Better Services Needed for People with Mental Illness: Message to Prime Minister of Japan, Junichiro Koizumi, the Mass Media, and the People of Japan (March.2002)

Written by Ms. Kazuko Hirota, a survivor of psychiatry and translated by Japanese Society for Rehabilitation of Persons with Disabilities.

(Note: Kazuko Hirota underwent a very difficult and traumatic experience through receiving medical treatment for mental illness and now works for the realization of better and safer treatments for all people.)

Background
From April 21 to May 19,1988, I had been in a mental hospital where there was no freedom, but instead, I was locked in with keys and iron-barred doors and windows. The reason that I was taken into the hospital was not because of an illness itself, but because of the side- effects from the injection that I was given by mistake. I reacted so badly to the injection that I was slobbering, had hallucinations, began to lose my eyesight, could not sit still, but had to keep on walking for 22 hours a day (because of akathisia), and I could no longer live a normal life.

After leaving hospital, my doctor said, "At that time, I was afraid that you might kill yourself, so I advised you to go into hospital." Indeed, during those hell-like agonies, I wished "I were dead". The side- effects of the injection were so painful that I didn't even have energy to kill myself. When I was injected, I had just started to work part-time, finally overcoming the office phobia, which I had suffered from for many years. I had already been receiving regular treatment from a psychiatrist for five years. Since I had a job, my mother went to the hospital, but she was told to make me come instead. Therefore, I took a day off and went there myself the following week. When I saw the doctor, he suddenly started to give me an injection just because I sometimes forgot to take medicine. I said, "Please wait a moment. I am allergic, so the injection may cause trouble and have side- effects. " But the doctor gave me the injection anyway without my informed consent.

As a result, I went through an awful experience as I mentioned and was immediately rushed to hospital, becoming as good as dead.

After a period of time when I finally recovered to be able to sleep for eight hours, I left hospital, but since the injection, I cannot sleep unless I take medication. Besides, even if I take medicine and fall asleep, I wake up as soon as I hear a small sound. This is very frustrating for me and also makes me get tired so easily that I have to rest for about 12 hours a day.
National and international exposure to different approaches After leaving the hospital, I attended a workshop, joined a patients' association for one year, while working part-time for a company. However, I was involved in a traffic accident in 1993 and quit my job. Afterwards, I started to work as a counselor and give lectures and became fully committed to these activities. They are all voluntary activities and so I live on social welfare.

In October 1991, I had an opportunity to attend the Conference of People with Disability in Japan and the USA, held in St. Louis. I was very lucky to be able to visit the Independence Center there, which operates for 24 hours a day. I used to think and complain that in Japan, the consumers receiving medical treatment or health care services are very passive and they cannot be independent. Through my visit to the USA, I came to realize that this was situation was also not favorable for the staffs that provide the treatment or health care service.

The consumers in the Independence Center impressed me because many of them were very positive and independent. In other words, my opinion that consumers should be more independent is not easily accepted in Japan, but it is quite natural in the USA. I was very fortunate to realize this fact.

Appointment to a national governmental committee
On December 14 last year, I was appointed a member of the official committee for the Ministry of Health, Labour and Welfare as a survivor of psychiatric treatment for people suffering from mental illness for the first time in Japan. This story was reported in all the major newspapers in Japan such as Asahi, Sankei, Tokyo, Chunichi and Yomiuri (with a combined circulation of about 23 million), as well as in a local newspaper called the Kanagawa Shimbun, in a big article introducing me with my photograph. In addition, NHK, the major public broadcasting company in Japan, televised this as top news in the evening and also in the following morning after the first meeting. It was the first case in Japan that the Japanese mass media featured a victim of psychiatric treatment for patients suffering from mental illness in such a way.

A deluge of requests
Within a month after this news release, I had received more than 350 telephone calls at home from readers of the newspapers and others. Most of them were asking me for some advice, and others encouraged me concerning for my appointment. There were also people who sympathized with my comments published in the newspaper, which was, "The government should apologize to the people with mental disorders for treating them in a wrong way and should make drastic reforms."

Examining the impact of negative media coverage
What I mean by "a wrong way" is the government's policy to isolate the people who are suffering from mental disorders in hospitals. This policy was accelerated after an American Ambassador, Reischauer, was stabbed by a young man with a mental disorder on March 25, 1964. At that time, the number of beds in mental hospitals had already started to increase, since in 1958 a discriminatory law had been enacted which allowed the numbers of doctors and health care workers at mental hospitals to be less than those at regular hospitals in order to increase the beds more easily.

The well-publicized incident was quite timely. As the ambassador of the USA, a country which was a superpower at that time, was stabbed, the mass media aroused public opinion, saying in effect, "Do not leave people with mental disorders unattended." Even after the public response faded, the government continued to lend money to build new mental hospitals with low interest and the number of beds in private mental hospitals kept on increasing.

As a result, hospitals now need more patients because they have plenty of beds. In Japan there are more than 330,000 patients staying in hospitals at present, which is the highest percentage of inpatients in the world. The Ministry of Health, Labour and Welfare itself admits that there are many inpatients that actually do not need any hospital treatment, but have to stay there only because they have nowhere to go after leaving the hospital.

challenge to change the system
However, the measures to care effectively for patients after leaving hospitals are not ready yet, as the manpower and budget are not sufficient at both the central and the local governmentﾅ@level. In almost every local government in Japan, there is neither emergency medical service for patients with mental illness available for 24 hours a day, nor social welfare services provided on a 24 hour basis. I believe that the government needs to apologize for having a policy to isolate the patients with mental illness in the past and now to carry out drastic reforms so that the people with mental disorder in Japan can live peacefully in their own hometowns.

At the same time, I want to caution the mass media to write articles about patients suffering from mental illness carefully, because in the Reischauer incident people misunderstood patients with mental disorder from reports in the media. I am also anxious to convey the present conditions of people with mental disorders to Prime Minister Koizumi, all the Mass Media and all the people in Japan.