In response to the massacre at the Sagamihara Facility against Persons with Disabilities, we have been analyzing the current status of the Administrative Involuntary Hospitalization scheme in Japan. Thereafter, based on the new series of guidelines we proposed, the Ministry of Health, Labor and Welfare (MHLW) issued "Guidelines for the Operation of Administrative Involuntary Hospitalization" and "Guidelines for Post-Discharge Support of Persons with Mental Disorders by Prefectural Governments" to optimize the scheme's operation under the current Mental Health and Welfare Act.
 According to the results of our survey among prefectural governments, designated physicians, and police officers, the establishment of the guidelines contributed to the enhancement of mutual collaboration among relevant facilities, but there were many concerns about conflict among the facilities. In particular, the criteria to determine administrative involuntary hospitalization has been fluctuating. There are no structural educational methods for the determination of whether a person should be admitted for administrative involuntary hospitalization. To optimize the operation of this scheme, there is a need to provide clarification on the necessary knowledge and technique for medical examination and the methodology for learning them.
 We conducted a questionnaire survey among designated physicians regarding their experiences and the optimal way to educate about administrative involuntary hospitalization. In addition, based on the best available evidence, we held a pilot training session for young, designated physicians about this issue.
 The interim analysis of the questionnaire results revealed that the mainstream of education was the teaching of supervisors and seniors and the treatment of patients who had been involuntarily hospitalized. Several methods, such as participation in training sessions and attendance at consultations with other designated physicians, were supported, but concerns about the neutrality of the decision- making were also raised.
 We also conducted a training session for 17 young, designated physicians and 16 other medical practitioners. The results of a self-administered questionnaire confirmed that the participants gained confidence in the implementation of the medical examination after the training.
 Based on the findings, it is urgent to establish an educational method on standardized medical examination techniques for administrative involuntary hospitalization. It may be possible to create opportunities for young, designated physicians who are not involved in the decision-making process to observe skilled designated physicians examining patients. Randomized controlled trials are necessary to verify the results of educational methods.
 Author's abstract