The Sagamihara tragedy occurred in 2016. Nineteen people were killed and 26 were injured at a care home for the disabled. The suspect was a former employee who had been hospitalized under the psychiatric practice of civil commitment (CC). This attack is regarded as one of the most severe in Japanese modern history.
 The Sagamihara tragedy should be not only be considered as a medical problem but also as a kind of hate crime. Moreover, it highlighted issues with the current legal system for CC in Japan. It has not been modified for more than half a century because its presence in society has declined since 1970, and is used for administrative and medical treatment purposes covered by public expenses. Thus, it has enabled prompt access to psychiatric emergency services and accurate clinical diagnosis. As this system was unconsciously applied, its operation differed among regions in Japan.
 Following the Sagamihara tragedy, the Ministry of Health, Labour and Welfare noted the following institutional issues with CC: (1) how the judicial side and the medical side share responsibility, (2) ambiguity of hospitalization criteria for CC, (3) lack of treatment guidelines for CC, (4) ambiguity of discharge criteria for CC, and (5) insufficient living support after discharge.
 In order to resolve these issues, the following changes are planned: Administrative organizations (regional health care centers) will be responsible for holding (1) conferences for related organizations to consider each case from the viewpoints of both the judicial side and medical side, and (2) planning individual case meetings for living support after discharge. In addition, certified psychiatric hospitals for CC will be obliged to appoint a post-discharge living support counselor to assess individual needs after discharge, and to decide discreet discharge from CC following the above conference and meeting.
 Even after reconsideration of CC, some issues still remain such as the standardization of application criteria for CC, clarification of roles between judicial and medical sides, and revision of the facility standard for CC. Moreover, difficulty in planning for living support after discharge, delay of discharge from CC, withholding of medical treatment after discharge, and heavy work load for the administrative stuff are expected.
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