[ SOCIAL AND PASTORAL BULLETIN No. 135 / Dec. 15 .2006 ]
Iwata Tetsuo (Catholic Kojimachi Church, Social Welfare Worker)
No matter the opposition of many disabled people the Diet approved the Law on the Assistance to the Self-support of the Disabled. The implementation of the law started on October 1 this year. As different from early legislation regarding the care of senior citizens and the payment system that provided a provisional 3-year term before its enforcement, this time its execution was so fast that it resulted in confusion of the persons affected by the law.
The present legislation stresses only the need to reduce the official Welfare budget without considering welfare principles and with almost no attention paid to the realities facing the disable and their needs. On top of that it is very difficult to understand its contents.

Historical Background of the Legislation
There are three main laws included in the welfare legislation for the disable
1. Welfare Laws for the physically disabled. This legislation was approved in 1949 and started implementation in 1950. Out of the 3,510,000 patients about 190,000 live inside welfare institutions and hospitals.
2. Welfare Laws for the mentally disabled. This legislation was approved in 1960 and was executed in the same year. A revision took place later, in 1999. Out of the 460,000 patients about 130,000 live interned in institutions and hospitals.
3. Laws regarding the welfare of mentally disabled people and their Insurance were passed by the Diet under the name of Mental Health Laws, in 1950 and were implemented that same year. Their revision was done in 1995 without change in their name. The total number of patients is 2,580,000 and about 350,000 of them live in institutions and hospitals.
Readers can realize that the name given in the legislation for the mentally disable does not bear the name of "Welfare" laws. The reason is because mental disorders have never been considered the object of welfare activities. The problem has been taken as "Health" insurance and thus it enters the field of sanitary health, not of welfare. And as a result, public offices regard the issue as the task of Health Centers where they perform public policy tasks from up down.
The three different legal levels are executed following various schemes and now they have been centralized. Nevertheless, it is a pity that, by unifying them there is no vision to recognize with fairness the three different impediments and the particular disabilities of the patients. In the case of mentally disabled people important elements, like changes in their physical condition, tiredness, diseases attached to their impediments, etc. have been practically overlooked. Taking for instance the issue of the recognition of the area of disability, if the patients are placed into a general category together with other disabled people, there is a possibility that, due to their physical condition, there is no appropriate area for them to be included.

Background of the Approval of the Legislation
The reason to pass legislation on the system for the expenses with regard to disabled persons was mainly due to budget cost expansions. The system to finance the expenses of physically and mentally disabled persons started to be implemented in the year 2003. But the costs soon greatly surpassed the forecasts of the Welfare Labor Ministry and from its start the expenses exceeded the budget allocated, thus the policy taken was a clear failure. Then, a new plan that surfaced was to include everything in the insurance for the care of old people. Nevertheless, the plan was abandoned due to the opposition of business and municipalities. A different option selected was this new legislation. Issues, like area recognition, one-sided burden, etc., borrow similarities from the old people's insurance and there is the belief that both will become integrated into one system.

The Legal System
According to this legislation, the welfare services conducted by the responsibility of the public offices, including financial expenses, are considered obligatory cost in order to assist self-support. On top of that, payment on a daily basis is provided in relation with different services, like home help, short stays and the entrance in welfare institutions, as well as training for self-reliance and jobs or community life, rehabilitation, medical training and regular visits to mental hospitals.
On the other hand, local centers that provide funds for main operations of small local workshops make discretionary payments, in accordance with the financial situation of the municipalities, but the financial basis of official funding is believed to be shacking.

Levels of Financial Burden
Before the present legislation was passed there was no financial burden imposed whenever people were not able to pay, but from now on by using welfare services, people will have to pay 10% of the use of services, under the excuse of "profit burden". Those who go to the workshops to work complain strongly about been obliged to pay a fee. And since comparatively speaking the fee is higher than the wages they receive there are people that remain always home without going to the workshops. There is a danger that this trend will greatly increase if the situation does not change. Something similar happens with medical treatment, patients begun to refrain from going often to hospitals after the financial burden imposed on medical expenses rose from 5% to 10%.

Meaning of Self-reliance
According to the new legislation "self-reliance" is understood as autonomous work, not as it naturally should be, i.e. to decide by oneself on one's way of life. The main principle is to work in a company to become economically self-sufficient. But I feel that a big flaw in the legislation is the fact that work environments are not appropriate for the disable and that, if one-stroke rule is decided, like "self-reliance of disabled persons means economic autonomy", then there is a danger that those unable to work because of disabilities will be labeled as disabled persons that can not become autonomous. Thus, such patients, most probably, will be removed from being covered by this system. There is a need to reflect in many different ways about the autonomy of the disable from the point of view of their needs.

The Principle of Competition
This time, "competition" was included in the legislation. The system works in such a way that, the remuneration provided to the institution to which the disable belong increases according to the number of persons working in companies. The numbers of patients to accept in the institutions are strictly officially fixed and, as a result, people worry that, in order to be able to fill the numbers needed to run properly the work, institutions will have to desperately compete to get enough people.

Recognition of the Degree of Disability
As already mentioned, following the pattern of the insurance for old people, a final verdict will be given in 6 different areas, after a detailed examination of 79 items as stipulated in the insurance of old people, besides 27 more items proper to the disable. Depending on the final verdict, there is a possibility of not being able to receive present welfare services. The legalization of such a system, as well as the clause related to "profit-burden", have certainly in mind a future integration into the insurance for old people.
Steps to Receive Assistance
The disable must follow a series of steps before they receive the payment. First of all, besides making the application, consultation about their situation, in order to be well understood is advisable. Then, comes the first verdict from the municipalities with regard to the level of their disability. After that, an assessment to pass a provisional decision on the mental and physical situation of the disabled person is done. The patient must then take a look at the inquiry items, before hand, with the help of persons they trust.
A medical inspection follows and before a decision is given to recognize the levels of disability, inquiries are done regarding housing conditions, life patterns, work and daily activities of the person concerned.
An important factor is that the disable explains its own desires and past experiences, his or her life environment so that the officials understand it fully. Once all this is done, a provisional decision on the allowance to be given takes place.
Considering the fact that plans for private assistance are proper to each disable, it is important for them to get actively involved in making plans that reflect his or her thinking and desires.
The final decision for getting allowances is provided after the medical inspection is given, but in case there should be disagreement the disable can make an appeal against the decision without any worries.

Local Welfare Plans to Assist the Disable
Municipalities, as well as urban and rural prefectures, must make plans to offer guarantees concerning welfare services, local life and job support to disabled persons in accordance with basic national policies. I think that, every three years, starting the year 2006, concrete policies will be produced with regard to targets on the numbers of welfare institutions and patients. Reports given at gatherings will take place and a system of public assessment is being considered. I would like such opportunities could be used to review such plans in front of the needs of those who will be directly affected. A few days ago reports were given at a public gathering in one Hall of Tokyo and out of curiosity I attended the meeting. I was a little shocked at the fact that, 10 minutes before the meeting took place, only two persons were present. Finally 11 persons attended.
Four local officials, the welfare head of the ward, the head of the department for the welfare of the disable, the heads of the sanitation and health prevention sections were also present. A good thing about the meeting was that a wheel-chaired disable with cerebral palsy also participated. He was a young person and making desperate efforts to make himself understood, strongly questioned the plans to make decisions just based on achieving numerical targets. He also demanded that the opinions of the disable should concretely be included into the local policies. Among the small group there were also two parents with disabled members that actively participated in the discussions.
I could clearly feel that the new legislation has not included the opinions of the disable.
The policies to produce the national welfare plan display the following objectives.
1. To move one percent of the actual disabled population living in institutions to live with local communities, until the year 2011
2. To move before the year 2012 about 70,000 patients out of mental hospitals
3. To move from welfare institutions to have jobs in common working places about 4 times the numbers of those presently working now, by the year 2011
Such concrete fixed targets are being strongly criticized by the disable themselves and their supporters. The Welfare Ministry specially opposes the plan to move mental patients from the hospitals, and proposes as a last resort the establishment of new institutions supporting those leaving mental hospitals.
This plan is also under criticism, because those institutions consist in just remodeling buildings in hospital compounds and are just a mere appearance of leaving the hospital. It's impossible to accept that mental patients without the need to be hospitalized should be isolated from social life.
Small-scale Workshops
The present legislation exerts a strong influence not only on the disable but also on those institutions using welfare services. I would like to introduce now an example of an small-scale workshop for the mentally retarded that I am related with.
According to the law, employment offices and welfare companies must provide jobs for those with disabilities unable to find work in ordinary places. Nevertheless, it is believed that, because their numbers are so limited, about 6,000 small workshops without official permits are functioning all over Japan to employ disabled people unable to find work. Most of those workshops operate under rigid strain with private support from urban and rural municipalities. But then, the new legislation was implemented at a time when there were strong demands around the country for providing much larger assistance to the existing workshops. The shift of such small-scale workshops is at the heart of the new legislation that stresses the official obligation to allocate public funds for shifting jobs and/or for continuing the jobs already undertaken, in order to become self-reliant. A survey done among the disable shows that, few people would like to take such steps, because shifting strongly implies job-self-reliance with the implication to have to pay a high fee.
On the contrary, the actual centers funding local activities answer the needs of people, because they are much at hand, give opportunities to make friends and provide work and training for the disable. At the same time, patients can get a wage for the work done and there are many opportunities for people to participate in creative events and recreation games. The persons attending the actual centers can talk and seek the advice of the staff and friends, can look for support to find jobs or the needed formalities required to obtain social welfare. In short, those centers look similar to the official ones and fill the needs and desires of those who use them. The problem is that, since their financial basis is very weak, they can not become confident on getting public funds from municipalities in the future due to tight budgets.

New Developments
Last October 31 a big gathering, "Public Forum to Review the Legislation to Assist the Self-Support of People with Disabilities" was organized on the first anniversary of the implementation of the new welfare legislation. The Forum had as a background a serious unwanted social situation related to public budget cuts on home and guide helpers, living expenses and controls on the disable.
More than 15,000 people with disabilities filled four public halls by the Hibiya Park (Tokyo) to discuss the new Welfare legislation and conducted a demonstration to the national Diet, demanding the review of the legislation. I felt in my skin the anger and the poignant heavy suffering of the disabled participants.

Quoting the Asahi Newspaper (2006/11/28), the government and ruling parties decided, on November 27, to temporarily diminish during the actual fiscal year the personal burden of those disable using welfare services that had to pay a fee of 10% out of the welfare assistance given. The measure will be implemented back from April this year. Realizing the fact that, the policies to include in the new legislation an increase in the financial burden of the disable created strong public criticism as measures to reject weak people with disabilities, the government introduced in the 2006 Supplementary Budget new policies to diminish their burden. In fact, the government was forced to rectify the welfare legislation only after one year of implementation. And as a result of this sudden change, there are discussions going on with regard to add measures to decrease the financial burden of low-income persons and to augment the funds given to institutions for the disable. Within this month, both the Labor and Welfare Ministry and the Finance Ministry will prepare the final draft budget. Nevertheless, there are no signs yet for a full revision of the new legislation for the disable. Decreases in the financial burdens are, certainly, most welcomed, but we must watch carefully so that the measures taken do not hide the movement to make a basic review of the welfare legislation.
The fundamental reasons behind the difficulty to understand the legislation do not originate in "welfare theories" or "the needs of the disable", but in measures to control the public welfare budget costs because of tight official finances and the lack of contact with the situation of people with disabilities.
In the Public Forum that took place last October 31, the cries of the disable shouting aloud "Do not make decisions about ourselves without counting on us" hit deeply my heart. I got to know persons there that felt like myself and I decided to spread this message in many different places.
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