Private psychiatric hospitals play a major role in mental health care in Japan, including public parts related to the Act on Mental Health and Welfare for the Mentally Disabled and the Medical Treatment and Supervision Act. In fact, private psychiatric hospitals account for 83.4% of the number of psychiatric hospitals, and 91.8% of the number of beds. Private psychiatric hospitals are dispersed across Japan (only 15 of 344 secondary medical districts have no psychiatric hospitals), and meet a variety of needs in individual communities.
 There are two categories of involuntary admissions stipulated in the Act on Mental Health and Welfare for the Mentally Disabled: admission by legal control, and hospitalization for medical care and protection. The admission by legal control does not require a treatment contract with the patient or the family that is different from other types of admissions. Additionally, difficult cases are increasing in private psychiatric hospitals in terms of the procedure for hospitalization for medical care and protection, as the range of the family's understanding of the situation and the consent of the mayor or head of the municipality has been limited in relevance to the legal amendment on the abolition of the guardianship system. In future reviews of the Act, it is predicted that there will be a discussion on whether the mayor or head of the municipality should be more committed, concerning consent for hospitalization for medical care and protection. Given the international trend whereby administrative or judicial public commitment is required in the procedures for involuntary admission, we should consider the commitment of the mayor or head of municipality concerning the procedure for hospitalization for medical care and protection, in a broader sense.
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