-To be able to call my town a place where I feel secure and where I can choose how I live

Kazuhide Kezuka
Coordinator for Support for Transition to Community Life in Tokyo
Platz - Community Life Support Center
Harakara-no-Ie Fukushi-kai (Social Welfare Corporation)

1. Introduction

I think that those who come into contact with persons with mental disorders are familiar with the system called the “Comprehensive Community-based Care System that Also Deal with Mental Disorders” (hereinafter referred as the “Comprehensive Care System”).  These words can be found in the revised Basic Guidelines of the 6th Plan for the Welfare of Persons with Disabilities and this year’s subsidy revision. Although no subsidy is granted to the establishment of the Comprehensive Care System itself, the Guidelines encourage further promotion of the system.

Hereunder, I would like to briefly explain what the “Comprehensive Care System” means, and discuss the points stated in the 6th Plan for the Welfare of Persons with Disabilities as well as the revision of the subsidies.

2. Background and Outline of the Comprehensive Care System

First of all, I would like to note that the Comprehensive Care System is NOT a community-based care system ONLY for persons with mental disorders.  Thus, it should NOT be mistaken as the system that deals with persons with mental disorders; rather, it is a “care system inclusive of dealing with mental disorders” so that anyone, as a member of the community, can hope to live life according to their choices, whether they are with or without disabilities, and regardless of the degree of their disabilities.

Next, I would like to explain why the word ‘mental disorders’ is there. Japan’s policy for community mental health and medical welfare has been centered on in-patient treatment, and many people are still forced to stay in the hospitals for a long time due to illness or disabilities.  To improve this situation, the concept of “from hospital treatment to community life” was clearly covered in the “Mental Health and Medical Welfare Reform Vision” formulated in September 2004.

Moreover, in February 2017 the report by the “Study Group on the Future of Mental Health and Medical Welfare” stated that it is necessary to establish a Care System that Includes Mental Disorders which comprehensively ensures medical care, disability welfare / long-term care, housing, social participation (employment), community support, and education (currently referred to as “public awareness-raising”) so that everyone can feel secure and live by their choices as a member of the community, regardless of the presence or absence of mental disorders and the degree of their disabilities, that the system should be made    respecting the uniqueness of each community, and that the method of creating the system should be decided by each community.

The Ministry of Health, Labour and Welfare holds a study meeting every year to promote the Comprehensive Care System.  The 2020 report discusses the contents included in the 6th Plan for Welfare of Persons with Disabilities and the revision of the subsidies.

In the field of mental disorders, in order to eliminate each community’s age-old practices of unnecessary long-term hospitalization, it is a good trend to officially discuss this question: “What kind of mechanism or system can we create in our community to resolve this problem?” At the same time, we also need a mechanism to prevent the conference body from merely becoming a formality.

3. Contents of the “Comprehensive Care System” that are in the 6th Plan for the Welfare of Persons with Disabilities and the Subsidy Revisions

Let me move on to the Basic Guidelines for the 6th Plan for the Welfare of Persons with Disabilities to discuss eliminating long-term hospitalizations and the strengthening of the support system within the community.

One of the goals to be reached by the end of fiscal 2023 (the end of this Plan) is to “increase the average to at least 316 days that one can live in the community after being discharged from the hospital.”  This goal was set based on the nationwide average number of days in a year spent in the community after discharge from a hospital.

It is good that this number clearly indicates the hope of a prolonged life in the community as it triggers the question, “How can we reach this target in our community life?”. On the other hand, there is a concern that this target could lead to laxity once the targeted figure is reached.”  In this regard, I thought a slightly higher number might have been better.

Regarding the revision of the subsidies of 2021, as I wrote at the beginning, it does not mean that subsidies will be granted once the “Comprehensive Care System” is implemented.  However, because welfare services are accompanied by subsidies, it shows that subsidies are still closely linked to the system.

It is important to note that there are such things as the “promotion of cooperation between the housing support corporation / housing support council, the welfare services of the government” and the “evaluation of peer support expertise.”

When considering the “Comprehensive Care System”, what is important is the sense of having a home, which means having a house to live in.  Securing a house and receiving housing support provides life in a familiar community.  More than that, a home is a place where one can have a sense of belonging, a place for one’s social and economic activities, and for living life in general.  I think that this revision of further promoting the securing of a house and providing housing support will lead to an awareness of the goal to provide everyone a place to belong and play one’s role in life.

Next, peer support provides various activities and roles, such as interactions with peers and engaging in projects related to public awareness-raising, and visiting long-term in-patients.  It is expected that giving high importance to peer support will cause opportunities for its use to arise.  Moreover, by collaborating with various professionals in different occupations related to mental health and medical welfare, we can expect understanding to broaden among professionals concerning persons with mental disorders, the increased awareness, and the improved quality of support for public awareness and education, mental health consultation, and decision-making, etc.  To develop such an environment, it is necessary for municipalities to promote participation in discussions with persons with mental disorders.  At the same time, it is necessary to work on the provision of opportunities and training to peer supporters by first gathering the data of the current status and issues of peer support activities in cooperation with prefectures.

4. In Conclusion

Basically, there should not be a need to specifically mention “the system that includes mental disorders.”  Rather, I think it is necessary to build a comprehensive community care system that, as a matter of course, should be “inclusive of those with mental disorders”.  In other words, it should be a care system which provides a community where “life for everyone is comfortable.”  For that, it is important to take “a person’s problem as the town’s problem” and to expand this as a concept for a comprehensive community care system starting from sharing the worries of one resident.  Similarly, one thing we must not forget is that “the one who is hospitalized is also a resident of our community.”

Lastly, I would like to end this article by quoting some words of some respectable seniors of mine.

Each person, with or without disabilities, is unique in this world.  It would be unbearable for me to be lumped together and treated as “mentally ill” or “mentally disabled” from the moment I become unwantedly ill or disabled.  I am sure there are many who would agree with me.

What is your town like? Do people with disabilities walk the streets with a smile? Why don’t you try to make your town like that, by building this “Comprehensive community-based care system that also deal with mental disorders”?

[Reference]

1)Ministry of Health, Labour and Welfare,
Information portal for Comprehensive Community-based Care System that can Also Deal with Mental Disorders
https://www.mhlw-houkatsucare-ikou.jp/index.html(Japanese only)

2)2nd Advisor / Prefectural Joint Meeting of FY2020
Reference Material 1 “Study Group on Making of Comprehensive Community-based Care System that can Also Deal with Mental Disorders”
Report – “To be able to call my town a place where I feel secure and where I can choose how I live”
https://www.mhlw-houkatsucare-ikou.jp/data/sysm030319ref1.pdf (Japanese only)

3)FY2020 1st Study Group on the Establishment of the Comprehensive Community-based Care System that can Also Deal with Mental Disorders
Reference Material: Current Status of Mental Health and Medical Welfare
https://www.mhlw.go.jp/content/12200000/000607971.pdf (Japanese only)