Just over a week has passed since the mass killing of disabled people at a care facility in Sagamihara, Kanagawa Prefecture, left 19 dead and 26 injured.

In the wake of the July 26 attack at Tsukui Yamayuri En, it emerged that suspect Satoshi Uematsu, 26, had been committed to a mental hospital after he made threats to kill people with disabilities earlier this year.

Prime Minister Shinzo Abe has since announced that the government will seek further measures on compulsory hospitalization.

But experts warn that more focus should be placed on aftercare, rather than mandatory hospitalization, to prevent such an incident from happening again.

“It is believed the biggest issue was that the system of compulsory hospitalization was not functioning properly,” said lawyer Hisao Kato, who is a member of Nihon Seishin Hoken Fukushi Seisaku Gakkai, a policy think tank for mental health and welfare.

Uematsu “left the hospital without sufficient assessment and with no aftercare,” Kato said, but added it is problematic that people with mental disorders are deprived of their right to be tried and are often forced into compulsory hospitalization.

Under the mental health system, a person with a mental disorder who is judged by two doctors as capable of hurting themselves or other people can be forcibly hospitalized. Based on the condition of the patient, a decision is made as to whether they should be released, or hospitalized voluntarily.

According to health ministry data, 1,479 patients were forcibly hospitalized in 2014. This compares with 6,064 in 1994. A ministry spokesman said the drop was due to improvements in treatment.

Uematsu was sent to a hospital on Feb. 22 after being diagnosed with a delusional disorder but left after nine days.

The doctors who allowed him to leave reported to municipal officials in Sagamihara that his condition had stabilized and that he would be visiting the hospital while living with family members.

The police have said they confirmed with Uematsu’s parents that he was living with them. However, he was living by himself when he was arrested.

The city said it recommended that Uematsu visit a mental health consultation service, but there was no record of him contacting the service.

Kato said there needs to be a probation program conducted after compulsory hospitalization, though such aftercare should be discussed carefully to avoid impeding on human rights.

According to a Sagamihara official, there is no proper guideline on the care to be provided to such patients after compulsory hospitalization.

“Administrations lack resources to be able to provide additional care to patients after they leave the hospital,” the official, Eiji Yagi, said. However, “it may be accomplished with backup from people in the community.”

Chiba University professor Yoshito Igarashi of the Center for Forensic Mental Health said it is important to build a regional network to support patients after they leave compulsory hospitalization.

“Such violent crime is not necessarily conducted by people with mental disabilities. It is unconfirmed whether (Uematsu) has mental disabilities, so there should be a further assessment carried out.”

Aftercare “cannot be accomplished only by doctors and nurses,” Igarashi said, explaining that family members and neighbors, as well as experts from organizations such as health and welfare centers should team up to support such patients and to ensure ongoing treatment.

“With such a network, information could be shared if a person consults someone or if others notice a change in that person’s condition,” he said. “It would be easier to recommend an additional medical treatment or hospitalization, preventing them from becoming unwell and hurting themselves or others.”

Igarashi pointed out that other countries, including Britain, have a law requiring such patients to visit hospitals after compulsory hospitalization, though the results of this type of system are inconsistent and it may entrench on human rights.

Regarding media reports that Uematsu is suspected of using marijuana and other illegal substances, Igarashi said that the network would not work for such patients, and that it may require judicial punishment rather than seeing the issue as a mental health-related problem.

Mental illness due to substance abuse requires a different type of treatment and aftercare compared with treating schizophrenia, even if the symptoms may seem the same, he said.

Information from Kyodo added