Today, I attended a symposium in whose topic was patients with serious mental illnesses.
In Japan, approximately 300,000 people are staying at mental hospital, of which two-thirds are schizophrenic. Some of the inpatients are not so severely ill, but cannot discharge because social resources are poor. On the other hand, not a few patients need to be aided intensively.
The government is willing to define such patients as “judo katsu mansei” [severe and chronic]. Patients who are identified as so expect to be supported more comprehensively.
However, the official plan remains still vague. Some clinicians suspect that the aim of the government is not to help the patients but reduce the budget of mental health.
In the symposium, some researchers presented their opinions and endeavor about this issue. I was inspired by their comments very much. However, I also felt that there are some points to be clarified before doing productive discussion.
Firstly, since the definition of “judo katsu mansei” is under developing, each of speakers imagine different stereotypes of patients, I guess. One speaker said that there are many inpatients who cannot take clozapine in the psychiatric hospital, and he seemed to expect the government to support them with enhanced human resource. But, I think that a half of such patients will get fully recovered with clozapine. In Japan, clozapine has been prescribed to only 4,000 patients. Many psychiatrists have not faced the power of clozapine. We should not deem patients as treatment-resistant unless clozapine is tried. Thus, the issue is how to spread the use of clozapine, not to treat patients without clozapine.
Secondly, some clinicians criticize the government on not dealing with serious patients. According to one speaker, chronically ill patients are hospitalized in a state hospital in the US. It is true, but quite biased. In the US, citizens cannot choose a hospital to stay because national health insurance is poorly provided. Private hospitals handle rich people who can pay the medical cost on their own. In contrast, most private hospitals in Japan adhere the regulation of national health insurance. Patients can choose either the public hospital or a private one with the same cost as a principle. It is meaningless to exemplify the US case for discussing the role of public hospitals in Japan.
Third, I sense that both the speakers and audience underestimated biological factor on the course of mental illnesses. It is inevitable because this symposium was conducted in the Japanese society for social psychiatry. In the future, we will be able to forecast the prognosis of each patient with schizophrenia. The more delayed social setup is, the more difficult the reintegration into the society of the patient. The biological point of view will be essential in combined with social thinking for the treatment of mentally ill patients.
Tomorrow, I will attend some other symposiums. I am willing to learn something valuable.