Hirata Toyoaki
Seishin Shinkeigaku Zasshi. 2016;118(9):707-713.
The prospective payment system in the psychiatric acute care ward began in 1996 in Japan. This was up-graded to the psychiatric emergency ward in 2002. Chiba Psychiatric Med- ical Center, the model institute of these wards, has been leading the transformation from asylums to therapeutic apparatus. Although emergency/acute care wards occupy only 8% of the total psychiatric beds in Japan, they cover 41% of annual admissions onto psychiatric wards because of their high bed turnover rate. Therefore, they contributed to reduce the aver- age length of stay to two-thirds, and for the numbers of inpatients to decrease by 11% up until 2012. The Ministry of Health, Labor and Welfare presented an image of future types of psychi- atric bed-emergency, acute, recovery, and severe chronic beds, and a plan to reduce long- stay patients. Outcomes and improvements of patients with severe mental illness in the emer- gency/acute care wards may be a determinant of the future design. We propose three plans to turn it into reality: increasing the number of psychiatric emergency wards/units in general hospitals, requiring some residency program in emergency wards to become a certified psychi- atric specialist, and limiting new admissions onto psychiatric emergency wards to involuntarily hospitalized patients. These plans could facilitate deinstitutionalization in Japan, sustaining the provision of continuous and responsible care.
日本精神科急性护理病房的前瞻性支付系统始于1996年。2002年升级为精神科急诊病房。这些病房的示范机构千叶精神医学中心一直引领着从收容所到治疗机构的转变。尽管急诊/急性护理病房仅占日本精神科床位总数的8%，但由于其高床位周转率，它们占精神科病房年度入院人数的41%。因此，到2012年，它们促使平均住院时间缩短至三分之二，住院患者数量减少了11%。厚生劳动省提出了精神科床位未来类型的设想——急诊、急性、康复和重度慢性床位，以及减少长期住院患者的计划。急诊/急性护理病房中重症精神疾病患者的治疗结果和改善情况可能是未来设计的一个决定因素。我们提出三项计划来实现这一目标：增加综合医院精神科急诊病房/单元的数量，要求在急诊病房开展一些住院医师培训项目以成为认证精神科专科医生，以及将精神科急诊病房的新入院患者限制为非自愿住院患者。这些计划可以促进日本的非机构化，持续提供持续且负责的护理。
