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Abstract

第122巻第12号

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Problems of Restraint and Seclusion in Mental Health Setting in Japan
Toshio HASEGAWA
Department of Occupational Therapy, Faculty of Health Sciences, Kyorin University
Psychiatria et Neurologia Japonica 122: 938-945, 2020

 The use of legal force in society originates with the state. Designated psychiatrists are given the right to exercise a certain degree of legal force. Restraint is a coercive practice that limits human rights, and should not be prescribed like medication. Minimization of restraint is a goal in mental health settings worldwide.
 According to the yearly 630 Report put out by the Japanese government, mechanical restraint incidents have doubled over ten years from 2003 in Japan, the number of cases of restraint and seclusion remains high, and their duration is longer than other countries. Comparing prefectures(Japan's health districts), the restraint rate differs more than tenfold. χ2(chi-squared)tests and residual analysis revealed that the rate of restraint was significantly higher in 12 prefectures, most of them in eastern Japan, while 23 prefectures with a comparatively low rate were located mostly in western Japan. Studies conducted in New Zealand show an 11-fold regional difference in the ratio of seclusion suggesting that the minimization of coercive intervention may relate to factors such as customs, practices in the workplace and different models. Moreover, while perceiving the patient as a part of the process of change, it is also an important part in minimizing coercive intervention which also holds true for the concept of recovery. It is necessary to link theory and practice in order to minimize restraint and seclusion. It has also been pointed out that application of restraint because a patient is suffering mental disorders is a violation of the United Nations "Convention on the Rights of Persons with Disabilities". Death in Japan resulting from mechanical restraint is an indication this practice is outdated. In this society, patients cannot even exercise their right of access to and control over personal information. There is a strong need to hold open discussion about life and death matters that experts have held behind closed doors.
 <Author's abstract>

Keywords:Restraint, Seclusion, Mental health, coercive measures, Convention on the Rights of Persons with Disabilities>
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