The Elder Abuse Prevention Act, which took effect on April 1, 2006, established a system that allows intervention in abuse cases where previously proactive action was difficult without the consent of relatives. Reports indicate that a high proportion of elder abuse cases involve older adults with dementia, highlighting the need to closely examine the relationship between the carers and care recipients. In cases of elder abuse involving carers of individuals with dementia, it has been noted that the severity of dementia plays a role. It is therefore important to examine the factors contributing to carer abuse alongside the treatment and care of older adults with dementia. Since the medical field is well positioned to detect abuse, it is important to address elder abuse through therapeutic intervention while taking into account its specific characteristics, in accordance with the Law for the Prevention of Elder Abuse.

In Japan, the Act on the Prevention of Abuse of Persons with Disabilities was enacted to prohibit abuse against individuals with disabilities by defining the responsibilities of the State and others, and by establishing the duty to make efforts toward the early detection of such abuse. However, preventing and addressing the abuse of people with disabilities is often difficult due to assailants’ lack of awareness about abuse and insufficient legal and administrative measures.

Therefore, preventing and detecting abuse of people with disabilities at an early stage, as well as implementing effective measures, are urgent issues.

In this article, we present our perspectives on the realities and challenges of such abuse, drawing on an overview shared at the Rights Advocacy Committee of Tokai University Hospital and on a case we encountered through home-visit care.

This report outlines the organization and operation of the Adult Abuse Prevention System established in the hospital and examines the measures needed for abuse prevention in medical settings. In Japan, elder abuse, abuse of persons with disabilities, and domestic violence are serious social problems, and laws have been enacted to address each type of abuse. However, few hospitals have established abuse prevention systems based on these laws. Hospitals are in a position to detect abuse at an early stage and should urgently develop a comprehensive system for abuse prevention measures.

In the revised Act on Mental Health and Welfare for Persons with Mental Disorders or Disabilities, which went into effect in April 2024, new provisions (articles 40-2 to 40-8) relating to the prevention of abuse in psychiatric hospitals were added as section 6 in order to further strengthen preventive measures against further. In response, this article addresses two issues from a legal perspective that are likely to cause disputes―the illegality of physical restraints on patients in psychiatric hospitals and precautions for handling suspected abuse cases―while also presenting relevant past court cases.

A major issue in the treatment of alcohol use disorder (AUD) in Japan is the “treatment gap.” It is reported that 95% of patients with AUD do not receive specialized treatment. The general hospital ward is one of the appropriate settings for early intervention towards AUD. To address the treatment gap, it is essential to gather clinical information on the distribution of AUD types, the interventions provided, the barriers to intervention, and the measures taken to overcome those barriers. We conducted a survey of the actual situation of psychiatric departments at general hospitals nationwide in June 2023. There were 154 valid responses. Barriers to intervention included patient denial, weak family relationships, and the limited timeframe caused by short hospital stays. The reported barriers cannot be solved by simply sending difficult patients to specialized facilities. Today, many general hospital psychiatrists face complex AUD patients and providing early intervention without patient transfer is ideal. Such intervention would only be possible by implementing effective systems such as resources to run alcohol use disorders identification tests (AUDIT) and enabling efficient multi-facility collaborations.