Japan’s Mental Health Crisis

The Great East Japan Earthquake of 2011 affected the mental health of individuals in the regions directly impacted by the earthquake, tsunami and nuclear disasters and throughout Japan, spreading fear and concern to all Japanese living in and outside Japan. This further exacerbated the existing dearth of mental health services and practitioners. Both national experts and local authorities recognized the need for enhanced mental health services and reformation in mental health service delivery. In April 2013, the Japanese government announced the intention to make mental health a fifth national priority for national medical services, changing the balance of care from institutional services to community-based services. A December 2013 fact-finding trip to visit with officials from the Japan Red Cross, Japanese Association of Psychiatric Social Workers, and Miyagi Prefecture Department of Mental Health found a predominant spending in infrastructure using disaster relief funds, yet little has changed to increase the country’s capability to provide effective psychological counseling and psychotherapy. This is to be expected as the United States underwent a similar transformation beginning in the late 1950s with John F Kennedy’s Community Mental Health Act signed into law in 1963 and 40 years passed before achieving the level of arguable success we see today.

Where to Begin?
While Japan undertakes efforts to educate and transform societal opinions about mental illness and treatment and builds a new mental health infrastructure, the people living in Japan continue to go without adequate mental health services. In regards to disaster relief, the development of stress response syndromes, depression and an exacerbation of underlying psychopathology is a concern. Two years after the 2011 disaster, the main concern is about post-traumatic stress disorder (PTSD), which can be disabling. Our communications with disaster area relief agencies indicate the most impactful intervention from CJMH is to address their immediate need for psychological counseling for relief workers, social workers, and other caregivers who have persisted in providing long-term care to disaster victims. These individuals are more accepting of psychological counseling than the general public which they serve, and their mental well-being is critical to their ability to continue providing quality care to others. There is also an urgent need to better train medical and mental health practitioners, social workers, and caregivers in Japan on how to recognize symptoms of PTSD for referral to mental health specialists for treatment. Undiagnosed and untreated depression also remains a large problem as evidenced by Japan’s high suicide rate which remains higher than most other industrialized nations.

Who Can Best Help?
Sadly, Japanese psychologists and psychotherapists are not up to the task yet. The Japanese government does not regulate clinical psychologists or psychotherapists, and Japanese insurance companies do not cover their services. The certifications for the Japanese versions of these vocations only require a fraction of the training hours required by California’s Board of Behavioral Sciences. Not surprisingly, Japanese psychologists and psychotherapists are prohibited from making diagnoses, and that task is left for Japanese physicians and psychiatrists who are already overburdened and favor medication over psychotherapy. American mental health practitioners, particularly those trained and licensed in California, are arguably the best qualified professionals to provide training and counseling to their Japanese counterparts. Japan will need to undergo transformations in service delivery and insurance reform to effect a true, lasting solution to its mental/health crisis. In the meantime, its people need treatment. Effective knowledge transfer and service delivery can only be enacted by competent practitioners who are culturally astute and native Japanese speakers, i.e. organizations such as our Center for Japanese Mental Health. Our psychotherapists and clinical staff are multilingual, native Japanese speakers and are fluent in Japanese language and culture, enabling them to provide effective multi-ethnic, cross-cultural counseling to Japanese-speaking patients. Our cumulative expertise in effective, applied psychotherapy, understanding of English and Japanese language, cultures, and value systems, and professional relationships in the USA and Japan enable us to bridge the language, cultural, and institutional divides to facilitate knowledge sharing and innovation in the field of mental health for the benefit of both nations.