Differences between British and Japanese perspectives on forensic mental health systems:A preliminary study

AIM To clarify the differences in views on forensic mental health(FMH) systems between the United Kingdom and Japan.METHODS We conducted a series of semi-structured interviews with six leading forensic psychiatrists. Based on a discussion by the research team, we created an interview form. After we finished conducting all the interviews, we qualitatively analyzed their content. RESULTS In the United Kingdom the core domain of FMH was risk assessment and management; however, in Japan, the core domain of FMH was psychiatric testimony. In the United Kingdom, forensic psychiatrists were responsible for ensuring public safety, and psychopathy was identified as a disease but deemed as not suitable for medical treatment. On the other hand, in Japan, psychopathy was not considered a mental illness. CONCLUSION In conclusion, there are considerable differences between the United Kingdom and Japan with regard to the concepts of FMH. Some ideas taken from both cultures for better FMH practice were suggested.

Audit study of the new hospitalization for assessment scheme for forensic mental health in Japan

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 Hf A 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 Hf A during the survey period. The case questionnaire was then used to collect data of the patients under Hf A 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 Hf A, information regarding seclusion and restraint during the Hf A, 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 Hf A 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 Hf A. 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 Hf A 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.

Effect of educational intervention on attitudes toward the concept of criminal responsibility

AIM To evaluate the effect of educational intervention on individuals' knowledge of and attitudes toward forensic mental health.METHODS We conducted a questionnaire regarding attitudes toward various ideas about forensic mental health. The respondents attended a 1-h seminar regarding forensic mental health after answering the questionnaire. On completion of the seminar, the respondents answered another questionnaire containing many of the same questions as contained in the pre-seminar questionnaire.RESULTS A total of 86 individuals attended the seminar, and 78 responded to the questionnaire. Only 13(18.8%) participants were supportive of the concept of criminal responsibility initially, and there was a statistically significant increase in those who became more supportive after the seminar, with 22(33%) being supportive after the seminar(Wilcoxon signed-rank test, P < 0.001). Logistic regression analysis revealed that participants who were skeptical about forensic mental systems and those with fewer opportunities to see media reports regarding psychiatry were likely to become supportive of criminal responsibility after the intervention.CONCLUSION These results suggest that public attitudes toward criminal responsibility and mental health can be influenced via educational interventions.

No change of attitude toward forensic psychiatry: 5 years after the Medical Treatment and Supervision Act in Japan

Objective: The forensic mental health system in Japan changed dramatically with the enforcement of the “Act on Medical Care and Treatment for the Persons Who Had Caused Serious Cases under the Condition of Insanity” or MTS Act, in 2005. The aim of this study is to evaluate the changes in attitude and behavior of general psychiatrists, towards forensic psychiatry. Methods: We conducted a questionnaire survey in 2010 on forensic psychiatry for Japanese psychiatrists, mirroring a previous study from 2007. Results: Comparing the results from both questionnaires, it is not evident that awareness of forensic mental health has improved among psychiatrists in the intervening three years. Conclusion: Further education about forensic mental health needs to be considered inJapan.