Mental health care in Japan: From isolation to inclusion?

This article presents a retrospective study of the institutional development of Japan's psychiatric care system. It examines the stages of the establishment of psychiatric services, beginning with the early legislative acts of the 20th century, the development of the hospital network, as well as changes in hospitalization methods and social support for patients with mental disorders. The historical overview, based on Japanese researchers' articles, includes an analysis of the legislative framework related to issues concerning people with mental disorders. These statutes are further examined to explore how the state discourse frames the perception of affected individuals, revealing a connection to the concept of “impurity” on the one hand and “public danger” on the other. This reveals both the state's efforts to humanize treatment for those with mental disorders and their persistent objectification. A paradigm shift occurred only in the 21st century. The study highlights the importance of the economic dimension that influenced the formation of the psychiatric hospital system, which exhibits significant inertia and rigidity during the reform process. Therefore, the work includes an investigation of the economic factors that affected the establishment of the psychiatric care system and the contemporary economic constraints influencing its reform; statistical data from the Ministry of Health, Labour and Welfare of Japan serve as the source. Additionally, data from the Ministry's official website are used to analyze the psychiatric care system reforms initiated in 2004. The concluding part of the study is devoted to examining these reforms and the current state of psychiatric care in Japan. The prospects for developing psychiatric care are considered in light of demographic trends and contemporary social demands. A systematic synthesis of the historical, legal, and sociocultural aspects of psychiatric care development in Japan is provided, with emphasis on current challenges and directions for reform in the context of increasing life expectancy and population aging.

1. +Nen ni muketa fukushi sâbisu to no kyôtsû kadai+tô ni kakaru genjô to kadai ronten ni tsuite [Current Status, Issues, and Points of Discussion Regarding Common Issues With Welfare Services Toward 2040]. (2025). Retrieved October 1, 2025, from https://www.mhlw.go.jp/content/12300000/001486024.pdf. (In Japanese).

2. Inaba, T. (2023). Gyakutai, innai shibô seishin iryô no yami gyôsei no kan'yo kyôka ga kyûmu [Abuse, In-Hospital Deaths: The Dark Side of Psychiatric Care: Increased Government Involvement Is Urgently Needed]. Mainichi Shinbun, October 24. Retrieved October 1, 2025, from https://mainichi.jp/articles/20231024/dde/018/040/011000c. (In Japanese).

3. Inoue, R. (2024). Nihon no seishin iryô no jittai to sono kadai ni kansuru bunkenteki kôsatsu: Itaria oyobi Igirisu no seishin iryô to no hikaku o tôshite [A Literature Review of the Current State of Psychiatric Care in Japan and Its Challenges: A Comparison With Psychiatric Care in Italy and the UK]. Kyoto Women's University Graduate School of Developmental Education, Doctoral Program Research Bulletin “Developmental Education Research”. Retrieved October 1, 2025, from http://repo.kyoto-wu.ac.jp/dspace/bitstream/11173/3842/1/0090_018_001.pdf. (In Japanese).

4. Iryô shisetsu (seitai dôtai) chôsa byôin hôkoku no gaikyô. (2023). [Overview of Medical Facility (Static and Dynamic) Surveys and Hospital Reports]. Retrieved October 1, 2025, from https://www.mhlw.go.jp/toukei/saikin/hw/iryosd/23/dl/11gaikyo05.pdf. (In Japanese).

5. Kanata, T. (2016). Japanese Mental Health Care in Historical Context: Why Did Japan Become a Country With so Many Psychiatric Care Beds? Social Work/ Maatskaplike Werk, 52 (4). Retrieved October 1, 2025, from https://doi.org/10.15270/52-4-526.

6. Kanja chôsa no gaikyô. (2023). [Overview of Patient Surveys]. Retrieved October 1, 2025, from https://www.mhlw.go.jp/toukei/saikin/hw/kanja/23/dl/kanjya.pdf. (In Japanese).

7. Kirihara, Naoyuki. (2021). Seishin shôgaisha no shakai undô ni yoru 1987-nen no seishin eiseihô kaisei e no shuchô. [Arguments for the 1987 Revision of the Mental Health Act by the Social Movement of People with Mental Disabilities]. Welfare Sociology Research, 18, 105—128. Retrieved October 1, 2025, from https://www.jstage.jst.go.jp/article/jws/18/0/18_105/_pdf/-char/ja/. (In Japanese).

8. Kôrei+sha no jisatsu no tokuchô. Kokuritsu seishin shinkei sentâ seishin hoken kenkyûjo teikyô shiryô [Characteristics of Suicide Among the Elderly. Data Provided by the National Institute of Mental Health, National Center of Neurology and Psychiatry]. (2006). Retrieved October 1, 2025, from https://www.mhlw.go.jp/file/06-Seisakujou hou-12200000-Shakaiengokyokushougaihokenfukushibu/s-5_3.pdf. (In Japanese). Seishin byôshô+sû, byôshô riyô+ritsu oyobi heikin zaiin nissû. (2002). [Number of Psychiatric Beds, Bed Occupancy Rate, and Average Length of Stay]. Retrieved October 1, 2025, from https://www.mhlw.go.jp/shingi/2002/12/s1219-7j.html. (In Japanese).

9. Seishin hoken fukushi shisaku no kaikaku bijon [Reform Vision for Mental Health and Welfare Policies]. Retrieved October 1, 2025, from https://www.mhlw.go.jp/topics/bukyoku/syakai/z-fukushi/gyosei/gyousei04.html. (In Japanese).

10. Seishin hoken oyobi seishin shôgaishafukushi ni kansuru hôritsu [Mental Health and Welfare for the Mentally Disabled Act]. Retrieved October 1, 2025, from https://laws.e-gov.go.jp/law/325AC0100000123#Mp-Ch_7. (In Japanese).

11. Seishin igaku kenkyû renraku+kai hôkoku. Kokoro no bariafurî o mezashite — seishin shikkan seishin shôgai no tadashii chishiki no fukyû no tame ni [Report From the Psychiatric Research Liaison Committee. Aiming for a Barrier-Free Mind — To Disseminate Correct Knowledge About Mental Illnesses and Disorders]. (2005, August 29) Retrieved October 1, 2025 from https://www.scj.go.jp/ja/info/kohyo/pdf/kohyo-19-t1032-6.pdf. (In Japanese).

12. Shinohara, F. (2024). 1950-Nendai no seikatsu hogo gyôsei to seishin shôgaisha shogû — kinkyû kyûgo shisetsu no sôsetsu to Kôseishô shakaikyoku no dôkô ni chakumoku shite. [Public Assistance Administration and Treatment of the Mentally Disabled in the 1950s: Focusing on the Establishment of Emergency Relief Facilities and the Trends of the Ministry of Health and Welfare's Social Affairs Bureau]. Social Policy, 16 (1), 264—275. Retrieved October 1, 2025, from https://www.jstage.jst.go.jp/article/spls/16/1/16_264/_pdf/-char/ja. (In Japanese).

13. Suicide prevention in Japan: A public health priority. (2024, September 9). Retrieved October 1, 2025, from https://www.who.int/news-room/feature-stories/detail/suicide-prevention-in-japan--a-public-health-priority

14. System of Social and Demographic Statistics, 2019 / Statistical Observations of Prefec+ tures 2025 / Social Indicators by Prefecture. Retrieved October 1, 2025, from https://www.e-stat.go.jp/en/stat-search/files?page=1&query=D%EF%BC%8E%E8%A1%8C%E6%94%BF%E5%9F%BA%E7%9B%A4&layout=dataset&stat_infid=000032169055

15. System of Social and Demographic Statistics, 2021 / Statistical Observations of Prefec+ tures 2025 / Social Indicators by Prefecture. Retrieved October 1, 2025, from https:// www.e-stat.go.jp/en/stat-search/files?page=1&query=D%EF%BC%8E%E8%A1%8C%E6%94%BF%E5%9F%BA%E7%9B%A4&layout=dataset&stat_infid=000040248625

16. Uchino, T., Fukui, E., Takubo, Y., Iwai, M., Katagiri, N., Tsujino, N., ... & Nemoto, T. (2023). Perceptions and Attitudes of Users and Non-Users of Mental Health Services Concerning Mental Illness and Services in Japan. Frontiers in Psychiatry, 14, 1138866.

17. Utsunomiya, M. (2011). Taishô 8-nen seishin byôinhô no rippô teian to sono giron. [Legislative Proposal for the Mental Hospital Act in 1919 and Its Debate]. Kinjo Gakuin University Journal. Social Sciences, 8 (1), 1—19. (In Japanese).

18. Yuhara, Etsuko. (2016). Kaigo satsujin jiken kara midaseru kaigosha shien no hitsuyôsei. [The Need for Caregiver Support as Seen in the Case of Caregiver Murder]. Nihon Fukushi University Social Welfare Review, 134, 9—30. Retrieved October 1, 2025, from https://nfu.repo.nii.ac.jp/record/2688/files/fukushi134-03yuhara.pdf. (In Japanese).