Association between feasibility of discharge, clinical state, and patient attitude among inpatients with schizophrenia in Japan

Spatial analysis for regional behavior of patients with mental disorders in Japan

AIM

The aim of our study was to clarify the geographical movement of patients treated in psychiatric facilities, which can provide important information on the resources and health-care system of psychiatric services.

METHODS

We conducted an analysis of nationwide data on psychiatric patients, collected as an additional survey to the conventional '630 survey' in 2014. For the 151 848 initially admitted inpatients during 6 months and the 144 401 outpatients on a specific day, we identified whether a patient was admitted to a psychiatric facility located in the same medical area as his/her residence. We estimated percentages of being from (i) within the medical area, (ii) within the prefecture, and (iii) outside the prefecture, using a Bayesian statistical approach for each secondary medical area.

RESULTS

The inpatients moved across wider areas than did the outpatients. Almost all inpatients and outpatients received their medical treatment at hospitals/clinics within their prefecture of residence.

CONCLUSION

The current mental health medical system in Japan has been operating according to prefecture unit; thus, it may be appropriate to plan a medical system at a prefectural level.

Review of mental-health-related stigma in Japan

The aim of this study is to understand the nature and characteristics of mental-health-related stigma among Japanese people. We searched relevant studies in English or Japanese published since 2001 using MEDLINE and PsycINFO, and found 19 studies that examined mental-health-related stigma in Japan. Regarding knowledge about mental illness, reviewed studies showed that in the Japanese general population, few people think that people can recover from mental disorders. Psychosocial factors, including weakness of personality, are often considered the cause of mental illness, rather than biological factors. In addition, the majority of the general public in Japan keep a greater social distance from individuals with mental illness, especially in close personal relationships. Schizophrenia is more stigmatized than depression, and its severity increases the stigmatizing attitude toward mental illness. The literature also showed an association between more direct social contact between health professionals and individuals with mental illness and less stigmatization by these professionals. Less stigmatization by mental health professionals may be associated with accumulation of clinical experience and daily contact with people who have mental illness. Stigmatizing attitudes in Japan are stronger than in Taiwan or Australia, possibly due to institutionalism, lack of national campaigns to tackle stigma, and/or society's valuing of conformity in Japan. Although educational programs appear to be effective in reducing mental-health-related stigma, future programs in Japan need to address problems regarding institutionalism and offer direct social contact with people with mental illness.