Observational Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. Nov 19, 2019; 9(7): 99-106
Published online Nov 19, 2019. doi: 10.5498/wjp.v9.i7.99
Outcomes of administrative involuntary hospitalization: A national retrospective cohort study in Japan
Akihiro Shiina, Aiko Sato, Masaomi Iyo, Chiyo Fujii
Akihiro Shiina, Division of Medical Treatment and Rehabilitation, Chiba University Center for Forensic Mental Health, Chiba 2608670, Japan
Aiko Sato, Masaomi Iyo, Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba 2608670, Japan
Chiyo Fujii, Department of Community Mental Health and Law, National Institute of Mental Health, Kodaira-shi 1878552, Japan
Author contributions: Shiin A, Sato A, Iyo M, and Fujii C designed the research; Shiina A and Fujii C performed the research; Shiina A and Fujii C analyzed the data; Shiina A wrote the paper.
Supported by a grant awarded to the corresponding author from the Japanese Ministry of Health, Labour and Welfare as part of a research project entitled “ Research of the inclusive care for the psychiatric patients discharged from involuntary admission by the prefectural governor’ s order.” The authors declare no potential conflicts of interest concerning the research, authorship, and publication of this article.
Institutional review board statement: The study was reviewed and approved by Ethics Committee of the Graduate School of Medicine at Chiba University on June 6, 2016 (No. 237).
Informed consent statement: All responding hospitals expressed their informed consent about usage of the data they provided with resending the interview form anonymously.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors contributed their efforts in this manuscript.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Akihiro Shiina, MD, MSc, PhD, Associate Professor, Research Associate Professor, Division of Medical Treatment and Rehabilitation, Chiba University Center for Forensic Mental Health, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan. shiina-akihiro@faculty.chiba-u.jp
Telephone: +81-43-2227171
Received: May 24, 2019
Peer-review started: May 27, 2019
First decision: August 2, 2019
Revised: August 16, 2019
Accepted: October 14, 2019
Article in press: October 14, 2019
Published online: November 19, 2019

Treatment for offenders with mental disorders is a key concern in public mental health. Provision of adequate psychiatric treatment is important for the offender and their community. An approach used in Japan to address this issue is administrative involuntary hospitalization. Under this scheme, a person at risk for harming themselves or others because of a mental disorder can be involuntarily hospitalized in a designated psychiatric hospital. However, this scheme does not include tracking of these patients after discharge. Although some data for administrative involuntary hospitalizations are available, it remains unclear what happens to these patients after discharge.


To evaluate follow-up of patients under administrative involuntary hospitalization after discharge and obtain data for later comparisons with outcomes.


We used a retrospective design and conducted a national survey of administrative involuntary hospitalizations. Questionnaires were distributed to 939 facilities across Japan. The questionnaire collected data for selected involuntary hospitalization cases in the hospital on June 30, 2010 (census date), and the prognoses of each patient on a specified date in 2011 and 2012. We also asked about the treatment provided to each patient. We stratified patients by prognosis (good or poor), and used logistic regression analysis to examine the relationship between treatment and prognosis.


We received completed questionnaires from 292 facilities (response rate 31.1%); 105 facilities had no relevant patients. Our analysis included data for 394 patients with valid data. Official statistics indicated 1503 patients were under administrative involuntary hospitalization as at June 30, 2012, meaning the capture rate was 27.2%. Approximately a fourth (104/394) at 1 year, and a third (137/294) at 2 years after the census had unknown prognosis. Treatment content included multi-disciplinary team meetings (78.2% of patients), counseling by public workers (59.9%), and discussion with external specialists (32.5%). Overall, 116 patients were categorized as having a good prognosis at 1 year, and 168 had a poor prognosis. At the 2-year point, 102 patients had a good prognosis and 150 had a poor prognosis. “Discussion with external specialists” was positively associated with a good prognosis at both 1 year (P = 0.016) and 2 years (P = 0.036).


We found that facilities in Japan currently have limited ability to track the prognoses of patients who were hospitalized involuntarily. Discussion with external specialists is associated with a good prognosis.

Keywords: Involuntary hospitalization, Japan, Mental disorders, Offenders, Discharge, Outcomes, Follow-up

Core tip: In Japan, involuntary hospitalization by the prefectural governor’s order is applied to psychiatric patients with risks for harming themselves or others. A certain amount of them cannot be followed up the practitioners. Good prognosis can be associated with discussion with external specialist before discharge.