Hashimoto A
School of Nursing, Yamaguchi Prefectural University.
Nihon Koshu Eisei Zasshi. 1997 Dec;44(12):992-1005.
In this article the mental health and welfare policies of the Tokyo Metropolitan Government and Yamaguchi Prefecture were analyzed, and the features of their development and problems were discussed. The results are as follows: a) The emphasis of the mental health and welfare policies both of Tokyo and Yamaguchi experienced changes according to national policies and is to be divided into the following four periods and key concepts. The 1st period (1950-1964): no policy or increase of psychiatric beds The 2nd period (1965-1975): dawn of "from hospital to community" The 3rd period (1976-1987): workplace for the mentally ill The 4th period (1988-present): accommodation for the mentally ill b) During the 2nd period, in terms of increase in psychiatric beds, the Tokyo Metropolitan Government tried to limit increase, whereas Yamaguchi Prefecture accommodated it. c) In the field of community mental health, the most remarkable development in Tokyo in recent years is that the number of workshops and group homes grew dramatically. The original policy of the Tokyo Metropolitan Government to subsidize such small institutions was recommended in the report of Local Advisory Council on Mental Health and Welfare (Chiho-Seishinhokenhukushi-shingikai). As a result many voluntary groups operate those institutions with help of subsidy. On the contrary the development in Yamaguchi is slow, because the establishment of institutions for rehabilitation was mainly implemented by the regulation of national law which demands high costs for its building and land. d) The original policies of the Tokyo Metropolitan Government, however, is based on the premise that a shortage exists of institutions for rehabilitation regulated by Mental Health and Law. In this situation, therefore, the development of community mental health depends on a subsidy from local government, development of community mental health depends on a subsidy from local government, development of voluntary groups, and accessibility to social services.
本文分析了东京都政府和山口县的心理健康与福利政策，并探讨了其发展特点和问题。结果如下：a) 东京和山口的心理健康与福利政策重点均根据国家政策发生了变化，可分为以下四个时期和关键概念。第一个时期（1950 - 1964年）：无政策或增加精神病床位；第二个时期（1965 - 1975年）：“从医院到社区”的开端；第三个时期（1976 - 1987年）：为精神病患者提供工作场所；第四个时期（1988年至今）：为精神病患者提供住宿。b) 在第二个时期，就增加精神病床位而言，东京都政府试图限制增加，而山口县则予以接纳。c) 在社区心理健康领域，东京近年来最显著的发展是工场和集体之家的数量急剧增加。东京都政府补贴此类小型机构的原政策在心理健康与福利地方咨询委员会（地方精神保健福祉审议会）的报告中得到推荐。结果，许多志愿团体在补贴的帮助下运营这些机构。相反，山口的发展缓慢，因为康复机构的设立主要是根据国家法律规定实施的，这需要高昂的建设和土地成本。d) 然而，东京都政府的原政策是基于心理健康法规定的康复机构短缺这一前提。因此，在这种情况下，社区心理健康的发展依赖于地方政府的补贴、志愿团体的发展以及获得社会服务的机会。
