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.
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