Mentally disordered offenders discharged from designated hospital facilities under the medical treatment and supervision act in Japan: Reoffending and readmission

Abstract

Background Current Japanese forensic mental health legislation (Medical Treatment and Supervision Act [MTSA]) was enacted in 2003. Little is known, however, about the actual outcomes for the offender patients detained within hospitals under this provision. Aim This study aimed to quantify reoffending and readmission following patients' discharge from forensic psychiatric hospital units across Japan and explore related risk factors. Methods We followed up 526 offenders with mental disorder who had been detained under the MTSA and who were subsequently discharged from any of the 28 hospitals nationwide between 2007 and 2015. Results The total cumulative reoffence rate was found to be 2.5% (1.1–3.9%) after 1 year and 7.5% (4.6–10.4%) after 3 years. The rate of serious reoffending was 0.4% (−0.18% to 0.99%) after 1 year and 2.0% (0.4–3.6%) after 3 years. The cumulative admission rate to local psychiatric hospitals following a discharge was 21.8% after 6 months and 37.6% after 1 year. Patients who had been discharged from their MTSA order but transferred to a general psychiatric hospital before open community residence—because it was necessary to build community supports—were more likely to reoffend than those discharged directly to the community. Patients who had been diagnosed with a substance use disorder (F10–F19) and had one subsequent admission were at higher risk of further readmissions. Conclusions The low reoffending rates could be attributed to the intensive treatment and care plans required by the MTSA. The high rate of readmission to psychiatric hospitals may indicate shortcomings in community mental health services in Japan.

Recent Developments in Community-Based Mental Health Care in Japan: A Narrative Review

“…Six studies reported on surveys assessing the performance of community-based mental health care on the ACT, compulsory treatment, home-visit nursing care, physical complications, and a welfare medicine collaboration on a remote island [ 14 , 15 , 16 , 17 , 18 , 19 ]. One article reported on two sets of results obtained using two different research designs [ 17 ].…”

Validity of Short-Term Assessment of Risk and Treatability in the Japanese Forensic Probation Service

“…Past studies have found that the total cumulative rate of reoffending after discharge was 2.5% (1.1–3.9%) at 1 year and 7.5% (4.6–10.4%) at 3 years. The rate of serious reoffending was 0.4% (0.18–0.99%) at 1 year and 2.0% (0.4–3.6%) at 3 years ( 17 ).…”

“…First, a short term was required, as START was deliberately developed to assess short-term risk and treatability. Second, the period of follow-up had to be long enough for incidents to occur, as a past study showed that the rate of reoffending within 1 year after discharge was <3% among MTSA patients ( 17 ), and cosiderably low rate. Therefore, it was assumed better to follow up for 6 months rather than three, in order to increase the chance of collecting negative incident data.…”

Analysis of psychopathological symptoms and aggressive expressive and instrumental behavior as a function of the risk of violence in offenders

“…On the other hand, studies based on empirical recidivism have also established a relationship between recidivism and substance use or dependence disorders (Honegger & Honegger, 2020;Nagata et al, 2019;Walsh et al, 2020;Wilton & Stewart, 2017), as well as with other psychic pathologies when such disorders are comorbid (Calvo et al, 2016;Cappai et al, 2017;Weizmann-Henelius et al, 2019). Specifically, several studies relate personality disorders to future incarceration (Calvo et al, 2016), even specifying the type of disorder (Martin et al, 2019;Walsh et al, 2020;Weizmann-Henelius et al, 2019), associating recidivism with antisocial personality disorder.…”