In 2005, the Medical Treatment and Supervision (MTS) Act was enacted in Japan to hospitalize the criminally insane and to promote a self-supporting lifestyle after deinstitutionalization. As of October 2010, 490 patients remain hospitalized in 23 highly secure forensic hospitals. Most patients are diagnosed with chronic schizophrenia and exhibit symptoms of drug resistance. Battering is the most common criminal act they have committed.

The increased prevalence of the combination of criminal insanity with drug dependence is a common problem in other countries as well. It is a serious problem that diversity in prison medical care has not been achieved.

A characteristic feature of care for criminally insane patients in Japan is that they must live in a residential district where a public health center is located and close to forensic hospitals after deinstitutionalization. Although there may be concerns about social prejudice against psychiatric disorders, this limited area would help support rehabilitation of patients because medical staff can easily know the whereabouts, psychiatric condition and aspects, of daily life for each patient through frequent reports obtained from home-visiting nurses. As a result, patients who have been successfully deinstitutionalized lead a self-supporting lifestyle without treatment interruption or repetition of similar criminal acts.

In this presentation, we will show the current status of forensic care in Japan, analyze its characteristics and problems described above, and make suggestions for the treatment of the criminally insane in countries with a small national land area such as Japan.