New support services to protect of the rights of persons with intellectual disabilities, senile dementia or mental illnesses (July 2004)

Written by Community Welfare Division, Public Health and Welfare office, Osaka Prefectural Department of Public Health and Welfare and translated by the Japanese Society for Rehabilitation of Persons with Disabilities. Edited by Hale Zukas, World Institute on Disability (hale@wid.org)

Introduction

A support services system called "Support for Community Living" was enacted in October 1999 by the Ministry of Health, Labor and Welfare in Japan. This system aims to protect of the rights of persons with intellectual disabilities , senile dementia or mental illnesses etc.

Prior to this service, the Osaka Prefectural Government had already started unique and pioneering support services for persons with intellectual disabilities , senile dementia or mental illnesses etc. by providing them with supports such as counseling and economic life support services at the Osaka Conservatorship Support Center in 1997.

Establishment of the Osaka Conservatorship Support Center

For a number of years, according to Ms. Michiko Ohkuni, the president of the Osaka Conservatorship Support Center, caseworkers and counselors have been discussing [the question of] how to protect the rights and property of persons with senile dementia, intellectual disabilities, or mental illnesses should be protected.

When she visited bed-ridden elderly people in the late 1970s and early 1980s, she encountered various dementia-related problems, with problems involving people's assets being a particular concern. One case in point was that of an elderly person who repeatedly handed over money to his/her daughter, who had "taken good care of him/her". But when dementia set in, the daughter vanished from the scene, leaving the elderly person high and dry, with neither money nor a helper. On the other hand, some parents who have a child with an intellectual disability or mental illness spend sleepless nights worrying about what will become of the child after they die.

The problems that need to be addressed thus run a wide gamut; some people shirk their responsibilities while others feel burdened by them. Problems may differ in their specifics, but parent/child relations and property-related issues are often common threads.

With each passing year the issue became more and more pressing, and in 1997 the prefecture of Osaka established the Osaka Conservatorship Support Center "Ai Ai Net" as the first project of its kind in Japan.

In cooperation with social welfare councils in each municipality in the prefecture, the Osaka Wardship Support Center is working toward development of the programs for advocacy for community welfare and provides persons with intellectual disabilities , senile dementia or mental illnesses etc. with opportunities for counseling by caseworkers and lawyers on various infringements, uncertainty about their lives and problems.

Details of the Services

Counseling Service

For those whose judgment is impaired because of intellectual disability, senile dementia or mental illness, the center offers counseling on how to exercise their rights. Telephone advice is available from 10:00 am to 4:00 pm 5 days a week, and , in cases where telephone advice is deemed not to suffice, people can meet with a social worker or lawyer by appointment 2 days a week.

Support for Community Living

The center serves persons with intellectual disabilities, senile dementia or mental illnesses etc. (including people in institutions) who either are unable to handle their own financial affairs, are unsure of their ability to do so, or simply find the task too difficult. Specifically, three services are available:

1. assistance in dealing with social services (both in finding appropriate social services and helping people to navigate their bureaucracies);
2. day-to-day money handling and management (for those who have difficulty getting to a bank or post office on their own, to withdraw money for living expenses, or who need someone else to manage their money because they cannot exercise sufficient judgment to do so on their own); and
3. holding important documents such as passbooks, certificates, seals etc. in trust (for those who forget where they put their passbooks, seals etc. or who are concerned lest their precious savings, registration certificates, etc. be stolen).

The center also promotes public awareness of various issues concerning the rights of persons with intellectual disabilities, senile dementia or mental illnesses etc.

Number of People Served (outside the city of Osaka)

In fiscal year 2003, 523 people were served by the advocacy for community welfare service. Persons with senile dementia were the largest group served, followed by persons with intellectual disabilities and persons with mental illnesses. The number of people served has risen steadily since the center was established and is expected to continue to increase as awareness of the services available grows among the target populations.

The center receives calls from the elderly themselves, their family or helpers and caseworkers asked by the elderly to do so. This telephone counseling is the first step, where most problems such as petty concerns and anxieties are solved. The number of telephone calls for counseling received was 1,457 in fiscal 2003.

Then lawyers or social welfare counselors conduct an interview with those who are deemed to require counseling with professionals. During fiscal year 2003 95 in-person interviews were held, 34 of which were with persons with intellectual disabilities and 31 were with persons with mental illnesses.

About 30% of the problems addressed were related to control or management of the client's assets. For example, among the problems faced by persons with intellectual disabilities are having family members misappropriate their disability pension or take out loans in their name, or being cheated by street vendors or door-to-door sales staff. Persons with mental illnesses often have problems with loans and some complain about concerns relating to their health.

When litigation is required in order to resolve problems such as disputes with consumer finance companies, the center refers clients to lawyers with the requisite expertise who will continuously engage in solving the problem.

At times an elderly client's intent may not be clear; this can make it really difficult to resolve their problem.

Take, for example, an elderly personwho, having complained to a helper about relatives [family members] stealing his or her pension money, gets to the center and makes wishy-washy comments to the counselor like "since they are my relatives, maybe I should not be too hard on them". Such equivocation does not help matters. One challenge that the center faces is how to deal with problems where money issues are inseparably intertwined with family relationships, such as parent/child and brother/sister.

The Future

Adapting the center's operations (including professional and life-support staff assignments) to meet the needs of its growing clientele, will be a challenge.

Therefore, it is necessary to actively promote measures including allocation of registered (part-time) life support staff to secure the implementation system that can flexibly respond to the increase in service users.

It is also necessary to promote the establishment of a "service promotion council" for each service institution, composed of public organizations, interested organizations that conduct welfare activities regionally, NGOs etc. to build up a mechanism that strengthens the cooperation concerning the advocacy for community welfare service in the region.

As an effort to accomplish this purpose, the center is promoting "the cooperation strengthening program", which is unique to Osaka. The needs of the target group will be considered, cases will be examined and information will be exchanged at meetings to be held at each area after the implementation of the program.