A recent report by Bloomberg news that the government is planning to reduce the number of patients in psychiatric hospitals signals an important shift in Japan's view of mental health. According to the report, which was not well circulated in the Japanese press, the health ministry set a 10-year timetable in 2004 for reducing long-term hospitalization of psychiatric patients. This issue deserves fuller scrutiny and more open public debate.
Japan has more than 300,000 psychiatric in-patients at a cost of ¥400,000 per patient per month, according to a 2009 health ministry survey. The Organization for Economic Cooperation and Development estimates that Japan's rate of hospital occupancy is one of the highest in the world, with 90 percent of beds filled. Japanese also average longer stays. Psychiatric patients in Japan are hospitalized for 307 days on average, compared with a week in the United States and 11 weeks in the United Kingdom. That's 13.5 times more psychiatric beds per 100,000 people than in the U.S. and 4.5 times the U.K. rate, according to OECD data.
The transition, especially with so many patients, will not be easy. Many have been hospitalized too long to smoothly return home and others need occasional hospital stays. For many patients, though, returning to society and their families is preferable to continual residential care. So, doctors and families need to find ways to help take care of those patients. Reducing the stigma associated with having a family member needing psychiatric treatment is basic to any plan. With greater awareness and better acceptance, patients will have hope of once again leading lives outside of institutions.
Because most psychiatric hospitals generate revenue by filling beds, there is often little incentive to get patients back out into the community and often little experience in doing so. Another system is needed where patients can be given structured environments and continued treatment, while gradually returning to work and family. Rather than releasing many patients all at once, a flexible program of reintegration must be established.
Mental health care can never be realistically made efficient and cost-effective by government or business standards, nor should it have to be. Rather than making financial calculations, psychiatric hospitals long accustomed to high occupancy and government bureaucrats used to trimming budgets need to consider new options for patient care. Releasing patients into the community will work only when there is a support system, sufficient outpatient treatment and different conceptions of mental health.
We can learn from the reality that ensued after "the U.S. and western Europe began closing asylums and integrating patients into the community in the 1960s". Many became homeless and now as the American National Coalition for the homeless website factsheet shows:
According to the Substance Abuse and Mental Health Services Administration, 20 to 25% of the homeless population in the United States suffers from some form of severe mental illness. In comparison, only 6% of Americans are severely mentally ill (National Institute of Mental Health, 2009). In a 2008 survey performed by the U.S. Conference of Mayors, 25 cities were asked for the three largest causes of homelessness in their communities. Mental illness was the third largest cause of homelessness for single adults (mentioned by 48% of cities). For homeless families, mental illness was mentioned by 12% of cities as one of the top 3 causes of homelessness".
"Mental Illness and the Homeless" - Published by the National Coalition for the Homeless, July 2009:
So as there is stigma against the homeless in the US I do question the unsubstantiated assertion that "“There’s no question that the stigma against mental illnesses is greater in Japan,” This and the following comment that, “There is a tendency to take an ill family member and get them out of sight and essentially out of mind.” takes no account of the growth,sustained development and large growth in the number of community based non-bed outpatient psychiatric clinics with adult rehabilitation daycare/nightcare centers that has taken place throughout Japan, and in particular in the large urban conurbations such as the Kansai and Kanto regions were the vast majority of Japanese live, since the first ones were established in the late 1970s by a younger generation of progressive psyciatrists. These community based small sized psychiatric clinic-daycare centers provided an alternative to long term hospitalization and consequent long term institutionalization of the mentally ill and allowed many to remain functioning with their families and within their local communities.
A very large number of the people in mental hospitals are already senior citizens, with a significant number in their '70s and '80s,and the psychiatric hospitals are the only home they have know for the vast majority of their lives. Many have no living relatives and could be said in a way to be 'old-ages orphans'. To throw them out into the streets at this time when the Tsunami has already caused so many children to become orphans too (at least 1500 having lost one parent and 234 of them having lost both parents to the unrelenting tidal wave) could easily be perceived around the world as an act of unforgivable cruelty in the middle of this period of national disaster for Japan. It would possibly be seen as an unforgivable irony that the government should send a wave of 70,000 of its citizens out being swept out into the streets at exactly the same time as it has plans to establish community centers to provide therapy and mental health care for the young generation of orphans whose hearts and minds are human too. Young or old Japan needs to show an example to the world that it truly has the compassion to provide shelter and mental care for all its people, young or old.
Kind regards from Tokyo,