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Abstract

第111巻第12号

Burden of the Designated Hospitals When They Receive Inpatients from a Distant Place by the Medical Treatment and Supervision Act
Ryoji MIYATA, Yoshiyo OGUCHI, Yasuo FUJII, Yukie KOBAYASHI
Yamanashi Prefectural Kita Hospital
Psychiatria et Neurologia Japonica 111: 1485-1498, 2009
Accepted in revised form: 3 October 2009.

 Objective: The current Medical Treatment and Supervision Act places a burden on designated psychiatric hospitals with forensic wards. We aimed to clarify the rate of discharge beyond the jurisdictional catchment area, for which overnight training becomes quite cost-ineffective, as hospital staffmust accompany the patients home. Subjects : On September 30, 2008, there were 16 designated hospitals in Japan, and 447 inpatients in these hospitals. They were the subjects of this study. Method : We collected information on the 447 subjects regarding the postdischarge administrative division, the nearest railway station to the postdischarge residential location, “treatment stage”,“overnight training”at the postdischarge residential location,and trouble during “overnight training”. We analyzed the collected data using the “designated bed sufficiency ratio”. We divided the 447 subjects into three groups : 1)Home inpatient group(home group); the administrative division of his/her postdischarge residential area is the same administrative division as the designated hospital. 2)Inpatient within a jurisdiction group(within group); the administrative division of his/her postdischarge residential area is not the same as the designated hospital but is in any administrative division within a jurisdiction of the Japanese Regional Bureau of Health and Welfare. 3)Inpatient outside a jurisdiction group(outside group); the administrative division of his/her postdischarge residential area is not the same as the designated hospital but is any administrative division outside a jurisdiction of the Japanese Regional Bureau of Health and Welfare. We compared : 1)the time required to travel to the railway station nearest the postdischarge residential location(time required), 2)traveling expenses,and 3)the distance from the railway station nearest the designated hospital to that of the postdischarge residential location(distance)between the three groups. We also analyzed staffcomments regarding “overnight training”. Results : The lack of designated beds was a serious problem in two jurisdictions of Kinki and the Hokkaido Regional Bureau of Health and Welfare,with a “designated bed sufficient ratio”of 0.08 and 0.00, respectively. Twenty-four Japanese administrative divisions had no designated beds, while 37 administrative divisions had less than 10 inpatients at the time of the survey. The numbers of people in the “home group”,“within group”, and “outside group”were 125(28.0%), 166(37.1%), and 145(32.4%), respectively. The “time required”, traveling expenses,and distance were 1: 00,¥735,and 29.8 km in the“home group”,2: 51,¥5,764,and 165.3 km in the “within group”, and 4: 14, ¥20,565, and 694.6 km in the “outside group”. Seventy-nine(59.4%)of 133 subjects who were at the “return to community stage”had already experienced “overnight training”. No difference was found in the rate of“overnight training”between the “home group”, “within group”, and “outside group”. Staffcomments included difficulties in providing stafffor “overnight training”, responsibilities during “overnight training”, and difficulties in finding places of residence in the inpatients' hometowns. Discussion : Because of the lack and maldistribution of designated beds in Japan,many patients are reluctantly admitted to designated hospitals far from their postdischarge residential areas, burdening not only hospital staffbut also families and the inpatients themselves. Increasing the number of designated beds will solve this problem. An effective way would be to set up a ward with a small-scale designated unit(less than 15 beds)in the 24 administrative divisions where there are no designaed beds at present.

Keywords:forensic psychiatry, Medical Treatment and Supervision Act, designated hospital for inpatients, burden, postdischarge residential area>
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