Treating the mentally disordered criminal offender in a hospital setting.

The author outlines the legislation and treatment system for mentally disordered criminal offenders in Japan, and reviews the recent studies on the treatment of refractory patients in mental hospitals. Involuntary admission of patients referred by a public prosecutor or by a head of a correctional institution is problematic regarding the judgment criteria for admission and discharge, and imposes a burden on practitioners. The author outlines the main problems of the treatment of criminal offenders in a hospital setting: reaction to the hospital environment, lack of motivation for treatment, therapists' reluctance to treat these patients, absence of support for rehabilitation and uncertainty about future risk. Suggested measures for the solution of these difficulties include the role of the Psychiatric Review Board, the psychiatric evaluation system, and therapeutic skills pertaining to dangerous patients.