Mental Health Care in Japan Lecture by Yuri Kitamura

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In order to improve mental health care in Japan, the government had started a policy from December 2015 whereby employers regularly employing 50 workers or more are required to offer an annual stress check to employees. This will include staff on secondment to overseas offices. Workplaces with fewer than 50 regular employees are encouraged (including subsidies), but not required, to offer the stress checks. Employees are recommended but not obliged, to undergo the stress check offered. The Industrial Safety and Health Act (Article 18) requires employers to establish a ‘health committee’. The health committee will be expected to oversee introduction of the stress check system and arrange for tests to be conducted. The Japanese Ministry of Health, Labour and Welfare expects the general stress check system to operate as follows:

- employee undergoes stress check overseen by doctors/public health nurses;

- results are delivered directly to the employee;

- the conductor of the stress check may recommend the employee meets with a doctor, if detected stress levels warrant this;

- employers must arrange a doctor interview of any employee who requests this in writing;

- after the interview, the doctor, employer and employee will consult regarding any necessary remedial measures, such as shorter work hours or a change of workplace or job duties.

In my opinion, there is some uncertainty concerning the program’s effectiveness in promoting worker mental health. First, no specified procedures are defined for some of the components of the program. In particular, improvement of the work environment, which is one of the evidence-based measures in this program, is not adequately detailed. There is also no obligation described in the law indicating that workers have to take part in the program. Workers would not participate in the program if there were a risk of leakage of their responses to a stress check questionnaire. As some may feel that may be treated in a disadvantaged way by a thoughtless employer because of the worker’s responses in the stress check questionnaire.

Further criticism that should be consider is that these amendments are aimed at only preventing work-related mental illness, and the government did not consider other situations that might cause stress in an individual such as household or personal issues. This measure is also targeted to a certain population (working class), and not the general population. And If we are looking as stress as a mental health problem, what about depression, anxiety or even more serious cases such as schizophrenia? More importantly though, I think that interventions should not only focus on treating the issue, but should also look at attempts to reducing the cause of the problem in the first place- the stigma of the society. Thus, interventions targeting education, attitudes or prejudice, discrimination and contact between the mentally ill and general population would be most fruitful. More specifically, the government should implement awareness campaigns to improve knowledge about mental illness as developing campaigns or other educational programs in Japan seems to be the best way to tackle mental health-related stigma and improve quality of life for those suffering from mental illness, and indirectly improve mental health of Japanese society.