooking and cleaning. He draws and goes to public baths -- time he calls blissful. He finally has a regular life, and he says it's "wonderful."
Asked what prompted him to file the lawsuit against the Japanese government, and Ito replies, "While I was in the hospital, there were several other people who had been held there for 20 or 30 years. There are some among them who seem like they could be released, and I thought I wanted them to return to society just like I have."
A Ministry of Health, Labor and Welfare representative declined to comment on the suit, saying the ministry had not yet received the complaint.
According to Ito's legal team, many other countries began shifting away from mandatory confinement for psychiatric patients in around 1955, after recognizing the practice as a human rights violation. The focus was put on localized care and living in the community. In 1968, a World Health Organization advisory to Japan stated that many patients in long-term confinement were falling into hopelessness, and recommended moving to a local care approach. However, the legal team is emphasizing, the recommendation was not acted on.
Health ministry statistics show that the average length of stay at psychiatric hospitals was 265.8 days in 2019. In 1989, that figure was 500 days, with stays getting shorter on average year over year since. However, Organisation for Economic Co-operation and Development (OECD) statistics show much shorter stays in other rich nations (though standards for calculating the figure differ by country), with the 2018 average at 176.4 days in South Korea, 35.2 days in Britain, 23 days in France, and 13.6 days in Italy.
The Japanese government is trying to reduce the number of long-term patients at psychiatric hospitals and shifting care to the local level, but the results have been less than anticipated.
Japan's disability and welfare policy plan for fiscal 2018-20 aims to reduce the number of people held for a year or more at psychiatric institutions by as many as 39,000, from the estimated 185,000 such patients held as of the end of fiscal 2014. However, there were some 166,000 of these patients at institutions nationwide in 2019. In other words, long-term patient numbers fell by about 19,000 from 2014 to 2019. The health ministry's vision for psychiatric treatment reform, issued in 2004, called for psychiatric care beds to be reduced by some 70,000 over the next decade. By 2019, bed numbers had fallen by only around 28,000.
So why isn't the shift to localized care progressing in Japan? The answer is complicated.
Professor Atsuko Otsuka of Teikyo Heisei University's Faculty of Modern Life told the Mainichi Shimbun, "First of all, the amount of funding for regular medical care that is directed to psychiatric treatment is quite small. Even among long-term psychiatric patients in chronic care wards with relatively less severe conditions, many still need support for daily living. And local authorities simply don't have the staff to help these patients with practice trips outside the institution."
Furthermore, "If they do leave the hospital, these patients would need local psychiatric aftercare, such as a home helper or home visits by a nurse. There are local authorities that do not have the support infrastructure in place for patients to live in the community. There are enormous regional disparities."
One mental health and welfare worker at a Tokyo hospital pointed out, "Sometimes it's the families who don't want the patient released. It seems that, based on experience, they simply can't imagine the patient living in the community. If these family members understand that the hospital could help their loved-one with daily life, and that there is a place in the community for them to go, then I think they'd be more agreeable."
(Japanese original by Hiroko Michishita, Special Reports Department)