A 2x2 matrix reveals Japanese forensic mental health systems

There are several methods for problem solving. Among them, 2x2 matrix is simple and useful to clarify your thought.

A 2x2 matrix is composed of four cells divided by two axes. At first, you need to decide these axes. It is often not easy to find the axes that can precisely categorize the components into four cells.

I will show an example of forensic mental health issues, as my specialty. There are several strategies to treat mentally disordered offenders. You can punish them in a harsh way. You can also choose to forgive them considering their severe impairment of mental ability. Forcible treatment in a psychiatric facility is another option. So, how do you classify these options?

I set the two axes: “Priority: punishment or treatment”, and “Responsibility: the subject or the society,” as below.

The Priority axis determines whether you punish the mentally disordered offenders or give psychiatric treatment to them. Of course, both are offered concurrently, but you should simplify the situation at this time.

On the other hand, Responsibility axis determines which is emphasized as the subject to be responsible for addressing the offending, the offenders themselves, or the society.

Thus, there are four cells each of which has mutually exclusive alignment. I named each cell conveniently like below.

In “Formalism” cell, mentally disordered offenders are punished in the same way as healthy people. Their punishment is not amended regardless of the severity of the offender.

On the contrary, in “Paternalism” cell, mentally disordered offenders are never punished. They are forgiven because of their mental illness. Instead, they are treated in a special hospital for addressing their psychiatric symptoms.

In “Authoritarianism” cell, mentally disordered offenders are deemed as criminals, but psychiatric treatment is given. The society is responsible for preventing further offending by them.

In “Humanism” cell, treatment is prioritized to punishment for mentally disordered offenders. But they are responsible for accepting treatment adequately. If they refuse to obey the treatment order, they can be incarcerated.

Ok, these four cells meet mutually exclusive and collectively exhaustive (MECE). Next, I will apply some archetypes of strategy in Japan into this matrix.

In Japan, prisoners are hardly given psychiatric treatment, unfortunately, without some exceptions. Most of them engage the correctional work in prison. So, Japanese prison is applied to the Formalism cell.

However, some prisoners who have so severe psychiatric symptoms that they cannot be managed in an ordinary prison are to be sent to a medical prison. In medical prisons, offenders are given psychiatric treatment, and they need not engage the correctional work. However, they are still prisoners, and will be released when the term of incarceration is over. So, medical prison is applied to Authoritarianism cell.

In contrast, Medical Treatment and Supervision Act provides a scheme of medical treatment for mentally disordered offenders. Offenders who were identified as not guilty for the reason of insanity or with diminished criminal responsibility are subjected to this scheme. Once approved, they will be never punished for the issued offense. Instead, involuntary treatment is provided to treat their mental disorders. So, psychiatric facilities offering the treatment based on the MTS Act is applied to the Paternalism cell.

The last cell remained is the Humanism cell. Surprisingly, there are no schemes applicable to the cell in Japan. It seems to be unbalanced. I think Drug Court in the US is appropriate to match this cell. Similar schemes are under consideration in Japanese administrative framework, but yet to be adopted.

Above all, the matrix thought has revealed the weakness of Japanese policy for mentally disordered offenders. So useful.