The man accused of the 2016 murder of 19 disabled people at a Japanese care home goes on trial Wednesday in a case that ranks among the country's worst mass killings.

Satoshi Uematsu, a former employee of the care centre outside Tokyo, has admitted carrying out the stabbing rampage, but his lawyer is expected to enter a plea of not guilty on grounds of diminished capacity.

Uematsu reportedly said he wanted to eradicate all disabled people in the horrifying July 26 attack at the Tsukui Yamayuri-en centre in the town of Sagamihara outside Tokyo.

The 29-year-old is accused of breaking into the facility and moving room to room, searching for victims. Nineteen people were killed and 26 injured -- half of them seriously.

He turned himself in at a police station, carrying bloodied knives and admitting the attack to officers.

Satoshi Uematsu, charged with murdering 19 disabled people at a care home he used to work at, being moved by police shortly after his arrest in 2016
Satoshi Uematsu, charged with murdering 19 disabled people at a care home he used to work at, being moved by police shortly after his arrest in 2016 JIJI PRESS / STR

It emerged later that Uematsu had left his job at the home just months before the attack, and had been forcibly hospitalised after telling colleagues he intended to kill disabled people at the centre.

But he was discharged after 12 days when a doctor deemed him not a threat.

He faces six charges, including murder, and faces the death penalty if convicted on some of the counts.

Police searching the home of murder suspect Satoshi Uematsu after his arrest in 2016
Police searching the home of murder suspect Satoshi Uematsu after his arrest in 2016 JIJI PRESS / JIJI PRESS

Since his arrest, Uematsu has shown no remorse and continued to espouse the views that apparently motivated the attack.

In interviews with Japan's Mainichi Shimbun daily he said those with mental disabilities "have no heart", claiming "there's no point in living" for them.

"I had to do it for the sake of society," he said of the attack.

"I don't think I'm innocent but it wasn't something punishable by death."

Despite his statements, his lawyers reportedly plan to enter a plea of not guilty on Uematsu's behalf, arguing he was unable to tell right from wrong at the time of the attack because he was on drugs.

A test following his arrest reportedly showed traces of marijuana in his system.

Satoshi Uematsu could receive the death penalty if convicted of one of several charges he faces
Satoshi Uematsu could receive the death penalty if convicted of one of several charges he faces JIJI PRESS / STR

In a recent interview with the Jiji Press agency, Uematsu said he would not deny in court having carried out the attack.

"It's depressing," he said. "It's like going there to get insulted."

And he appeared to take pride in the devastating rampage

"I did my best", he told Jiji.

Uematsu's self-styled mission to rid the country of people with disabilities shocked Japan, with experts and activists raising questions about whether others in the country might hold similar views.

Japan has been making efforts to increase accessibility -- particularly in Tokyo ahead of this year's Paralympic Games -- and activists hailed last year's election of two disabled lawmakers.

But some critics feel the country still falls short at fully integrating people with disabilities, and the government last year was forced to admit data on hiring people with disabilities had been padded to meet quotas.

Uematsu appeared to have been open about his prejudices well before the attack, even delivering a letter to the speaker of the lower house of parliament in which he threatened to kill hundreds of disabled people.

The letter reportedly clearly outlined a plan for night-time attacks against Tsukui Yamayuri-en and another facility.

In the rambling letter, he presented a vision of a society in which those with serious disabilities could be euthanised with the approval of family members since "handicapped people only create unhappiness".

Japan has one of the lowest rates of violent crime in the developed world, and the attack ranks among the worst ever in the country.

At the time it was the deadliest since 1938, when a man armed with an axe, sword and rifle went on a rampage that left 30 people dead.

In 2019 an arson attack at a building belonging to the Kyoto Animation studio killed at least 36 people.

The court is expected to hand down a verdict against Uematsu on March 16.