Unfair staff-patient ratios of mental hospitals in Japan]

Japanese Medical Service Law regulates the staff-patient ratios of the hospital beds which are divided into four categories: tuberculosis, psychiatric, infectious diseases and others. The staff-patient ratios for mental hospitals have been regulated under the lowest level since 1958. Consequently, there have been frequent use of restraints and segregation of patients. A committee was set up to review the above standards in the fall of 2000 for the first time. The conclusions drawn by the committee for the change of various standards including staff-patient ratios for mental hospitals were far from desirable from the view of mental health professionals and patients' family members. At this presentation, the reasons for the difficulty of improving the staff-patient ratios in Japanese mental hospitals will be noted with critical analysis, the author having been the member of the hospital standard review committee.     

The mental hospital magazine

Psychiatric Quarterly -     

The past and future of psychiatry and mental treatment in Japan from the standpoint of clinical psychiatry]

In the early 1950s, there was a serious shortage of hospital beds for mentally ill subjects in Japan, i.e., 30,000 in number as compared to 570,000 in the USA. Plans to supply sufficient beds achieved the goal of providing 280,000 beds in 1975. There were, however, a number of hospitals that fell short of medical and ethical standards, and invited severe criticism. To reconcile the situation, new laws and regulations were introduced to promote many projects for treating patients in the community through social welfare service. Day care institutions and outpatient mental clinics have increased markedly in recent years. Therapeutic measures for mental patients have changed dramatically in the last half of the 20th century, since the discovery of the anti-psychotic effect of chlorpromazine. A great number of psychotropic drugs, some produced in Japan, have been used routinely in psychiatric practice. In the same period of time, many kinds of psychotherapies, some originating in Japan such as the Morita and naikan therapies, have been developed for the relief of various psychological distresses. The diagnosis and classification of mental illnesses have long suffered from uncertainty and discrepancy, even among eminent psychiatrists. The publication of DSM-III in 1980, followed by DSM-III-R and IV and ICD-10, provided professional staff with practical manuals for making diagnoses of mental disorders, and for classifying them using common technical terms. These diagnostic criteria contributed greatly to the development of clinical and basic research in psychiatry. However, it should be noted that no manuals can replace textbooks and writings made available by elaborate studies.     

The past and future of psychiatry and mental treatment in Japan from the viewpoint of dynamic psychiatry]

Many psychoanalytic papers of S. Freud have been introduced in this country since the 1910s. However, a majority of psychiatric professors were critical of them. K. Marui was an exception. H. Kosawa, as a student of Marui, had studied with R. Sterba and P. Federn under the direction of S. Freud in Vienna. After WWII, interest in psychoanalysis increased in this country. The Japan Psychoanalytical Society and the Japan Psychoanalytical Association were organized in 1955. Also, international exchanges in this area have been developing. The psychotherapeutic and psychoanalytical needs of individuals in Japan have been increasing in relation to social and cultural changes. For the further development of dynamic psychiatry, some tasks are considered necessary, as follows: 1) collaboration with biological psychiatry, 2) contribution to psychiatric diagnosis, and 3) utilization of the therapist-patient relationship in psychiatric treatment.     

The past and future of psychiatry and mental treatment in Japan from the standpoint of biological psychiatry]

The history of academic meetings, research institutes, and governmental or private grants, as well as physiological, biochemical, pharmacological, histostructural, brain imaging, animal model, and molecular genetic studies related to biological psychiatry in Japan were reviewed. We expect to be able to elucidate individually different factors related to an attack of illness or relapse. In the treatment of functional mental disorders, future development depends on new drug creations that do not have any side effects or drug-dependence characteristics. Special attention should be paid to new anti-depressants or anti-anxiety drugs that have prompt euphoric effects. Instruments attached to a patient should be as small as possible to avoid psychological stress, and a telemetry feature is desirable to enable recording even during an acute severe stage of behavior disorder. To avoid fixation to the present treatment manual based on EBM (evidence-based medicine), new hypotheses should be investigated. I suggest my own plan in this speech.