"Once you're hospitalized there,

it's like you can't get out until you're dead."

"It's deep in the hills, out of sight from the public."

"Hey, why are you spilling?"

"I'm sorry."

"'Sorry'? Can't you do as I say?"

"Gonna cry again? I'll punch you if you do."

What? What did you say?

What?

Watch your tongue.

- Did you say, "Hey"?
- I didn't.

You did. I heard you. Don't you mess with me.

I didn't.

- Don't mess with me.
- That hurts!

Video and audio recordings we obtained from a whistleblower in 2022

exposed conditions inside a certain psychiatric hospital.

"Shut up, or I'll kill you."

"Can't you see I'm busy, man?"

"You want me to hit you good? Here goes."

"How's that? You like it hard?"

"That hurts."

"I'll let you have it. I'll break your arm."

"Want me to beat you to death? Do you?"

"Here goes."

The footage documented the abuse of people with mental disorders.

There are no human rights inside there.

Medical care is sloppy, and the patients just get worse.

The patients here no longer have any place where they belong,

neither within their family nor in the community.

They are long-term residents, many of whom remain hospitalized until they die.

They're being discarded because they're not needed and have no place to go.

They're placed there, in fact,

because someone requires them to be in that place.

It's a necessary evil, I suppose.

What is taking place at this hospital?

Our reporting revealed the hidden reality within some psychiatric care hospitals in Japan.

"This is a place where people kill people."

"Please help me."

"Please!"

I've been to the hospital often, but when I first meet a client,

I feel a certain amount of tension.

The attorney Aihara Keisuke.

When a hospitalized patient sends an SOS, he tries to provide support.

This is Takiyama Hospital, in western Tokyo.

It has 288 beds.

Many patients have mental disorders, dementia, or require dialysis.

Aihara kept video recordings of his meetings with patients.

I'll show the patient in, so please wait here.

It's unlocked, but the window won't open.

Aihara has assisted 10 patients to date.

In April 2022, he met one of those patients in this room.

I want to go home right now.

If I go back to the ward, I'll be killed.

- Do you think you'll be beaten?
- Yes.

- Do they tie you down at night?
- Sometimes.

They sometimes tie you to the bed.

I was tied down before by --.

-- tied you down. Is that a man or a woman?

- A man.
- A man.

I can't go back to my ward after I told you these things.

They'll say I tattled, and kill me.

I don't want to go back to my ward,

because I was beaten in the dialysis unit.

That's why.

Kōda Kiyoshi has an intellectual disability.

He also has schizophrenia and requires dialysis for chronic kidney failure.

The whistleblower's footage included a scene of Koda in the ward.

- The person on duty...
- Shut up and go to sleep, I told you.

But it's almost time for dinner.

It's a while still. I'll wake you.

- Stay quiet until then.
- Okay.

Don't cry. Shut up!

- I don't want to hear that.
- Okay.

I'm supposed to drink 500 ml, right?

Shut up and sleep, I told you!

It's all right.

It tastes good.

- I told you to shut up!
- I'm scared. Ow.

- Shut up until dinner!
- Okay.

That hurts.

Who said you could talk?

I don't want to suffer any longer.

- It's tough for you on the ward?
- Yes, I'm scared.

I can't sleep at night, and I feel like I'm losing control.

I'll start looking for a proper place for you to move to.

I don't care how much it costs.

I don't want to die.

I want to go home, I really want to be with my mother.

Koda had written a letter, addressed to his family.

"I am being bullied," he wrote.

"I am emotionally exhausted. Please help me!"

But the letter was simply placed in his file.

It never reached his family.

Why did you take him to the meeting room?

- I was told to bring him there.
- By whom?

- A lawyer.
- You're kidding.

- What did he ask you?
- What did you tell him?

About a week later, I took a welfare specialist to see him.

That person's assessment was, "He's able to live in the community."

"We can get him discharged. Let's do our best."

We decided to move as quickly as possible,

but 2 or 3 weeks after our second meeting,

less than a month after I first met him,

Koda died very suddenly.

A recording of Koda, made before his death.

"♪ You have no need to worry."

"♪ Your thoughts will reach someone."

"♪ Tomorrow will surely come."

Dead at age 46, of acute heart failure.

The cause was described as "unknown."

Aihara suspected that he died from abuse, and he consulted the police.

An autopsy was performed, but no cause of death could be confirmed.

I couldn't help thinking, in the end...

that he died because I didn't take him out of there right away.

I felt that very strongly.

It was a very intense...

experience.

Since that happened, whenever someone seeks my help,

no matter the circumstances, I have to get them out of that hospital right away.

After that incident, I drew a very strong line on that.

A ward, before lights out.

This one needs restraint. That one is a risk too.

Patients were being tied to their beds, the application of physical restraint.

This one just needs arms and legs tied.

By law, restraint can only be used under limited,

emergency conditions at the order of a physician, and records must be kept.

This man was restrained.

There was no notation of an order in his chart or the log book.

We don't want them to fall or to make a mess.

It's just to prevent hassles.

We make it so they can't move their arms or legs, and they resist.

When they resist, the staff gathers and holds their arms to tie them.

I was there when inspectors came,

and we'd all gather the restraint belts and hide them.

A ward at night.

49 patients are overseen by 3 members of the nursing staff.

Shut up!

Everyone's asleep, right?

You have to keep quiet.

90 percent of the staff are part-time employees.

"It would be great to have 80% regular and 20% part-time staff, but we're the opposite."

"We can see that patient care suffers, as a result."

"Nothing to be done about it. Some patients require a lot of attention."

"I too found those guys annoying,

and I have shouted and scolded them."

"There certainly is abuse, and it happens everywhere."

"There is verbal violence toward patients, sad to say,

it's an everyday affair at this hospital."

"That's true."

"We'll 'fry' the numbers for Ward 2?"

- "That's right."
- "I see."

"For Ward 2, there's rarely anything to report."

- "Some report temperature, blood pressure..."
- "Just one nurse records those."

- "Usually, 'all quiet' is enough."
- "Got it."

"That other nurse was useless, trash."

"Trash."

"You only note changes in condition, at a mental hospital."

"So we use 'quiet' as shorthand for the whole scene."

"That's sufficient."

In the midst of our reporting, on February 15, 2023, Metropolitan Police entered Takiyama Hospital.

They arrested one nurse on suspicion of violence against patients.

3 other staff members are under investigation.

A separate investigation is being conducted by the Tokyo Metropolitan Government, which supervises the area's hospitals.

Asked for comment, the hospital said,

"We have never condoned abuse, and we have conducted thorough supervision."

Asked about physical restraints and fabricated nursing records, the hospital said,

"We're not aware of this. We'll look into it."

Takiyama Hospital has provided psychiatric care in this area for over 50 years.

Why were abusive practices overlooked, while the hospital continues to operate?

During the course of our investigation, we obtained 1,498 patient records from the past 10 years.

In the listings for contact information, we often saw notations like,

"Family is out of contact," or "Never want to be involved."

Families often tell us, "We can't care for them anymore."

They become violent,

they make strange noises or wander around at night.

The families worry about their status in the community,

and they're often exhausted in body and soul.

Then, a month or so after the patient is admitted,

the family completely stops coming to visit.

What emerged was a picture of families that were unable

to bear the burden and depended entirely on the hospital for care.

This is the voice of the hospital director.

"The problem is not with the patient, it's the family."

"The family should just say, 'We want to discard them.'"

"They leave them here because they don't want them back, it's OK if they die."

"It'd be more honest if they said, 'It's OK if they die.'"

- "We let them go."
- "I think we do."

"What those who come here and then die all have in common

is that, somewhere, there's a problem with the family or the patient."

As we studied the hospital records, we discovered another reason that patients ended up there.

They were transferred from other psychiatric hospitals.

Few psychiatric hospitals in the Tokyo area provide kidney dialysis care.

Many patients with both kidney failure and mental disorders are sent to Takiyama.

"Takiyama is a hospital that accepts patients who have medical complications,

in addition to advanced age."

People who have no family,

who other hospitals won't admit, who can't enter a nursing home,

they end up being hospitalized there, with no prospect of leaving.

There's no place to turn but Takiyama.

People often say, "Going to Takiyama is the end of the road."

There's violent treatment, a bad reputation,

and you don't want to be involved with them.

But for Takiyama, which takes the patients, and the hospitals that send them,

it's a situation that benefits them both.

A necessary evil.

In addition to the role of families and other hospitals,

the records revealed the involvement of local governments.

A man died at the hospital in August 2022, in his late 50s.

He had worked as an editor after graduating from a university in Tokyo.

Collapsing from overwork, he became depressed.

He later required dialysis and was admitted to Takiyama Hospital.

His contact information listed the welfare office of a nearby city.

The man had been receiving public assistance.

The records listed 1,498 patients.

Of these, more than half -54%- were receiving public assistance.

We often heard Takiyama Hospital mentioned at the public assistance office.

This man was a caseworker at a local government that sent many patients to Takiyama.

Welfare office caseworkers

carry very heavy loads and they're really exhausted.

Psychiatric patients require close support.

It's extremely difficult to deal with people who have no place to go.

Having them admitted means much less attention is needed,

so Takiyama Hospital is like a godsend.

It takes public assistance patients, so naturally many get sent there.

"The welfare office told me, 'Don't let him out.'"

"Ah, the welfare office. They knew he'd cause trouble."

"Sure they did."

"When we tried to discharge him, the city said no."

"The city looked at other facilities, but no one would take him."

"We said OK, so they brought him here."

Experts also say that Takiyama Hospital benefits from taking patients receiving public assistance.

Public assistance is paid from government funds.

So it's a stable...

source of income.

There's no danger of medical fees going unpaid.

Public assistance costs are now about 4 trillion yen, or about 27 billion dollars.

About 10 percent, or 400 billion yen, covers the cost of psychiatric and neurological hospitalization.

This situation is a product of the shared interests of hospitals and government administrators, Okabe believes.

Mutual beneficiaries coordinate things, saying, "That's a good fee."

They direct things in that manner, in the absence of the patient.

The patient is abandoned, or forced to conform.

They are caged in.

Caged inside of hospitals.

It is a policy of abandoning people.

Some psychiatric hospitals have become receptacles,

for use by families, other hospitals, and government agencies.

Serious problems have repeatedly emerged over the years.

About 40 years ago, it was discovered that nurses at Utsunomiya Hospital

beat two patients to death with a metal pipe.

Uncertified personnel were found to have practiced medicine, and numerous arrests were made.

The hospital remains in operation today.

Since 2022, a new trial involving forced admissions to the hospital has been taking place.

In March 2020, patient abuse by a group of nurses at Kande Hospital in Kobe came to light.

Six staff members were convicted of crimes in that case.

According to a third-party investigation committee, abuse and illegal physical restraint was rampant at the hospital.

Their report also noted sexual abuse.

In some years, more than 40 percent of the patients in the hospital died.

The former hospital chairman was found to have received about $17 million in compensation over 8 years.

The committee's report severely criticized city and prefectural government agencies

for "neglect of duty" in their oversight of the hospital.

The prefecture "gave no guidance whatsoever."

It was inevitable that the hospital "made light" of officials.

Two and a half years after the incident, in November 2022...

Hospital, city, and prefectural officials met for the first time to discuss ways to prevent recurrence of the problems.

"Did you consider halting operations?"

After submitting written guidance to the hospital,

we observed efforts to make improvements,

so the closure option is on hold.

The city's approach is to work together with the hospital

to ensure that patients are no longer treated that way.

- "With the hospital?"
- Well, of course...

We will issue guidance and take needed steps together.

We will work on behalf of the patients.

"Thank you."

Many of the patients subjected to abuse remain in the hospital, as before.

- Ow!
- Don't do that!

- Ow! That hurts!
- Stop doing that!

Put your hands up, on your head! Hands on your head!

Tokyo Metropolitan Police investigated Takiyama Hospital.

The metropolitan government is responsible for oversight of the hospital.

Authorities responded to our inquiries as follows:

"Despite regular supervision and onsite inspections, we did not find evidence of abuse."

These are government reports on the oversight of Takiyama Hospital dating back to 2017.

For "human rights violations due to violence, etc.," the rating was "B" on a 4-point scale.

On the use of physical restraint,

most of the reports gave an "A" rating.

At least for this period of 6 years, the hospital was not given strong guidance to improve its practices.

How does the national government view the lack of progress on abuse

and other unsuitable practices at psychiatric hospitals in Japan?

- "Is government supervision functioning?"
- Well...

We are not directly involved in auditing the hospitals.

We inform the prefectures about the basic framework for auditing,

and request them to carry it out effectively.

Medical facilities must not violate the rules excessively,

and I don't believe that many of them do.

But when that does occur,

we have to respond in a rigorous manner.

This is the office of the attorney, Aihara, who assists patients.

Today, a woman has come to consult him about assistance for a friend who is hospitalized at Takiyama Hospital.

This is the message account I share with my friend,

It says, "Come help me!"

- "That was the day she was admitted?"
- Yes.

It wasn't just "I want to leave here." It was "Help!"

I want to get her out, as soon as possible.

Kawai Haruko was active as a professional manga artist.

In 2013, she developed a serious illness that causes muscle atrophy.

Then, she was hospitalized at Takiyama Hospital.

Shall we go?

Kawai's friend Kamaki wants to get her moved to a different hospital,

and she has repeatedly sought advice at City Hall.

She's worried about the progress of Kawai's disease.

However, because of the COVID pandemic, she hasn't been allowed to visit for more than a year.

Today, again, she is not allowed in, and the attorney will see Kawai alone.

A staff member who worked on Kawai's ward gave us a picture of the treatment she was receiving.

Patients were ignored. If Kawai was in bed, they left her in bed.

Her feet were bloated, from being bedridden.

She said, "I'm getting steadily worse."

She wanted to know about her condition and prognosis,

so she waited to ask a doctor, but the doctor never came around.

She pleaded with me, crying.

Most psychiatric hospitals are part of a regional network

that assists discharged patients, making connections to the community.

But at Takiyama, there's no office to assist with discharges.

Once you're admitted, it's like you're there until you die.

What approach was being taken to treat Kawai's illness?

We showed her chart to a specialist in neurology.

This tells you her illness was not being treated.

Her body was contracting and getting stiff, so they should have responded.

Since they didn't, she wasn't getting medication that might have helped.

What are the consequences?

She'll become bedridden sooner.

For its part, the hospital insists it delivered care through medication and physical therapy.

I think it's best to deal with the most important things first.

Do you desire to be discharged from Takiyama Hospital?

If so, please blink once.

Could you blink once more?

OK, thank you.

Hospitalized for 7 years, Kawai's condition has deteriorated and she now has difficulty speaking.

"I authorize the attorney named below..."

On this day, Aihara began the process to have Kawai released from the hospital.

Is this close enough?

Please blink if you can read this. So it's okay.

Your friend Kamaki wasn't allowed in, and she recorded this.

How are you, Haruko? It's been so long since we met.

You asked me a long time ago to find an attorney to help you get out,

but I couldn't find one.

Now, at last, I hope you'll be able to tell him what you're hoping for.

I want to see you soon.

You'd like to see Kamaki too, wouldn't you?

Thank you. She's responding with her fingertips.

If you would like to see Kamaki, blink quickly in succession.

Thank you. That's great.

I'll show this to Kamaki, who's been waiting outside.

Her expression and movement...

She couldn't move much, but she was tuned in.

I could see that she was a very strong person.

I was glad to see that.

I really wanted to get her out earlier,

while she could still move, and I regret that.

Really...

I want to see her soon.

The list of patients at Takiyama Hospital over the last 10 years contains 1,498 names.

Families that could no longer bear the burden...

Psychiatric hospitals that couldn't treat medical complications...

And the public assistance administration.

The patients were hospitalized for various reasons.

The reason for discharge: Death.

Death.

On the list we obtained, 1,174 people were discharged by death.

This was 78% of the total number of patients.

This is Kawasaki Mioko.

In January of 2022, her husband Koichi died, while hospitalized at Takiyama Hospital.

My husband was shy and didn't talk much.

- You met at a ski resort?
- Yes, at Happo-one.

He helped me prepare my skis.

Here, he's singing karaoke again.

Every shot is of karaoke.

He'd sing, "Thanks for the Evening Mist."

Koichi was a taxi driver.

He was diabetic, treated with kidney dialysis.

He developed dementia, making it hard to care for him at home.

His local doctor recommended hospitalization at Takiyama Hospital.

This is footage of Koichi, 3 months before he died.

His chart records that he had developed a large bedsore on his back.

The bedsore grew over the next 2 weeks.

His skin eroded, exposing his flesh underneath.

Don't complain, I'm just shifting you.

Ah!

- It hurts!
- Shut up!

Bedsores increase the danger of infection from bacteria and viruses.

Koichi developed various symptoms, including fever and pneumonia.

But because of the COVID pandemic, the family was not allowed to visit.

The nurse told me he had developed a bedsore.

I thought it was an ordinary, small sore, not something so severe.

It was awful. It must have been so painful.

In December of 2021, the family was notified that Koichi was in critical condition.

At one point, his heart had stopped.

We were told he was in the ICU.

When we saw him, he was unconscious, wearing a mask.

He appeared to be suffering, with all kinds of tubes attached.

They said it was the ICU, but it was a ward.

- There were many patients there.
- More than 10, maybe 20.

Many of them were suffering.

t's a bit embarrassing to say, but it smelled bad.

It made me worry if he'd be OK.

- It was very sad.
- He was totally changed.

He had changed.

At that point, the family talked about

whether it was wise to continue treatment.

We decided it was best to stop.

- "Medical treatment?"
- Yes.

- "Who did you tell?"
- We told the doctor.

We also called the hospital director.

We told him, "Stop medical treatment."

The family had asked that medical treatment be discontinued.

But Koichi's chart shows that treatments continued for a month,

including blood-pressure medication and intravenous tube-feeding.

Dr. Ono served as chief of internal medicine at Japan's largest psychiatric hospital.

At an ordinary psychiatric hospital, this treatment would be unthinkable.

The duration of life...

this treatment unnecessarily prolongs the duration of life.

Administering albumin or giving transfusions...

Those extend the duration of life,

but the underlying disease does not improve.

It's not made better.

The family wanted treatment stopped, so what purpose was served?

It's unfortunate that this is what happened.

Treatment continued for 6 weeks.

In January 2022, Koichi took his last breath.

When we went to retrieve his body,

he was lying at rest behind the hospital.

We were led to a storage room,

and told, "His corpse is in there."

He was no longer treated as a human being.

Even though we asked them to stop,

he was put through an ordeal.

Takiyama Hospital claims that, as a hospital equipped with an intensive care unit,

it gives priority to difficult-to-treat patients with multiple disorders.

"Another one bit the dust."

"It's too bad, but they all end up dying."

"Nothing we can do. (Hee-hee)"

"Some guys hang in there when we try, but others just die on us."

"There's no way we can cure them,

so they just die. (Hee-hee)"

In 2001, at the Asakura Hospital in Saitama Prefecture,

an incident occurred in which 40 patients suffered suspicious deaths.

The hospital had gathered patients receiving public assistance.

Many were illegally restrained, and the hospital was doing unnecessary tube-feeding

in order to illicitly boost fees for medical services.

We spoke with someone who was then on staff at the hospital.

"It was really extreme, this long row of IV-feeding bags."

"20 or 30 people on IVH drips, that's pretty extreme."

"This began after Dr. Asakura arrived."

"How many people died?"

"With no respect for their dignity, having lost everything."

"Like cast-off shells of human beings."

After the incident came to light, the hospital was effectively closed,

and the hospital director had his medical practitioner license revoked.

The same man who served as director of Asakura Hospital is now director of Takiyama Hospital.

Director.

I'm Aoyama, from NHK. We'd like to talk about Takiyama Hospital.

Director.

The hospital responded to our inquiries as follows:

"We are cooperating with investigators and administrators,

and we believe the truth will be made clear by that process."

Despite being stripped of his medical practitioner license,

why is Asakura once again serving as a hospital director?

Under the law, one can reapply for a license after 5 years.

In cases where the Minister of Health deems someone "signally inappropriate," that person cannot register.

When we inquired about the recertified director of Takiyama Hospital, Health Ministry officials responded.

"We cannot comment on individual cases."

Hello, Ms. Kawai.

You seem to be in good spirits.

Kawai Haruko has been hospitalized here for 7 years.

In December 2022, attorney Aihara tracked down a hospital for her to transfer to.

After you're out of here, soon, we can get you the treatment you need.

In any case, we'll get you to a place where you can live as you choose.

Then we'll consider it carefully.

Things will be OK.

Good morning, Ms. Kawai.

It's OK, it's OK.

It will take a while. Please be patient.

This is great. We'll get you out of here.

After 7 years in the hospital, I expected lots of luggage.

You lived a very compact life.

- We'll get under way.
- Okay.

Your first road trip in years.

You've been here 7 years.

We have a great view of Mt. Fuji.

Ms. Kawai, this is the view of Mt. Fuji that we are seeing now.

We can see all the way to the foothills.

After this program was produced, the number of arrested medical staff members reached 5, but the hospital is still in operation.

In January 2024, the hospital’s management team announced they would step down, as soon as successors were identified.

We continue to follow this story.