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2014年7月14日 (月)

精神医療改革 社会的入院の解消を図りたい

The Yomiuri Shimbun
Mental health care reform urgently needed for ‘deinstitutionalization’
精神医療改革 社会的入院の解消を図りたい

It is a matter of urgency to transform the nation’s mental health care system to shift away from the current hospital-centered treatment to making arrangements for encouraging care at the homes of the mentally ill.

A report recently produced by the Organization for Economic Cooperation and Development has pointed out that the number of psychiatric care beds in hospitals in Japan is four times the average of OECD member countries. While treatment of the mentally ill at their homes has been increasingly spreading in industrially advanced countries, Japan trails other nations in “deinstitutionalization,” the shifting of care away from hospitals and toward patients’ homes or in the community, the report noted.

About 320,000 of the nation’s 340,000 psychiatric beds at hospitals are occupied by patients, 200,000 of whom are long-stay patients having been hospitalized for one year or longer, according to the report. Psychiatric patients in this country are hospitalized for about 300 days on average, far longer than the approximately two weeks in other developed countries, it said.

Many patients stay for a long period at hospitals even though the need for their hospitalization is low, only because they have nowhere to go after being discharged. In many cases, people with mental illnesses suffer further declines in their living competence due to long-term hospitalization, finding it all the more difficult to get out of the hospital. It is imperative to resolve the problem of such patients in long-stay beds, a situation often referred to as “social hospitalization,” or socially unavoidable hospital admissions.

In Japan after the end of World War II, the government adopted a psychiatric medical treatment policy of largely separating the mentally ill from society, encouraging establishment of private-sector psychiatric hospitals through the introduction of a subsidy system. Special steps have also been taken to relax staffing requirements to allow a relatively small number of medical doctors to take care of many psychiatric inpatients. The increases in the number of social hospitalizations were partly due to these steps.

‘Social hospitalization’

In 2004, the government hammered out a policy changeover in favor of “shifting from hospitalization to the community” in mental health care, setting a goal of reducing the number of psychiatric beds at hospitals by 70,000 during a period of 10 years. The actual number of reduced beds in the 10-year program, however, is considered to be no more than around 10,000, primarily because hospitals are not keen on the cuts in beds as they mean less revenue.

In April this year, the government announced a set of guidelines for psychiatric treatment aimed at having patients discharged from hospitals within a period of one year after their first-time hospitalization and improving support measures for treatment of patients at their homes.

The guidelines should be considered proper in seeking to limit hospitalization to those patients with serious disorders, while having those with mild and moderate problems taken care of in communities where they are accustomed to living.

A key task in this connection is how to expedite the discharges from hospitals of social hospitalization patients, the long-stay inpatients.

A study panel of the Health, Labor and Welfare Ministry has created a report in favor of the idea of converting part of the hospitals with such long-stay beds into residential facilities for the patients. The idea is designed to proceed with the reduction of hospital beds in consideration of the desires of inpatients reluctant to be discharged from hospitals, while also taking into account the need to prevent hospitals from suffering declines in revenue.

However, the proposed conversion into residential facilities has been strongly criticized for being only a change in name. In addition, anxieties on the part of patients and their families over the possibility of being enclosed in the compounds of hospitals are understandable.

The ministry panel’s report said the planned conversion should be contingent on the choice of the patients themselves, while stipulating the length of the periods of accommodation at the envisioned facilities. It also came up with an idea of limiting the users of the facilities to currently long-staying patients.

The envisaged facilities should certainly be used as temporary measures, placing priority without fail on creating a system to enable patients to return to their communities.

To ensure sufficient support for the patients’ life in their communities, it is indispensable to help them manage such pecuniary affairs as those relating to public assistance benefits, as well as improving counseling services for them.

It is also important to ensure the provision of housing or group homes for them. To accomplish these objectives, coordination of efforts is essential between municipal governments and medical and welfare service organizations.

(From The Yomiuri Shimbun, July 13, 2014)


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