Staff writer A typical busy morning at this "bento" delivery shop in Tokyo's Taito Ward starts at 9 a.m., when around 15 workers come to prepare over 100 boxed lunches to be delivered to nearby office buildings.

With each worker skillfully doing his or her part, the shop seems no different from other bento shops, except that a one-hour meeting to review employees' mental state takes place after each shift.

The bento shop, Karen, is one of about 1,600 such establishments set up throughout the country to employ psychiatric patients who live outside hospitals while receiving medication.

"It is good that I'm out of the hospital and work to help support myself," said a 41-year-old worker at Karen who suffers from schizophrenia. "It is also good for my illness, because I felt so miserable and frustrated when I was solely reliant on my parents in my late 30s."

The 22 psychiatric patients who currently work at Karen earn between 300 yen and 400 yen per hour. While the schizophrenia patient said the wages are hardly enough to support himself, he added he was lucky to find such a rehabilitation facility.

"You have to wait several months to enroll in a rehabilitation facility for people with mental illnesses, and the number of such places is not sufficient to cover all the patients who want to live outside hospitals," he said.

While working at another facility that was designed for patients with more serious symptoms, he earned even lower wages. But he worked there for two years because it was the only place that had an opening for him.

Since the Mental Health Law was amended in 1987, the government has begun efforts to reduce the number of institutionalized patients.

But the number of people hospitalized for mental illnesses has yet to decline much, due partly to the lack of sufficient welfare facilities, such as sheltered work sites and group homes, which enable psychiatric patients to live outside institutions.

It is believed that many of the people institutionalized in Japan's psychiatric hospitals are so-called socially hospitalized patients, who are kept in such institutions not for medical reasons, but for personal or social ones.

This was evident to one patient at the time of his release. "I thought that if I was judged well enough to leave, probably between 30 and 40 percent of my ward mates could leave, too," he said.

The man, in his 20s, suffered from depression and spent a month in a psychiatric hospital in Ibaraki Prefecture following suicide attempts in 1997. While there, he was kept in a closed-off ward with around 40 patients whom doctors categorized as having "serious symptoms."

"Some said that they had no place to go or their families want them to stay (in the hospital)," he said. "Many others said they were just terrified of living outside alone after living in the ward for too long."

The health ministry estimated in 1984 that about 30 percent of the 333,000 patients at psychiatric institutions throughout the country had no medical need to stay in hospitals.

The Japanese Society of Psychiatry and Neurology estimated in 1999 that such patients account for 32 percent of psychiatric patients who stay in hospitals for over a year.

In 1995, the ministry launched a seven-year plan to establish 2,629 private and public facilities to rehabilitate people with mental illnesses. Such facilities would help 20,000 to 30,000 patients leave hospitals and lead normal lives.

But the Health Ministry's efforts to build the planned facilities have progressed slowly.

As of last October, 1,527 facilities, or only 58 percent of the initial target, had been established nationwide.

Also, there are 1,614 privately-run sheltered work sites for psychiatric patients, like bento shop Karen, but only 872 have been authorized to receive financial support from the central government.

Haruo Furuya, chairman of the National Federation of Families with the Mentally Ill in Japan, urged the government to make every effort to achieve its original goal. This would still be far from sufficient to cover the needs of psychiatric patients in this country, he said.

"The original target was set too low to bring all the socially hospitalized patients out of institutions, and to help the over 1 million psychiatric patients who already live outside hospitals," said the 74-year-old Furuya, whose 42-year-old son suffers from schizophrenia. The Health Ministry estimates there are around 2.04 million mentally ill people in Japan.

Yaeko Aizawa, manager of Karen, said that most sheltered work sites in Tokyo are forced to take care of nearly twice the number of patients that they can properly handle.

She added that three psychiatric patients are currently on the waiting list to enroll at Karen.

Aside from budgetary limitations, opposition from residents who live near the planned welfare facilities has delayed the government's program, explained Yoko Izumi, deputy director of the ministry's Mental Health and Welfare Division.

"Many people are still prejudiced against psychiatric patients and think they are unpredictable and dangerous," she said, adding that people "often campaign to oppose the building of such facilities in their neighborhoods."

Furuya of the patients' family association also said psychiatric patients and their families must struggle against not only the disease, but also against the prejudices their neighbors and even of their own relatives.

"My life is characterized by struggles for my son against the public, hospitals and government," he said. "But the hardest fight was my inner struggle until I accepted my son's disease, because I myself was as prejudiced as others."

The June 8 killing of eight children at an Osaka elementary school by a man who had a history of mental illness triggered an old debate on whether courts should have legal powers to send psychiatric patients accused of crimes to a special judicial facility for treatment to prevent them from repeating their misdeeds.

But groups representing the rights of psychiatric patients have opposed the step, arguing that it might label people with mental illnesses as potential criminals.

"Such a system will perpetuate prevailing prejudice against us," said Makiko Kato, who runs a self-supporting group home for psychiatric patients in Tokyo.

She added that even the current Mental Health and Welfare Law is discriminatory, given that it allows parents of psychiatric patients or authorities to send people to hospitals without their consent. Around 1 percent of the country's 330,000 hospitalized psychiatric patients have been institutionalized without their consent.

Kimio Moriyama, president of Yowa Hospital in Nerima Ward in Tokyo, said that the situation surrounding the country's psychiatric practices reminds him of that of Hansen's Disease patients, who were subjected to the government's segregation policies for decades even after medical advancements made their disease curable.

"The health ministry once allowed discriminatory treatment of mental patients, reflecting traditional prejudice by the general public against them," he said, adding that government indifference is still perpetuating public prejudice, just as it did with Hansen's Disease.

"(The government) has neglected its duty to bring about necessary changes even after the discovery of effective medicine, which makes it possible for (the mentally ill) to live in society."