Problems for deinstitutionalization: Should we also abolish institutions for people with intellectual disabilities in Japan? ―
Yokohama Research Institute for Disability, Education and Industry
Although the current trend is for "deinstitutionalization," why were such huge exclusionary spaces constructed in Europe and North America? I will discuss the history and the theoretical basis for exclusion in a separate article. Among facilities that specialized as institutions for mentally handicapped people, those with around 1000 beds became standard, especially in the United States, and there was a rapid growth in such institutions in the 1950s. This can be seen as being in line with psychologists' theories who proposed that living at home had an adverse effect both on people with intellectual disabilities and their siblings. However, it may be added that the backdrop of high growth in the United States and the Cold War swayed public opinion in the United States into seeing those with intellectual disabilities as a burden on society. However, these huge institutions require large budgets for maintenance and management, and the North European concept of "normalization," meaning deinstitutionalization and living in the community, provided a convenient excuse for abolition of the institutions. This hidden motive has been clearly described in books such as James Trent's "Inventing the Feeble Mind," In France, the expression "In the United States, the disabled are left by the side of the road" used by Jacques Hochmann in his "Histoire de la psychiatrie," part of the Que sais-je? Collection, seems emotive, but France has never had any huge specialized institutions for people with intellectual disabilities with 500 to 1000 beds. Most facilities with around 100 beds have been created thanks to the enthusiasm of concerned parties rather than by the state, and are used effectively for residual education and welfare. These facilities are called "treatment and education facilities,"(Institut médico-éducatif) and a distinction is made between those who are educated there until around the age of 18 and are able to get a job at 20, and those who continue to live at the facility. In terms of economic strength and construction ability, Japan can be said to be similar to France in that there never used to be any institutions of 1000 beds where housing only people with intellectual disabilities. In fact, there were only facilities of around 100 beds at most, paid for by benefactors in the community. These residential facilities, in particular, have a limited numbers of places, and strict conditions have to be satisfied in order to use them. In detail, when patients' families were completely unable to care for them and the government were unable to avoid involvement in the protection of the patients due to their psychiatric symptoms or poor abilities, the admission into such facilities was only possible for the first time. For this reason, to use the same concepts of "deinstitutionalization" and "abolition of institutions" in Japan, as in European countries and North America, would appear to conflate the terms "institution" and "facility." In addition, for the administrative department, such as the Ministry of Health and Social Welfare seem to aim the attempts to cut costs behind closed doors. If even these facilities are completely abolished, the disabled children in their own homes transfer directly to group homes of some social welfare organization, its staffs must become very nervous to anticipating an increase of accidents risk because there will be insufficient time and staff to understand the characteristics of residents' disabilities and psychiatric condition as compared with the case that such persons with intellectual disability stay for a half or one year in the facilities and observed by the staffs with sufficient number and time.
Finally, regarding welfare support for people with intellectual disabilities not clearly divided in France, because of temporary excited states associated with intellectual disabilities like continue to be conflated with psychiatric illness on the French law on disabled people, and the separation of “handicap psychique” (psychiatric disorders) and “handicap mentale” (intellectual disabilities) was included in the law for the first time in February 2005. In Japan, physical disabilities, intellectual disabilities, and psychiatric disorders are clearly distinguished, thanks to the social welfare laws for long time which was enacted by USA occupying army just after World War 2. However, in many cases, more than one disability is present (dual diagnosis), so in recent years, there has been a move toward to grouping these three types of disabilities together without any distinction. It is certainly true to say that the rigid distinctions between these three types of disability result in great difficulties when treating disabled people have multiple disabilities. However, it is also fair to say that the traditional distinction of intellectual disabilities from other psychiatric disorders has resulted in a more rational approach to medical treatment and welfare service in Japanese various social welfare care centers. Based on this, I feel that we should look again at the separation policy of generally handling these intellectual disabilities and psychiatric disorders, with a referencing the policy of other countries like France.