An armed man with knives attacked a care facility in Sagamihara, outside Tokyo, killing 19 disabled patients, and injuring 26 others. It’s been reported that the assailant told police, “It’s better that disabled people disappeared.” This is the worst attack on Japanese soil in decades. The suspect, named Satoshi Uematsu, a former employee of the care facility, later turned himself in to the authorities.

Petrified staff at the Tsukui Yamayuri En (Tsukui Lily Garden) facility in Sagamihara, south of Tokyo, called police at about 2:30am local time after Uematsu launched his attack. Emergency workers said that at least 20 of those injured were in critical condition. “I did it,” the 26-year-old former employee of the facility was quoted as saying.

Uematsu, a resident of Sagamighara, was carrying a bag full of knives and other sharp-edged tools covered in blood when he turned himself in to the authorities. Police officials have declined to disclose details about the ongoing investigation and said they were still investigating it.

Nine women and 10 men were killed, the fire department was quoted as saying, while the victims aged from 18 to 70 years. Police have yet to formally establish a motive for the attack. However, Uematsu was put in hospital earlier this year for almost two weeks after he said he would kill disabled people.

Authorities said Uematsu had been admitted against his will to hospital on 19 February, after police in the town of Tsukui contacted him in response to a letter he had tried to pass to the Speaker of the Lower House of Japan’s Parliament.

In the letter, Uematsu debated that the government should permit euthanasia for disabled people, that he would be willing to carry out such killings himself, and detailed how he would do it.

“I envision a world where a person with multiple disabilities can be euthanized, with an agreement from the guardians, when it is difficult for the person to carry out household and social activities,” the letter said.

Uematsu’s letter said he could “wipe out a total of 470 disabled individuals” by targeting two facilities for disabled people during the night shift “when staffing is low”.

“The act will be carried out speedily, and definitely without harming the staff. After wiping out the 260 people in two facilities, I will turn myself in.” He was released from hospital on 2 March, 2016.

This violent act raises two major issues: first, the issue of euthanasia, and secondly and rather more importantly, the social stigma behind disabilities, especially mental diseases. In Japan, assisted suicide is legal, moreover Japanese culture holds its traditions very dearly, and Sepukku, the act of suicide through disembowelment commonly used by samurais, is common as well.

According to World Health Organization (WHO), an estimated 350 million people currently experience mental health issues. In 2014, one in five American adults experienced some kind of mental issue. One in 25 Americans lived with a major mental disorder such as depression, bipolar disorder or schizophrenia.

The biggest risk associated with mental health issues is that they remain undetected, mostly due to the fact that friends and family members think of them as a phase and do not regard them as life-threating diseases. Most of the time, when serious mental health diseases go undetected, they can lead to suicidal thoughts in patients. Suicide, being the 10th leading cause of death in the United States, makes mental disease an issue that cannot be taken lightly.

It’s not just adults who are at threat. According to WHO, 20% of the world’s adolescents face mental health problems. WHO also states that mental disorder is the leading cause of disability worldwide.

Hence it is important to raise questions about a person’s mental health and try to resolve it using proper techniques such as cognitive behavioral therapy, instead of sweeping it under the rug, taking it as a social stigma, and not giving it the importance it deserves.

Mentality Behind Lone Attackers

Most attackers are oppressed, acting on their own accord, due to suppressed rage, angst and may even be suffering from mental diseases such as schizophrenia and depression. It is quite difficult to correctly assess a person’s state of mind, and extremely difficult to correctly predict when a person will resort to such extreme acts of violence and terror.

Knife Attacks vs Gun Attacks

According to the latest statistics released by FBI, nearly five times as many murders are committed with knives than assault rifles. The stats reveal that out of 11,961 murders committed within the US in 2014, 660 were committed unarmed, 1,567 were committed with knives and only 248 murders were known to have been committed using rifles of any type, including single-shot long arms and assault rifles. These stats will give even more heat to the age-old argument that “guns don’t kill people, people kill people”, often stated by gun conservatives and members of the Republican Party who prevent stricter gun control laws in the US.

This news came just a day after the Florida shooting, where at least two people died and 17 were injured in gun attack at Fort Myers nightclub. It comes six weeks after a lone gunman shot dead 49 people at a gay nightclub in Orlando, Florida. The venue, Club Blu, was hosting a teen night when the shooting took place, at approximately 12.30am on Monday morning. These incident haven’t gone unnoticed by the Democratic Party, where President Obama has urged the Republican Party for more gun control laws but sadly to no avail.

US vs Japanese Disability Rights

The United States has always led from the front in terms of rights for the disabled. 43 years ago it legislated reasonable accommodation in “any program or activity receiving Federal financial assistance” under Section 504 of the Rehabilitation Act of 1973. The US one-upped these laws for the protection of disabled individuals working in the private sector 26 years ago under the Americans with Disabilities Act of 1990. The federal government has hired people with disabilities and banned office equipment that is difficult to use for people with disabilities. The US has decades of experience over Japan in implementing such laws.

The Fundamental Law for Disabled Persons which was implemented in 1993 in Japan serves as the basis of wellness policies in the country; it was revised in the year 2004. The revised law sets forth ‘full participation and equality’ as its guiding philosophy and intends to uphold the individual livelihood and dignity of people with disabilities, stating these must be guaranteed. The Fundamental Law states that opportunities for people with disabilities to take part in Japanese society must be secured, discrimination based upon a person’s disability must be removed, and the equal rights of disabled individuals in Japan must be protected.

The Fundamental Law also has contingencies for medical care, employment, training and education, barrier-free institutions, information, housing, and prevention of the causes of disabilities but until acceptance on the part of non-disabled persons becomes widespread, Fundamental Laws and Disability Acts will remain partially effective in Japan at best, and this incidence proves just that.