Mental Health Care In Japan: Balancing Care In Hospitals And In The Community

@#In Japan, the number of people with mental illness, especially depression and dementia, is growing. Although mental health care in Japan is in its transition phase from traditional hospital-based care to community-based in the recent decades, it has been characterized by orientation to large psychiatric institutions. This paper aims to provide recommendations for achieving well-balanced mental health care both in hospital and the community in Japan by reviewing facilitators and barriers of current mental health care system. A narrative literature review was conducted to identify facilitators and barriers to implementing community-based mental health care in Japan. The databases PsycInfo, Medline, Pubmed, CiNii and Google Scholar were searched in English and Japanese. 46 studies published from 1980 to 2016 were included in the review. The review identified six categories of mental health care services provided in the Japanese community: Outpatient clinics, Outreach services, Rehabilitation and Living support, Case management and public health centers, Community-based residential care, and Work and Occupation. The crosscutting themes of facilitators and barriers to implement these services in the community were funding, staff management, and collaboration among community resources. To further promote the transition to community mental health care in Japan, this paper recommends the following actions: to shift funding and human resources from inpatient to community care services, to strengthen a capacity building system and supportive environment for service providers in the community, and to set a clear policy and strategic framework integrating medical and social welfare services in the community.

Alternativas a la hospitalización crónica / Alternatives to chronic hospitalization in mental health

No es posible ocuparse de alternativas a la hospitalización crónica sin tomar en cuenta una reforma del sistema de atención en salud mental. Desde el inicio del proceso de deshospitalización en la década de 1960, en los EE.UU. y en los países europeos, se ha acumulado mucha experiencia y se han hallado muchos problemas que aún no se han resuelto. Buscando el cierre de los hospitales psiquiátricos monovalentes se puso el énfasis en el sitio físico de tratamiento y no siempre en la calidad de la atención brindada ni en las necesidades reales de los individuos afectados. Se hace un repaso de la experiencia acumulada y se señalan pautas para evitar algunos de los principales errores y problemas que se presentaron. Para una reforma de la atención psiquiátrica exitosa son fundamentales la decisión política, la consulta a profesionales con experiencia, "un presupuesto adecuado y estable, la modificación de las leyes, la creación de las instituciones necesarias acordes con las necesidades de los pacientes antes de mudados, la formación de postgrado en rehabilitación, flexibilidad y creatividad con bases empíricas y científicas sólidas.

It is not possible to work on alternatives to chronic institutionalization without taking into account a reform of the mental health care system. A great deal of experience has been accumulated and a lot of unsolved problems have arisen since the beginning of the deinstitutionalization in USA and Europe in the 60s. The aim was the closing of psychiatric hospitals, and so the accent was put on the physical place of treatment instead on the quality of the treatment or on the actual needs of the people involved. A review of the experiences is made and some clues are given to avoid the major problems and errors that have presented. Political decisions, experienced professionals, a stable and sufficient budget, modification of some laws, the creation of community institutions that fulfill the patient's needs before moving them, postgraduate training in rehabilitation, flexibility and creativity with empirical and scientific grounds are needed for a successful reform of the mental health care system.