Fuki Sato
Kyosaren (1

COVID-19 infections spread around the world from the beginning of 2020. We wondered how best to continue with our longstanding international activities, which involved travelling outside Japan for exchanges, and were forced to temporarily halt them. Our attempts to carry out international exchanges using Zoom (which is no longer anything unusual) through a process of trial and error began at this time. In FY 2020, we went ahead with exchanges with the Asian countries of Hong Kong and Thailand, with which there is a smaller time difference, and in FY 2021, with Germany and Belgium. I will introduce our exchange with Belgium here.

It is said that 20% of the world’s psychiatric beds are in Japan, and 20% of Japan’s hospital beds are on psychiatric wards. The human rights violation of “social hospitalization”, in which patients have to remain in hospital because there are no places or systems to support them in living in the local community, even though they do not require medical treatment, is still ongoing in Japan. The “exception for psychiatric departments”, which allows 1/3 of the number of doctors required on regular wards and 2/3 of the number of nurses, also remains a reality.

We wanted to learn how a system to reduce the number of beds and enable people with mental disorders to live in the community was established in Belgium where, like Japan, 85% of psychiatric hospitals were in the private sector, and so we set up an organizing committee together with Kyosaren’s Mental Disorder Group and made plans.

In November 2019, before the start of COVID, we invited Bernard Jacob from the Belgian Ministry of Health (Mental Health Care Reform Project Manager/ International Coordinator). We were very surprised as we listened to his talk, entitled “Co-created Mental Health Care Reform: Why Did Belgium Change, and Why Isn’t Japan Changing?”, where he spoke about the government-led reform to reduce psychiatric beds and move ahead with transition into the community.

However, questions still remained about how the lives of people with disabilities and their families had actually changed as the result of this reform, or indeed, whether they had changed at all. In order to learn more about these issues, we planned two online forums in FY 2022. We invited people with disabilities from Belgium and Japan to the first, and the families of people with disabilities from both countries to the second.

When it came to holding the events, we made full use of Zoom, such as holding two preliminary meetings before each forum. The report will be completed at the end of July [2022].

We were able to hear various eye-opening things, such as that the mental health care reforms in Belgium were led by the government, that psychiatric hospitals are so pleasant that people hesitate to leave them, that psychiatric beds were reduced and mobile teams play the core role in supporting people with mental disorders in the community, that peer workers are active both in communities and in hospitals, and that meetings in which none of those directly affected take part reflect badly on the trustworthiness of the organisations concerned. Many of the responses to the questionnaire expressed a renewed intention to work hard for reforms to Japan’s mental health care without giving up.

We experienced many discoveries and joys despite the large number of restrictions impose by the COVID-19 pandemic, such as being able to experience heart-to-heart exchanges with people sharing the same vision even online, and being able to prepare thoroughly in preliminary meetings even at a distance. We intend to continue doing whatever we can in Japan, looking forward to the day when COVID infections end and we can meet in person.

Leaflet about the “Co-created Mental Health Care Reforms: Learning from Belgium’s Processto Take Back Our Own Lives” online forums

Cover of the report on the online forums

(1 Translator’s note: Kyosaren is a network made up of around 1,840 service providers for people with disabilities.