Mental Health Care in Japan Edited by Ruth Taplin and Sandra J. Lawman (review)

Non-Japanese, especially Western, views of the Japanese mental health system tend to be simplistic: there is hardly any decent care available in Japan equivalent to the level of care in other highly developed nations. Although there are serious problems within mental health care in Japan, this (rather superficial) impression is not correct. As in any institution in a rapidly changing society, there has been much change and effort in improving mental health care in Japan, especially during the last 50 years. However, it is only recently that the social pathology of Japan, represented in the continuing high suicide rate, has drawn international attention to the mental health care system and health policy.

Mental Health Care in Japan, edited by Ruth Taplin and Sandra Lawman, consists of seven chapters written by various mental health professionals in Japan and may be the first book to detail the Japanese mental health system from the points of view of insiders: practitioners on the clinical frontline and those who have struggled to campaign for change, as well as researchers of Japanese mental health care. The book is timely and is an excellent source of information never before available in English.

None of the contributors is happy about the current mental health care reality in Japan. They point to profound problems embedded in the existing system, for example, the large number of psychiatric beds per capita in international comparison (27 beds per 10,000 population as of 2010), which often means fewer staff per patient; many cases of “social hospitalization” (long-term hospitalization for nonmedical reasons—estimated to be 70,000); and massive doses of psychiatric drugs. In chapter 4, Yayoi Imamura, a psychiatrist, criticizes the practice of high-dose poly-pharmacy medications including antipsychotics, antidepressants, and antianxiety as well as sleeping pills in Japanese psychiatric hospitals. One reason for this heavy medication, also pointed out by other contributors, is that the lack of medical personnel leads to forced sedation of some patients with dangerous behaviors. Another reason is that under the Japanese national health insurance system, more prescriptions mean more income generated for the hospital. Imamura’s report of complications from overprescribed antipsychotics such as Ileus and water intoxication, a phenomenon she says has never become an issue in other countries, may give the reader a dreadful picture of Japanese psychiatric hospitals. Imamura also presents an interesting historical perspective on characteristics of the contemporary Japanese mental health care system. She argues that the laws during the Edo period, which allowed the family of the mentally ill to imprison the patient in an isolation room of their own house, have influenced Japanese society’s deeprooted tendency to hide away the mentally ill (p. 73).

The first modern psychiatric law legislated in the 1900s failed to address the quality of treatment and rehabilitation. A post–World War II law under the Allied occupation stipulated for the first time the protection of mentally ill patients but failed to include consideration of how patients could live in their local communities. The 1964 incident in which a mentally ill man tried to injure U.S. Ambassador Edwin O. Reischauer became the cause for a drive to build more psychiatric hospitals and to establish public health centers. As Imamura says, this led to a boom in opening new psychiatric hospitals. However, these hospitals were exempt from providing the required number of medical staff per patient. It was not until the notorious 1983 case of the abusive treatment of patients in a psychiatric hospital that psychiatric care in Japan was scrutinized. In 1987, the Mental Health Act (a revision of the earlier Mental Hygiene Act) was enacted, and human rights protection and the move from hospitals to social rehabilitation facilities began to be emphasized. However, discharge of “socially hospitalized” patients is not progressing smoothly because of a number of social structural obstacles.

Hiroto Ito and other contributors say that another characteristic of Japanese psychiatric care is that an overwhelming...