Regardless of country or region, issues related to mental health are having significant effects on modern society. In 2017, it was estimated that 4.193 million people in Japan were living with mental health issues and their number is expected to continue to increase. Already, the number of people living with mental health issues is greater than the number of people who have been diagnosed with cancer, stroke, acute myocardial infarction, and diabetes combined. In particular, the number of people receiving outpatient treatment is increasing each year and is estimated to have grown to approximately 3.891 million people in 2017. An estimated 302,000 people are hospitalized with mental health-related issues. Although their number is trending downwards, Japan has the most people hospitalized in psychiatric wards on a per capita basis in the world. According to the 2018 Hospital Report from the Ministry of Health, Labour and Welfare (MHLW), the average length of stay for psychiatric care beds was significantly longer than for general care beds, at 265.8 days and 16.1 days respectively. That report also found significant regional disparities in average lengths of stay. Various factors can cause poor mental health or mental illness. In addition to social and economic stress factors, they include the conditions encountered after natural disasters like the Great Hanshin-Awaji Earthquake or the Great East Japan Earthquake as well as changes in the employment or household environment caused by a worsening economy. For these reasons, issues related to mental health must be approached as issues that affect society as a whole, without responses being limited to the field of healthcare.
The World Health Organization (WHO) recently enacted its Comprehensive Mental Health Action Plan 2013-2020. Meanwhile, efforts are advancing to promote the spread of best practices and information through international cooperative initiatives and comparative studies. In Japan, the enactment of the Act for Mental Health and Welfare in 1995 or the issuance of the Vision for Reform of Mental Health and Medical Welfare in 2004 have led to cooperative efforts between healthcare and welfare aimed at building support systems for people with mental disorders and their families. In addition, mental health was included as a targeted field in the sixth revision of the Medical Care Plan System, which came into effect in 2013. Meanwhile, the seventh revision of the Medical Care Plan System and the fifth revision of the Disability Welfare Plan both mentioned building an Integrated Community Care System for Mental Disorders. To empower people who have developed mental disorders to live as full members of their communities with peace of mind and pride, these developments aim to create an integrated care system that provides healthcare, welfare for people with disabilities, long-term care, housing, social participation (i.e., employment), networks for mutual support in communities, and education. Achieving these goals will require broad cooperation between multi-stakeholders.
Compared to the international situation, however, there are many domains of policy in Japan for which efforts must be intensified in the future. These include promoting knowledge and understanding towards each mental illness among the public, establishing care practices that are based on the needs of people with mental disorders, involving those most affected in the development and provision of services, creating support systems which unite the public and various professions while advancing the establishment of the Integrated Community Care System for Mental Disorders, and building systems with the capacity to provide mental health care over the life course. Rapid reforms based on international trends are also necessary. At the same time, policies that provide effective guidance are needed to make a smooth transition from existing healthcare provision systems. For example, existing stakeholders should be provided with incentives in the event of reform. Other necessary efforts that will contribute to improving quality of life (QOL) for people with mental disorders include examining the best way to structure the hospitalization system, providing diverse high-quality inpatient care, strengthening the mental health and medical welfare systems so people who are hospitalized can transition back to community living, and creating more treatment options by introducing new non-pharmacological therapies in addition to traditional pharmacotherapy. All of this will require the creation of an environment in which regional disparities in access to care have been eliminated and everyone has equal access to care.