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Japan has marginalized those considered mentally ill for a long time and has developed a stigma against it.  Previously, mentally ill Japanese prisoners were ordered to be executed.  Today, the Japanese are taught to endure their mental issues privately, rather than to seek help from doctors.

Japan has one of the highest suicide rates in the world. In 2007, 33,093 people committed suicide, the second-highest number ever recorded, and it is the leading cause of death among people who are 20-49 years old and accounts for more than 30% of all deaths in Japan.  Primary causes for suicide include despair triggered by tragedy or a personal sense of failure and clinical depression caused by mental or emotional trauma or neurological factors.

Local doctors do not fully understand depression, its diagnosis and its treatment and are more likely to prescribe anxiety medications to relieve patients of their symptoms.  They most commonly prescribe anti-anxiety medications, sleep medications and antidepressants, resulting in a massive spike in the distribution of these drugs.

Although they effectively treat symptoms, addiction to these drugs has become a concern.  Withdrawal from them has been proven to be more difficult than withdrawal from heroin.  Professionals believe that long-term use of antidepressants can be much more harmful than their original condition.

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In October 2013, according to a survey conducted by the Health, Labor and Welfare Ministry, 400,000 people used harmful substances in Japan.  In the 2013 fiscal year, 41% of total visitors at the Saitama Prefectural Mental Health Center were addicts of these drugs.

The country does not have enough treatment programs for drug addictions. According to the health ministry, they are only provided in 25 hospitals and 13 administrative entities across the nation.  In fact, 24 prefectures lack any facility providing such a program.

With a sharp increase in the number of addicts of dangerous drugs, the Japanese ministry has worked harder to set up treatment centers.  The ministry plans to increase the number of treatment centers for addicts to 69 by the end of the next fiscal year and aims to deepen cooperation between these facilities and other related entities, such as local psychiatric hospitals and groups encouraging self-reliance.

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Many Japanese have a somewhat romanticized image of living in Britain. While for some those expectations may be fulfilled, the reality for others is that they struggle to adapt to a very different culture. A common complaint of those having difficulty adapting to British life is a feeling they cannot make themselves understood in English, and this leads to a sense of powerlessness, isolation, inferiority and frustration, says Nippoda. Unable to describe their true feelings, Japanese women may argue with their British partners and, on some occasions, turn violent, she said. In addition, some Japanese women may feel disappointed that British men do not match up to their expectations of a traditional English gentleman. Japanese students frequently find they are unable to follow lessons and, rather than seeking help, withdraw from life and become demotivated.
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Japan’s Mental Health Crisis
The Great East Japan Earthquake of 2011 affected the mental health of individuals in the regions directly impacted by the earthquake, tsunami and nuclear disasters and throughout Japan, spreading fear and concern to all Japanese living in and outside Japan. This further exacerbated the existing dearth of mental health services and practitioners. Both national experts and local authorities recognized the need for enhanced mental health services and reformation in mental health service delivery. In April 2013, the Japanese government announced the intention to make mental health a fifth national priority for national medical services, changing the balance of care from institutional services to community-based services. A December 2013 fact-finding trip to visit with officials from the Japan Red Cross, Japanese Association of Psychiatric Social Workers, and Miyagi Prefecture Department of Mental Health found a predominant spending in infrastructure using disaster relief funds, yet little has changed to increase the country’s capability to provide effective psychological counseling and psychotherapy. This is to be expected as the United States underwent a similar transformation beginning in the late 1950s with John F Kennedy’s Community Mental Health Act signed into law in 1963 and 40 years passed before achieving the level of arguable success we see today.

Where to Begin?
While Japan undertakes efforts to educate and transform societal opinions about mental illness and treatment and builds a new mental health infrastructure, the people living in Japan continue to go without adequate mental health services. In regards to disaster relief, the development of stress response syndromes, depression and an exacerbation of underlying psychopathology is a concern. Two years after the 2011 disaster, the main concern is about post-traumatic stress disorder (PTSD), which can be disabling. Our communications with disaster area relief agencies indicate the most impactful intervention from CJMH is to address their immediate need for psychological counseling for relief workers, social workers, and other caregivers who have persisted in providing long-term care to disaster victims. These individuals are more accepting of psychological counseling than the general public which they serve, and their mental well-being is critical to their ability to continue providing quality care to others. There is also an urgent need to better train medical and mental health practitioners, social workers, and caregivers in Japan on how to recognize symptoms of PTSD for referral to mental health specialists for treatment. Undiagnosed and untreated depression also remains a large problem as evidenced by Japan’s high suicide rate which remains higher than most other industrialized nations.

Who Can Best Help?
Sadly, Japanese psychologists and psychotherapists are not up to the task yet. The Japanese government does not regulate clinical psychologists or psychotherapists, and Japanese insurance companies do not cover their services. The certifications for the Japanese versions of these vocations only require a fraction of the training hours required by California’s Board of Behavioral Sciences. Not surprisingly, Japanese psychologists and psychotherapists are prohibited from making diagnoses, and that task is left for Japanese physicians and psychiatrists who are already overburdened and favor medication over psychotherapy. American mental health practitioners, particularly those trained and licensed in California, are arguably the best qualified professionals to provide training and counseling to their Japanese counterparts. Japan will need to undergo transformations in service delivery and insurance reform to effect a true, lasting solution to its mental/health crisis. In the meantime, its people need treatment. Effective knowledge transfer and service delivery can only be enacted by competent practitioners who are culturally astute and native Japanese speakers, i.e. organizations such as our Center for Japanese Mental Health. Our psychotherapists and clinical staff are multilingual, native Japanese speakers and are fluent in Japanese language and culture, enabling them to provide effective multi-ethnic, cross-cultural counseling to Japanese-speaking patients. Our cumulative expertise in effective, applied psychotherapy, understanding of English and Japanese language, cultures, and value systems, and professional relationships in the USA and Japan enable us to bridge the language, cultural, and institutional divides to facilitate knowledge sharing and innovation in the field of mental health for the benefit of both nations.