Weisstub David N, Carney Terry
Legal Psychiatry and Biomedical Ethics, Université de Montreal, Canada.
Int J Law Psychiatry. 2006 Mar-Apr;29(2):86-100. doi: 10.1016/j.ijlp.2005.09.002. Epub 2006 Jan 31.
Since the 1980s Japan has undergone a number of mental health law reforms culminating in the 2005 forensic law. This added to its enactments on involuntary commitment, long-term aged care and substitute decision making, bringing Japan into focus as an industrialized state now possessed of a full package of civil and forensic provisions. This article seeks to demonstrate that the new forensic law cannot achieve its own stated goals without seeking to put into place financial and administrative supports aimed to integrate the myriad of patient populations that will be inevitably affected by the new forensic system. In order to avoid the widespread syndrome that has already been experienced internationally of warehousing mentally ill offenders in jails, it is critical that the Japanese government develop effective and culturally sensitive techniques for dealing with low risk populations through a diversionary process. Furthermore, although the legislation addresses serious crimes, it is imperative that policies be put into place to avoid directing young offenders, violent patients from the general hospital system, the developmentally handicapped, already convicted persons found in hospital settings and problematic cases in the correctional system, to the new forensic units established by the legislation. It is only though contemplating unintended outcomes of the legislation that the Japanese government will be able to avoid the ongoing stigmatization and prolonged institutionalization of mentally ill populations. Despite apparent cultural differences internationally vetted human rights requirements must be properly protected, not only in the forensic context, but throughout the mental health system at large. The coordination of services and the development of specialty training are necessary conditions for the realization of improved and humane conditions for mentally ill persons in Japan.
自20世纪80年代以来,日本进行了一系列精神卫生法改革,最终形成了2005年的法医法。这一法律补充了其关于非自愿住院治疗、长期老年护理和替代决策的法规,使日本成为一个拥有一套完整民事和法医条款的工业化国家而备受关注。本文旨在表明,新的法医法若不寻求建立旨在整合将不可避免地受到新法医系统影响的众多患者群体的财政和行政支持,就无法实现其既定目标。为了避免国际上已经出现的将患有精神疾病的罪犯关押在监狱中的普遍现象,日本政府必须开发有效且符合文化特点的技术,通过分流程序来处理低风险人群。此外,尽管该立法涉及严重犯罪,但必须制定政策,避免将年轻罪犯、综合医院系统中的暴力患者、发育障碍者、在医院环境中被发现的已被定罪者以及惩教系统中的问题案例导向该立法设立的新法医部门。只有通过考虑该立法的意外后果,日本政府才能避免对患有精神疾病的人群持续的污名化和长期的机构化。尽管存在明显的文化差异,但经过国际审查的人权要求不仅在法医背景下,而且在整个精神卫生系统中都必须得到妥善保护。服务的协调和专业培训的发展是在日本实现改善和人道的精神疾病患者状况的必要条件。