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David LeCount Report

Making Japan's Mental Health System the Finest
Moving From Hospitalization to Community-Based Treatment
A Report to the Ministry of Health

(Two Weeks of Observations (Site Visits) Joint Lectures, and Consultation in Japan)

David LeCount, MSW, ACSW, ICSW

Forward

A special word of thanks, gratitude, and appreciation goes to Dr. Mariko Kimura for all of her work in making this entire experience happen. It was Dr. Kimura who originally contacted me with the invitation to participate in this two-week multi-tasking process. Dr. Kimura and I were in communication with each other since the first of the year in preparation for this working experience. My final PowerPoint presentation was sent in advance of the visitation, thereby affording Dr. Kimura and Mr. Tsutomu Oyama the opportunity to translate the primary points into Japanese, which in turn, more readily facilitated the communication process.Dr. Kimura also made available the Japanese translation of an article about the Madison system that I had previously written. Dr. Kimura also disseminated an article she had written about the Madison Model. Additionally, Dr. Kimura procured the funding to make all of this possible; made all of the advance preparations for each of the sites visited and for all of the events that occurred; accompanied me throughout the entire time I was in Japan; and most crucial of all, acted as the primary translator. I am truly indebted to Dr. Kimura for making this experience so meaningful and successful.



Chapter 1 Introduction

1-1 Forward
1-2 Primary Premise
1-3 Background
1-4 Madison Model Presentation
1-5 Reactions
1-6 Contextual References
1-7 Itinerary
1-8 General Impressions

Chapter 2 Presant State of Mental Health System in Japan

2-1 Hospitalization
2-2 Expenditures
2-3 Composition of the People Hospitalized
2-4 Length of Hospital Stays
2-5 Psychosocial rehabilitation
2-6 Decreasing Hospital Utilization

Chapter 3 Approaches in Local Community

3-1 Community Practice
3-2 Housing
3-3 Exemplary Practices
3-4 Community-Oriented Psychiatry
3-5 Future Perspective

Chapter 4 Recommendations & Strategies

4-1 Impressions of Consumers
4-2 Interdisciplinary Teaming
4-3 Challenges
4-4 Recommendations
4-5 Guiding Principles of Community-Based Treatment
4-6 Hospital Reduction & Cost Strategies
4-7 Hospital Diversion/Reductions - Front-End (Decision Making Pertaining to Hospitalization)
4-8 Hospital Diversion: Back End (For those already in-patient)
4-9 Reasons for Hospital Discharge
4-10 Hospital General Discharge Strategy
4-11 Hospital Related Use - Dementia Related
4-12 Obihiro Pilot Project - A Model Community Centered System of Care

Chapter 5 Conclusion

5-1 Conclusion