Please review the use of physical restraints in Japanese psychiatric treatment
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In May 2017, my son Kelly Savage, who worked as an English teacher in Japan, died after being found in cardiopulmonary arrest while he was in a psychiatric hospital in Kanagawa prefecture.
The cardiopulmonary arrest was completely unexpected, and occurred after he had been hospitalized on the psychiatric ward for 10 days.
We asked the psychiatric hospital to investigate the cause of his death and to review their policy on the use of physical restraints, but they refused to do so.
From the first time that a Japanese high school student came to our house on an exchange programme, Kelly loved Japan. He loved watching Japanese movies such as Totoro and became fascinated by Japanese culture. He studied Japanese through high school and university and qualified to be an English teacher in Japan. He taught English to Japanese children in elementary and junior high schools in Kagoshima for about two years. The students and other teachers loved his fun-loving, friendly personality.
Unfortunately, he became depressed and entered a Japanese hospital in April. But less than two weeks later, he was discovered in cardiopulmonary arrest. It seems that he was tied to his bed with leg, waist and wrist restraints almost the entire time he was in the hospital.
Compared to other countries, Japanese psychiatric hospitals keep patients in restraints for a much longer time. According to a survey conducted on 689 patients in 11 psychiatric hospitals, the average time spent in physical restraint is 96 days. Meanwhile, the average time in foreign countries is at most several hours to tens of hours.
Although it is thought that there are not many people in Japanese psychiatric hospitals, in fact, the number of people who are physically restrained in Japanese psychiatric hospitals continues to increase. In 2014 more than 10,000 people were restrained-the highest ever recorded, and more than double the number a decade earlier .
It is well known that long-term restraints can cause grave physical, as well as psychological, harm to patients. It may cause deep vein thrombosis, also known as economy-class syndrome, which can be fatal[3,4]. In order to give proper treatment for hospitalized patients, the use of physical restraints in psychiatric medical treatment must be reduced.
Together with Toshio Hasegawa, Professor of Health Faculty at Kyorin University, we have set up a group to try to appeal to the country to reduce the use of physical restraints in psychiatric treatment.
According to Professor Hasegawa, experiences similar to Kelly’s occur to many Japanese people as well .
At the very least, we hope that Kelly’s experience will not be repeated. Kelly, who was fascinated by Japan and loved Japanese culture, would want Japanese psychiatry to improve. We hope that this incident will lead to improved psychiatric care in Japan.
We appreciate your continued support so that this request can be delivered to the Ministry of Health, Labor and Welfare.
- To prohibit the use of body restraints for a long period of time (24 hours or longer) in psychiatric hospitals.
- To quickly investigate whether there are human rights violations caused by physical restraint in psychiatric hospitals.
- In order to prevent human rights violations and deaths from occurring in psychiatric medical care, require a visual record, such as a video recording, whenever physical restraints are used. Allow access to those recordings for patients or next of kin within 14 days to determine the actual conditions employed.
- The government should demonstrate leadership by setting targets with specified dates by which both the number of people in physical restraints and the time period of restraints are reduced.
- To provide medical information to patients and bereaved families, require hospitals to disclose information based on "guidelines for providing medical information" by the Ministry of Health, Labor and Welfare.
We ask for your continued support so that people receiving psychiatric treatment in Japan will receive proper medical care, will not be restrained more than necessary and will not lose their lives.
長谷川利夫. (2016). 精神科医療における隔離・ 身体拘束実態調査 ～その急増の背景要因を探り縮減への道筋を考える～. 病院・地域精神医学, 59(1), 18–21.
 Dickson BC, Pollanen MS: Fatal thromboembolic disease: A risk in physically restrained psychiatric patients. J Forensic Leg Med 2009; 16:284–286.
 【ホームページ 精神科医療の身体拘束を考える会】 https://www.norestraint.org
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