by Dr Kanna Sugiura, MScPH, Department of Mental Health, Graduate School of Medicine, University of Tokyo
The national health service in Japan covers everyone and also provides mental health services. I started to practice medicine and psychiatry in Japan in 2004. It has been 13 years and I can see how the way we talk about depression determines what it means to us and I see a positive shift in the general awareness and perception of depression.
Historically, it had been difficult for individuals to identify themselves as suffering from mental disorders when they were experiencing low moods or loss of interests. They would often consider themselves lazy and try to cover it from their families, friends, or workplace. Images around psychiatry clinics or hospitals were too negative for them to seek immediate help. Some people would come to clinics by themselves and others would come due to pressure from others. It was difficult to communicate a diagnosis to patients as a doctor, as it had instant adverse reactions from patients. They were reluctant to start treatments, particularly pharmacological. Doctors working in psychiatry were also treated with negative stigma and fear. I often came across comments such as “Are you reading my mind now?” and “Are you becoming a psychiatrist? I thought you were becoming a doctor.”
Today, mental health services are seeing people self-diagnosing and seeking support at the early stages of depression. The number of people who use psychiatric services grew from 2.04 million in 2000 to 3.92 million in 2016. Out of those people with depression were 0.42 million in 2000 and 1.1 million in 2016. People are more comfortable seeking support at psychiatric clinics when they have trouble sleeping, eating, or carrying out everyday tasks. It is easier to communicate a diagnosis such as depression to patients and their families and they are open to exploring treatment options and more likely to complete treatment. Taking time out of school or work is much more acceptable. The image of psychiatrists among the public and other doctors has changed drastically. People I meet tell me that they have experienced mental health conditions once, or want to know how to offer effective to support to friends and families who have mental health conditions. Doctors and nurses from other disciplines are now more willing to consult psychiatrists and accept their recommendations.
The last 13 years have seen many positive changes at different levels of society regarding depression. For example, depression is now one of the five priority health conditions when local governments develop health plans. CBT and other forms of talk therapy are now provided under the national health services apart from pharmacotherapy. Annual health checkups at work places now cover mental health. Sick leaves due to mental health conditions are more common and understood. Media coverage of depression is more positive and accurate. Ultimately, people feel more comfortable to talk about depression. This is helping people with depression to seek help more quickly and access necessary treatments to manage their lives. I really hope that Japan continues this trend and the theme of World Health Day this year ‘Depression: Let’s talk’ will help other countries and people further.
110 and 119 are the national emergency numbers for police and ambulances in Japan.
TELL (http://telljp.com/lifeline/) provides a free, confidential English-language Lifeline service, plus clinical mental health services, for the international community in Japan.
Befrienders Worldwide Osaka Suicide Prevent Center (http://www.spc-osaka.org) Hotline: +81 (0) 6 4395 4343
Befrienders International, Tokyo Hotline: +81 (0) 3 5286 9090
Tell Lifeline Hotline: Counselling: 03 5774 0992 Hotline: Face to Face: 03 3498 0231
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