A young Kiwi living in Japan died after having his legs and waist strapped to a bed in a psychiatric ward for 10 days without release, his family says.
Kelly Savage died in Yamato City Hospital on May 17, a week after suffering a heart attack and more than two weeks after he was hospitalised for mental health issues.
The 27-year-old's family is fighting for access to his medical records, after hospital officials denied saying he had been restrained for so long.
His mother and brother, Martha and Pat Savage, have spoken to the Herald about his death in the hope international attention on Japan's use of restraint on mental health patients will help force change.
"They're sick, they're not criminals," said Martha. "They need care and help."
The Ministry for Foreign Affairs and Trade (Mfat) confirmed the New Zealand Embassy in Tokyo had been providing consular assistance to the Savage family.
Correspondence between Mfat and the family also showed Mfat offered to help where it could with access to Kelly's medical records.
Kelly, from Wellington, had a history of mental illness and had previously been hospitalised in New Zealand.
But he'd recovered and was enjoying life in Japan as an English teacher, where he'd lived for nearly two years.
Then, in April this year Kelly began acting paranoid, lashing out and behaving in increasingly bizarre and concerning ways.
He came to stay with his brother Pat, who also lives in Japan. Pat, 32, organised for Kelly to go into medical care in the hope it would be the first step to recovery.
"I was really worried that something was going to happen to him, so I was trying to protect him and do what was best for him."
But on May 10, Kelly's heart stopped beating for nearly an hour.
He was rushed from Yamato Hospital, where he had been receiving psychiatric care, to Yamato City Hospital for treatment, but he never recovered from the extensive brain damage caused by the cardiac arrest.
A week later he suffered another cardiac arrest and died.
His cardiologist, Dr Kei Miyagishima, suspected the first heart attack was a result of a pulmonary embolism caused by deep vein thrombosis (DVT).
DVT is a common affliction of patients who have been restrained for long periods of time and can cause blood clots.
While the autopsy was inconclusive, cardiological medical records seen by the Herald show Miyagishima suspected pulmonary embolism due to Kelly's long restraint and to several pieces of evidence including his blood pressure and oxygen levels.
In a meeting with Kelly's psychiatrists at Yamato Hospital following his death, Pat and Martha say they were told that, apart for releasing his arm restraints at meal times, he was never fully unrestrained from the bed he was strapped to.
However, in a letter sent to the family by Kazuhiko Ishii, director at Yamato Hospital, and translated into English for the Herald, it was claimed "the physical restraint was stopped at suitable times, and it was limited to the times when physical restraint was necessary".
He denied the hospital was responsible for Kelly's death.
The Herald has contacted both hospitals but has not received a response.
A much-loved son gone too soon:
Kelly Savage was a loving, playful son, his mum says.
Martha Savage said although the family sometimes felt overwhelmed by grief, she was comforted knowing her son had been working in his dream job in Shibushi city, Japan.
Father Mike found talking about his son too painful.
Kelly's first serious battle with psychosis was in 2012, and it took him years to recover.
But in 2015 he graduated with a BA in psychology and Japanese from Wellington's Victoria University, moving to Japan shortly after to teach English, where his older brother Pat also lives with his wife and two young children.
His teaching job was a triumph, a dream job for someone who loved kids and proof of how far he'd come.
"He worked really hard for this, he finished his degree even though he had this depression," Martha said.
"We take a little bit of comfort that in his last years he was doing what he wanted to do and that he was appreciated.
"He was a very loving person, everyone loved him."
The outpouring of love from Kelly's friends following his death was hugely appreciated, she said.
Rules around restraint:
The United Nations Convention Against Torture, which Japan has ratified, says use of excessive restraint is a breach of human rights, which must only be used as a last resort, and should be removed as soon as possible.
However there are no exact guidelines about how long is too long or when restraint must be lifted.
A recent report into seclusion and restraint practices in New Zealand linked restraint to an increased risk of death and physical harm, including blood clots.