Lessons for Japan from U.S. Rebalancing of Mental Health Care

November 27, 2012

As of April 2013, the Japanese government will make mental health a fifth national priority for national medical services, along with cancer, stroke, acute myocardial infarction, and diabetes. This change is a result of multiple factors: an aging population; increases in the demand for mental health care services; and a concern about a system that overly emphasizes institutional mental health care. The plan for shaping the future of mental health delivery in Japan is focused on changing the balance of care from institutional services to community-based services. In pursuing this goal the Japanese government has identified four aims for change: create a system of care that differentiates functions according to the intensity of need of patients; assure high-quality care throughout a restructured delivery system; make investments to support community-based services; and expand community education and expand opportunities for patient preferences to drive the delivery system.

The United States initiated a formal policy of reorienting mental health delivery away from large public mental institutions during the late 1950s and early 1960s, and the U.S. policy goals of that era are quite similar to those recently identified by the Japanese government. For this reason, there may be some valuable lessons for Japanese policymakers from studying the experience of the United States. Consequently, this paper focuses on three sets of lessons from U.S. mental health policy: (1) reducing reliance on hospital-based mental health care; (2) supporting community-based care; and (3) coordinating care for people with complex needs.