Kazuhide Kezuka, Manager, Community Living Support Section,
Platz Community Living Support Centre, Harakara no Ie Welfare Group Social Welfare Corporation

1. Introduction

Harakara no Ie Welfare Group runs Platz Community Living Support Centre (a community living support centre; hereinafter, “Platz”), Satsuki Community Workshop (a multifunctional workshop), four group homes, and a network promotion project (medical care partnership) with the aim of providing comprehensive support for people with psychological disorders living in local communities. Among these services, Platz carries out advice and consultation, care management for disabled people, and the provision of spaces for them, based on the three concepts “Everyone can participate in society”, “People can live a motivated life just as they are”, and “There is someone at Platz”. It is also distinguished by the way that it implements all-round support for life in the community, always bearing in mind support with transition back into the community (encouraging people to leave hospital).

In addition, between 2006 and 2022, we were entrusted by Tokyo Metropolitan Government with the Community Transition Promotion Project for the Mentally Disabled, and carried out activities related to transition back into the community in Tokyo. This project aimed to enable people who had been in psychiatric hospitals for a long period to plan smooth transitions back into their local communities, and to put systems in place to allow them to lead stable lives there. Ever since our centre took on this project, we have made it our philosophy to “carry out our activities encouraging people to leave hospital together with those with lived experience”, conducing peer support activities. Even now that we are no longer entrusted with this project by the local government, we are continuing it as an independent project key to our organisation’s work.

2. The background to starting peer support activities

In the course of carrying out support for transition back into the community, we often felt that information clearly came across very differently to patients when a peer supporter was talking with them compared to when a support worker or professional was talking, even if they were talking about the same thing. I do not know whether the expression “the gleam in their eyes was different” is correct, but in any case, the disparity was plain to see. We thought that if this were the case, one of our roles was to create many occasions for patients and peer supporters to meet with one another, so we incorporated peer support activities into the practice of community transition, creating opportunities to work together. In actual fact, the peer supporters, as people living in their local communities, had a great impact not only on patients but also on hospital staff. In order for patients to consider transitioning into their communities, there needs to be a push from within the hospitals, at the same time as the creation of structures in the communities. Even some hospitals where it had been very hard for community transition to make progress saw the peer supporters, as well as the changes in their patients as they interacted with the peer supporters, and gradually became more open.

The reason why we wanted to work together with peer supporters to encourage people to leave hospital and transition back into their communities, then, was because we understood support based on empathy with patients to be a situation in which peer support (support provided by people with lived experience) could show its full power.

3. The role and effectiveness of peer supporters

In the light of this background, and aiming to create such situations, we gave peer supporters the title of Life Partners with the intention of putting greater emphasis on the way in which they act as “companions in people’s daily lives”. They began activities to transmit necessary information about everyday living, based on the fundamental stance of going from the local community to meet them at the hospital in their role as “people who had already trodden the same path”. They instructed patients get prepared while they were still in hospital, continued to send them the message that they were waiting for them to come out of hospital, and shone a light of hope and expectation into the hearts of people who were confused and anxious about leaving hospital, providing safety and security, and truly taking on the work of being “human supporters”.

All the Life Partners have experience of being patients in psychiatric hospitals, and are now living in their local communities. They have a wide range of experiences of the process of becoming ill and going into hospital, episodes from while they were in hospital, the moves to leave hospital, and the changes in their lives after leaving. They tell patients about their own experiences during the programmes run within the hospitals in preparation for leaving. They listen to patients’ stories based on a deep empathy born of being in the same position, and are able to show compassion for their feelings. They talk about their activities as peer supporters during training sessions and lectures, broadening their effectiveness. These are their main roles. In the past, they also accompanied patients on outings outside the hospital and in trial use of daytime activities.

Through these activities, I have had the opportunity to meet with many patients who have changed, whether by deciding to leave hospital after hearing Life Partners talk about their experiences, hearing real stories about daily life directly from Life Partners while going outside the hospital together and becoming able to go outside in this way, or being able to open up about their feelings with Life Partners, although they had been unable to do so with hospital staff, and gradually becoming able to talk about their hopes to leave hospital.

4. The current situation and issues

I think that there are various moves to encourage people to leave hospital and transition back into their communities together with peer supporters at places other than our centre. The number of psychiatric hospitals willing to hold peer support activities within the hospital was growing, albeit gradually. Just as this trend became apparent, COVID-19 came along and fewer psychiatric hospitals accepted peer support activities as a result. As medical institutions which need to take precautions against infection, this is continuing even now. The number of venues in which peer supporters can carry out their activities has decreased, and this is causing an ongoing headache for us.

However, ICT use also became more prevalent during the COVID pandemic, and there are some hospitals which are prepared to consider running new, online programmes with us within their hospitals (Photo 1*).
* Photo 1 is not posted on the website due to copyright issues.

While community transitions in partnership with peer supporters move ahead in each community, many people are still left with no option other than a long hospital stay, even though we are seeing a fall in the average length of psychiatric hospital stays. In order to break free from this status quo, carrying out activities such as ours inside each psychiatric hospital ought to be useful; nevertheless, the reality is that many hospitals are still not incorporating peer support activities, for reasons unrelated to the impact of COVID-19. In addition, many hospitals currently have a negative attitude towards using ICT to hold online programmes from the standpoint of data protection. For these reasons, we believe that it is important to share current best practice at hospitals with many other hospitals, telling them about the need to carry out peer support activities, even online, and the fact that holding these activities furthers transition back into the community.

5. Conclusion

Peer supporters are essential in bringing about an inclusive society. However, this way of thinking has unfortunately not yet completely filtered down through the field of mental health and welfare in Japan. Although recommendations have been received from the United Nations on the rights of disabled people, reports of terrible incidents at psychiatric hospitals continue. To escape from this situation, we need to encourage the transition back into the community of people who are being forced to stay in psychiatric hospitals unnecessarily. My experiences thus far have convinced me that it is peer supporters who enhance these efforts. Local communities in which it is easy for people with psychiatric disorders to live are surely pleasant living environments for everyone. I would strongly encourage you to introduce peer support activities in psychiatric hospitals and support centres in order to create these communities in which it is pleasant to live

We intend to continue our journey with peer supporters in order to allow as many people as possible to take up their lives in their local communities once more.　

Edited and published by the Japanese Society for Rehabilitation of Persons with Disabilities.

Published on April 25th, 2023.