[A comparative study of local mental health and welfare policies in Japan: Cases of Tokyo Metropolitan Government and Yamaguchi Prefecture].

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.