[Toward further reform of mental health care and welfare].

The Committee for Investigating the Future of Mental Health Care and Welfare, launched in 2008 by the Ministry of Health, Labour and Welfare, issued its final report in September 2009. The 2009 report was an expert-driven interim review of implementation of the 10-year plan proposed in the 2004 "Vision for Reforming Mental Health Care and Welfare," which marked its midpoint in 2009, and was conducted in order to identify priority issues in the final five years of the plan. The report recognizes that "mental illness significantly impairs quality of life and causes great socioeconomic loss"; that "health care and welfare assistance systems that support the ability of people with mental disorders to live in the community are inadequate"; and that "large numbers of patients with schizophrenia remain institutionalized over the long term. The report notes that this is due to previous policies that promoted institutionalized care, with regard to which concerned parties, including government entities, have expressed regret." The new approach described in the report can be summarized as (1) promoting the basic principle of moving from institutionalized care toward community-based care, based on the vision for reform noted above; (2) creating a society where patients who have mental disorders can receive high-quality health care, and depending on the patients' symptoms and wishes where they can receive appropriate health care and welfare services while continuing to live independently and securely in the community; and (3) speeding up the process of reform in mental health care and welfare. The core focus of reform is expressed in four fundamental principles: (1) restructuring mental health care (restructuring and improving the healthcare system by upgrading community-centered healthcare, shifting the focus of hospital care to the acute stage, and similar efforts) ; (2) improving the quality of mental health care (improving the quality of health care provided to each individual patient, whether it involves pharmacological or psychosocial therapy, and also improving the quality of health care by promoting staff development) ; (3) strengthening community living support systems (developing welfare services that support the ability of persons with disabilities to live in the community, improving care management, improving emergency and community health services, securing places of residence, etc.) ; and (4) prioritizing increased awareness and understanding of psychiatric illness (promoting an accurate understanding of mental disorders so that patients can obtain help at an early stage, and so that people with mental disorders can live as fully-participating members of the community). The committee also reviewed the targets stated in the vision for reform, and established a new maximum limit of 150,000 patients institutionalized with schizophrenia (the number was 196,000 in 2005). By 2011, the committee will also set a concrete target for the number of patients institutionalized with dementia. Preserving the 2004 goals expressed under the vision for reform, the mean target ratio of patients remaining hospitalized in psychiatric wards less than one year, for all prefectures, was set at 24% or less, while the target discharge rate for patients hospitalized for one year or longer, for each prefecture, was fixed at a minimum of 29%.