Patients in Japanese psychiatric facilities are more than 3400 times more likely to be tied down than they are in New Zealand hospitals, newly released statistics show.
In Japan on one day in 2017, 9.86 people per 100,000 population were restrained by devices used to immobilise parts of their body. These could include straps to tie people to beds or chairs by their wrists, waist, shoulders and ankles, and mittens to stop people using their hands.
Over the same period in New Zealand, the rate was 0.0026 people per 100,000 population. Last year, New Zealand's rate dropped to 0.0019 per 100,000.
The analysis was done by Wellington woman Martha Savage, whose son Kelly died in a Japanese psychiatric hospital after being continuously tied to his bed for 10 days in 2017.
Mrs Savage compared the number of people restrained in general adult psychiatric in-patient care (excluding forensic mental healthcare units) across New Zealand's 20 District Health Boards, with results from Japan's 'June 30' survey, which counted the number of people mechanically restrained in psychiatric hospitals on that day, each year.
In New Zealand, in 2008 there were 61 mechanical restraint incidents reported, declining to 41 in a one-year period in 2016/2017 and to 30 in 2018.
In a letter to the United Nations' Committee on the Rights of Persons with Disabilities and members of the World Health Organisation, Mrs Savage wrote that Japan's inpatient psychiatry establishment had a "well-known, documented problem with systematic and prolonged use of mechanical restraints, despite laws meant to minimize their use".
Read more: DEATH BED - The story of Kelly Savage
She said five separate agencies wrote submissions to the committee advocating the reduction or elimination of mechanical restraints in Japan's psychiatric institutions.
Kelly Savage's death was one of at least 13 cases of abuse in Japan's psychiatric hospitals, but Mrs Savage said the number was "undoubtedly far higher."
She said a 2014 study found almost one in five psychiatric patients restrained for more than three days develops deep vein thrombosis - a condition that can be brought on by a lack of movement and can cause cardiac arrest.
In 2016, 40-year-old carpenter Kazuya Ohata died after he was restrained in a Japanese hospital for seven days. An autopsy found the cause of his death was a pulmonary thromboembolism, likely caused by deep vein thrombosis.
In 2005, during a psychotic episode, New Zealand woman Kathryn Morris stepped into the path of an oncoming train in Japan. Two years earlier she had been held for four days in a Japanese psychiatric hospital - loaded with antipsychotics, restrained at her waist, ankles, and wrists, wearing a diaper and a urinary catheter. Her mother, Marilyn Morris believes Kathryn chose death in 2005, over being hospitalised in Japan again.
In a 2015 report on mental healthcare in Japan, the OECD noted that restraint can be very stressful and traumatic for the patient, and can have a lasting impact on their confidence in medical staff
In Japan, the practice of mechanical restraint in psychiatric hospitals is illegal unless a person is a risk to themselves or others. Yet the practice is common: More than 12,000 patients were mechanically restrained in psychiatric hospitals on 30 June, 2017.
Mrs Savage said most of New Zealand's District Health Boards did not allow mechanical restraint use in general adult psychiatric facilities at all.
Mrs Savage has travelled to Japan to campaign against the prolonged use of mechanical restraints twice since her son died in May 2017. First to present a petition to Japan's Ministry of Health, Labour and Welfare calling for a review of restraint use, and a second time to present an open letter addressed to Prime Minister Shinzo Abe, signed by 31 psychiatrists, calling for an international inquiry into the issue.
*Numbers originally quoted were annual restraint rates. These have been now been changed to reflect daily rates.