[A questionnaire survey of mental health and welfare in city health centers prior to the partial amendment of the mental health and welfare law going into effect].

OBJECTIVE: The situation of mental health of health centers in cities prior to the partial amendment of the Mental Health and Welfare Law going into effect was investigated to provide data relevant to mental health and welfare in cities. METHOD: 81 health centers were recruited from designated, core, and ordinance-designated cities as well as the 23 sections of Tokyo City, and were supplied into questionnaires by mail. RESULTS: Less than 10 percent of the health centers had played a central role in establishing rehabilitation facilities. Regarding active support, small community-based workshops were most commonly subsidized. Only 13.3% of the health centers in Tokyo City provided support for daily life training facilities, while 60% had rehabilitation facilities. Seventy percent provided in-home services. More specifically, in contrast to the 64.7% of health centers in the designated cities which provided home-helper services, the figure was only 10.0% in ordinance-designated cities. Regarding the 2000 social adaptation training program, this was put into effect by less than half of the health centers in Tokyo City. No patients were admitted to rehabilitation facilities through 28.6% of the health centers, or underwent the consultation for rehabilitation facilities at 37.1%. Participation in care manager training sessions was low in Tokyo City but high in the other areas. Applicants for the health and welfare handbook and medical expense assistance for people with mental disorders were interviewed in 40.0% of Tokyo City's health centers and in over 70% of the others. There were problems with counter application in 50% of health centers in the core cities but not many in the remainder. More than 70% of health centers in the designated cities and Tokyo put the transfer system based on Article 34 of the law into effect but the percentages were lower for core and ordinance-designated cities. Patients were transferred at 34.2% of the health centers where the transfer system was enacted. Most of the designated cities and Tokyo established a council for mental health and welfare. However, this was the case for only 21.4% of the core cities and many of the ordinance-designated cities did not even consider this matter. Many health centers answered that welfare policy had advanced with the partial amendment. CONCLUSION: The study revealed major gaps among health centers and specific problems with different background types.

[A questionnaire survey of mental health in cities, towns and villages for the partial amendment of the law on mental health and welfare for people with mental disorders].

OBJECTIVE: In accordance with the partial amendment of the Law on Mental Health and Welfare for People with Mental Disorders, some mental health and welfare work has been performed under the jurisdiction of cities, towns and villages instead of prefectures since April, 2002. What is the role of prefectural health centres in supporting cities, towns and villages under the partial amendment? To consider this question in the light of transfer of responsibilities from prefectures to the municipalities, we investigated the situation in municipalities in October, 2001. METHODS: A total of 500 municipalities with populations less than 100,000 were recruited and questionnaire survey was carried out to study the mental health and welfare work, the department in charge and other relevant data. RESULTS: A total of 359 municipalities responded to the questionnaire (the response rate was 71.8%). Mental health and welfare work came under the jurisdiction of 58.5% of the municipalities. The persons in charge were mainly public health nurses and officers and few municipalities had specialists. About 64% of the municipalities had designated a department in charge of the transferred work, but only 16% had designated the number of persons in charge. Although municipalities must provide services for patients living at home as of April, 2002, under the partial amendment, 24.2% of municipalities had already been providing such service previously. About 60% of municipalities had staff who planned to participate in training for care management. For the office work related to the delivery of the health and welfare note for people with mental disorders and public expenditure for hospital expenses, 16.2% of municipalities had designated specialists as persons in charge and 24.2% of municipalities had secured space for privacy. Almost all (98.6%) municipalities pointed to problems in the transfer, which included the shortage of specialists and requested health centres to provide specific information. CONCLUSIONS: Although mental health and welfare work comes under the jurisdiction of over half of the municipalities, few have specialists for this purpose. Support services for patients living at home were often provided by the municipalities prior to the partial amendment of the Law going into effect. As municipalities stressed the shortage of specialists and requested specific information, health centres need to support municipalities from the standpoint of their specialized abilities.