[Mental health services in Japan: development of community care for mentally ill patients and their families].

Psychiatric care in Japan has received criticisms not only within Japan but from other parts of the world. In contrast, the services for the mentally ill in England are considered to be superior, despite serious criticisms. Psychiatric services in Japan and England are compared using government statistics. In Japan, the number of inpatients per 100,000 population has increased from the 1950s, while that of England has decreased since 1954. Since 1972 the prevalence of inpatients has been higher in Japan than in England. The history of psychiatric services in England where, after World War II, deinstitutionalization has been occurring is briefly described. For developing community care of the mentally ill in Japan, alternatives to inpatient care are thought to be important. These include primary care, day care and residential service in the community. Studies on families of mentally ill patients are crucial in community care and, among them, Expressed Emotion (EE) study is promising. Twenty cohort studies on EE and schizophrenic relapse, most of which successfully replicated the relationship between EE of the family and the course of the disease, are reviewed. Finally, some important aspects of EE study in Japan are discussed.