Thursday, November 21, 2013

Problems about mental health in each country

Huff Post reports a problem around the mental health system in Virginia.

Huff Post: Long Before Deeds Case, Virginia Tech Massacre Pointed To Mental Health Service Gaps

According to this, there are some difficulties for functional mental health service: Lack of emergency beds, inadequate assessment of the patients, failure of sharing information among  practitioners.

These errors can also occur frequently in Japan. However, I was surprised to know some things happened in Virginia. Temporary detention order seems to rarely be adopted. I do not know the reason. In any places, there are patients who are needed to compulsory hospitalization, unfortunately. It is also quite rare in Japan that a patient discharge soon after the hospitalization.

Indeed, foreign report about mental health system is a little difficult to understand, since the scheme of public mental health are various be regions. How to deal with the patients with mental disorders often depends on cultural background and social resources available in each area.

In Japan, the landscape of mental health has three characteristics.

(1) Rich beds
Japan has large amounts of psychiatric beds. The number per population is doubled by western countries. There is a historical reason for it. About 90% of the mental hospitals is managed by the private sector. Thus, it is difficult for the government to control mental hospitals. On the other hand, almost all patients are able to be hospitalized without waiting a long time. It is an advantage in Japan.

(2) Familial aid
In traditional Japan, the family was responsible to take care of other members with some disabilities. Even now, compulsory hospitalization to a psychiatric bed requires a consent by a particular family member, as a principle. To maintain the outpatient care of the patients is also a task of the family. Instead, social resources such as Assertive Community Treatment (ACT) or Day & Night Hospitals has not grown enough yet.

(3) Opinion of doctors
In Japan, doctors, including psychiatrists have strong power to determine the strategy of therapy. When a doctor suggests an option, patients and family members are seldom opposed. Psychiatrists are also decisive in compulsory hospitalization. The judges and lawyers participate only in a special case under the Medical Care and Treatment Act.

It is meaningless to consider which system is superior. Each scheme has own argument.

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