AuditstudyofthenewhospitalizationforassessmentschemeforforensicmentalhealthinJapan

摘要： AIM:Toclarifythecomponentsofhospitalizationforassessment(HfA)andthemanagementchangesfromthebeginningoftheschemetothepresent.METHODS:Thisstudyiscomposedoftwosurveys.In2013survey,wecreatedtwopaperquestionnaires(facilityandcasequestionnaires)forpsychiatristsworkinginpsychiatrichospitalsacceptingHfApatients.Questionnairesweresentto205hospitalsthatwereidentifiedasacceptingtheHfAcases,andresponseswererequestedviamail.Thefacilityquestionnairewasdesignedtoclarifythefollowingspecificationsandcharacteristicsofeachfacility:thefacilityorganizer(publicsectororprivatehospital),andthenumberofbeds,psychiatrists,psychiatricnurses,occupationaltherapists,psychiatricsocialworkers,psychotherapists,publichealthnurses,andpatientstreatedthroughHfAduringthesurveyperiod.ThecasequestionnairewasthenusedtocollectdataofthepatientsunderHfAbasedontheMedicalTreatmentandSupervision(MTS)ActwhoweredischargedbetweenJuly1,2012andJune30,2013.Gatheredinformationincluded:legalinformationofeachcase,demographicdata,pasthistoryoftheoffenders,issuedoffenseandtherelationshiptothevictim,informationregardingpastpsychiatrictestimonies,psychiatricdiagnoses,contentsofthetreatmentduringHfA,informationregardingseclusionandrestraintduringtheHfA,theverdictoftheDistrictCourtpanel,andsoforth.Next,wecomparedthoseresultswithrelevantdataobtainedin2007.The2007surveycompriseddataofHfApatientsfromJuly15,2005(thedatetheMTSActwasenforced)toJanuary15,2007.RESULTS:Weobtained171cases,approximatelyahalfofwholecontemporarycasesofHfA,from134facilities,ofwhich46werenational,prefectural,orsemi-officialhospitals,and88wereprivatehospitals,in2013survey.Themajorityofsubjectsweremale,schizophrenic,andexperiencedpreviouspsychiatrictreatment.Themostfrequenttypeoftheoffensewasinjury,followedbyarson.Mostofthesubjectsweremedicated,andafewcasestookpsychotropicinjectionduringtheHfA.Thefrequencyofinjectionwasdecreasedin2013(χ2=7.54,df=1,P=0.006)thanin2007.Psychiatrictestimonywasmorelikelytobeconductedin2013(χ2=8.56,df=1,P=0.004).TheexaminerpsychiatristwasmorelikelytobelongtotheHfAfacilitytowhichthepatientwashospitalized(χ2=5.32,df=1,P=0.02).Hospitalizationordersweremorefrequentlyselectedin2013(χ2=19.76,df=3,P<0.001),althoughthecharacteristicsofthesubjectshadnotchanged.CONCLUSION:AlthoughthemanagementofHfAhasimprovedinrecentyears,structuralproblemsremain. ... （共9页）