[On the two types of voluntary admissions in Japan--including the issue of the competency to consent to admission].
Voluntary admissions are classified by four factors-limitation of discharge, limitation of actions, procedures of protection of human rights, prescription of the special law concerning with mental health. The voluntary admission prescribed in the Mental Health Law in Japan (NIN'I-NYUUIN) has all of these four factors. But we are using also the informal admission (JIYUU-NYUUIN), which is not prescribed in the Mental Health Law in Japan, and does not have limitation of discharge. The government has done several acts against the informal admission, and some disputants argued against it, but either logically or practically, it is beneficial to use the informal admission as the one that is distinguished from the voluntary admission, and the government should stop those acts immediately. Although one disputant argues that the informal admission should be prescribed in the Mental Health Law and should have procedures of protection of human rights, we should pursue complete voluntary admission, that is, the one that is similar to admission of medical or surgical patients, and that has neither of the four factors of voluntary admissions. And we should consider the competency to consent to admission. Some disputants argue with Zinermon v. Burch, the decision of the U.S. Supreme Court in 1990. But this decision necessarily did not argue that the patient should be tested whether competent or not before voluntary admission, and some argued that the decision should not be read expansively. On voluntary admission, the clinician should consider not only the competency of the patient, but also the therapeutic benefit of voluntary admission.
Department of Neuropsychiatry, University of Tokyo Hospital.
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Nakajima
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Tomita
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Akamatsu
D003134:Commitment of Persons with Psychiatric Disorders / Q000331:legislation & jurisprudence*; D006806:Human Rights; D007258:Informed Consent; D007564:Japan; D016743:Mental Competency; D010344:Patient Advocacy