Hospitals in Japan refusing COVID-19 patients with developmental disabilities & mental illness

From The Mainichi

March 2 2021

TOKYO – More than 60% of patients found to be infected with the novel coronavirus while in psychiatric hospitals in Japan could not be transferred to other medical facilities designated for COVID-19 cases, as general hospitals apparently tend to refuse them due to the perception that they are difficult to deal with, a survey has revealed.

Some of these patients even died from COVID-19, and experts are concerned that more may end up with insufficient treatment.

The Japan Psychiatric Hospitals Association, based in Tokyo’s Minato Ward, sent questionnaires to 1,192 member hospitals and received responses from 524 of them. The survey revealed that 1,012 inpatients at psychiatric hospitals tested positive for the coronavirus between March 2020 and January 2021. They needed to be transferred to other medical facilities because it is difficult for psychiatric hospitals to provide full-scale COVID-19 treatment, but 631 of those patients — 62.4% — “could not be transferred,” while 381 patients — 37.6% — “were relocated,” according to the survey.

Many hospitals cited reasons related to psychiatric symptoms for not being able to find other hospitals to transfer such patients to, such as, “Patients with mental disabilities cannot keep quiet.” One hospital responded to the questionnaire, saying, “A public health center worker unilaterally told us, ‘It’s difficult to transfer any more patients, so treat them at your hospital until they die.” Another medical facility said in a reply that “three patients have already died” because they could not be transferred to other hospitals.

Even in one case where a patient was transferred, the psychiatric hospital said, “A patient died at the hospital they were transferred to. Their life might have been saved if they had been moved a little sooner.”

When patients cannot be transferred, psychiatric hospitals have to treat them. But according to the association, there are many cases in which patients cannot get sufficient treatment even after their symptoms suddenly worsen because psychiatric hospitals lack COVID-19 experts and special equipment.

Japan Psychiatric Hospitals Association Vice Chairman Wataru Nogi is concerned that many COVID-19 patients may die due to a lack of treatment. He said, “COVID-19 symptoms can worsen quickly. The patients must be transferred while their symptoms are mild, but not all of them have been.” He expressed a sense of crisis, saying, “The ‘selection of life,’ in which treatment for patients with mental disabilities is put on the back burner, has started.”

Psychiatric hospitals are generally under conditions where it is difficult to take countermeasures against COVID-19.

It is said that it is difficult to properly ventilate closed hospital wards, where the doors of rooms and corridors are locked. In addition, it is difficult to prevent infections because there are patients who do not understand why they must wear masks, and these hospitals cannot place disinfectant in rooms in case patients accidentally swallow it. The Japan Psychiatric Hospitals Association said that COVID-19 clusters have occurred at more than 30 member hospitals.

Despite their high risks of infection, patients with mental disabilities are not among those prioritized to receive vaccinations.

The association submitted a written request to the central government on Jan. 20 to add patients with mental disabilities to those prioritized to receive inoculations. They pointed out that “it is often difficult to transfer patients to other hospitals designated for infection cases, and an increasing number of psychiatric hospitals are forced to stay locked up while having clusters.”

Japan Psychiatric Hospitals Association Chairman Manabu Yamazaki said, “Those who decided on the priority for vaccinations don’t know the situation (at hospitals). I also think social prejudice against psychiatric care is behind the decision. Inpatients at psychiatric hospitals, who are at high risk, should be prioritized for inoculation.”

According to the Japan Psychiatric Hospitals Association’s survey, some psychiatric hospitals could not transfer COVID-19 patients to other hospitals for the following reasons:

— Officials at public health centers or other institutions said that they give priority to those infected at facilities for the elderly.

— As the number of infected individuals surged in the prefecture, there was a shortage of hospital beds. They asked psychiatric hospitals to treat the patients at their own hospitals.

— Transferring patients was difficult because mentally unstable individuals cannot keep quiet.

— Local public health centers responded with comments such as: “You bother us by repeatedly asking for transfers,” and “It’s difficult to transfer any more patients, so treat them at your hospital until they die.”

— There are extremely few hospitals that accept patients with complications (such as those with mental disabilities plus comorbidities, such as requiring dialysis).