Mental Health Support in Japan
Sometimes we all need some support. While there may be friends, family members or coworkers we can turn to to talk things through, sometimes we might be nervous about being open or vulnerable or we might be concerned about being a burden. The people in our lives might also worry they are not best equipped to provide the support we need or they may simply not have the capacity to be there for us when we need them. Other times, it’s possible there are just not people around us that we feel comfortable with or close enough to to work through our feelings and experiences.
So while the people already in our lives can be really supportive, there are other options out there that we can also tap into. Some of these options may be limited by logistics – chances are there will be more options available in an urban environment than in the middle of the countryside, but the wider availability of distance services make location less of a concern these days. We also may be limited by language needs, what we can afford, which services are covered within insurance and which are paid out of pocket etc. We also all have personal preferences and previous experiences which shape our choices and comfort. We may really want therapy but be unable to find a therapist that matches all of the checkboxes we desire. We may find different things are a different fit for different issues we experience, or at different times in our lives.
Some services we may not have even thought about until we encounter a situation where we need or want to explore what’s on offer. When we are already not in a great place, we are stressed, or even traumatised, having to seek out the possible options available and then wading through to find something that works for us can feel even harder than it would normally. Needing to navigate the system in our non native language can make the barriers even higher.
So, even if you never end up needing any support, knowing what is available through the medical system, in the community, at your school or workplace etc can be beneficial, for us as individuals, but also in knowing what supports are there for the people we care about.
Here is a brief introduction to a non-exhaustive list of mental health supports available in Japan.
Psychiatric Care
If cost is a concern, a more accessible option for mental health support may be to talk to a psychiatrist. Psychiatrists generally work out of hospitals or clinics.
Generally, psychiatric clinics do not offer talk therapy, but focus more on a biomedical approach. Psychiatrists should be able to prescribe medication, if necessary and this is something you want. Generally appointments will focus on checking in briefly with you, asking about any prescribed medications and how they are working for you. The initial intake appointment will typically be longer than subsequent follow ups.
Medication is not something that everyone wants or needs to use. It is also not usually an instant fix. It can take time to find a medication that works for you and also to feel the effect after starting the medication prescribed. Not all medications that are prescribed overseas are licensed for use in Japan, so you may not be able to get exactly the same medications that you have used before.
You can search for a psychiatrist/clinic in an area convenient for you by contacting a medical information service such as Navii (Greater Tokyo area) or the Association of Medical Doctors Asia (AMDA). They may also be able to suggest options where doctors can offer languages other than Japanese, though there is no guarantee there will always be a practitioner available that can offer every language.
Inpatient Psychiatric Care
Inpatient care may arise in a variety of forms.
Voluntary Admission: at the choice of the patient after a doctor at the hospital has deemed it necessary
Admission for Medical Care and Protection: admission without the consent of the patient but as deemed necessary by their doctor and with the consent of the patient’s guardian
Emergency Admission: The patient is admitted for up to 72 hours even without their consent or that of their guardian or person with a duty to support them, if a designated mental health doctor regards emergency admission as necessary.
Involuntary Admission: The patient is admitted on the authority of the governor if two designated mental health doctors ordered by the governor to examine the patient determine that the patient’s admission is necessary as a result of examination because of a risk of self-harm or hurting others.
Emergency Involuntary Admission: The patient is admitted for up to 72 hours on the authority of the governor as a result of examination by a single designated mental health doctor if a hospital cannot complete the official procedures for involuntary admission and speed is required.
In Tokyo, non Japanese patients are generally provided inpatient psychiatric care at Matsuzawa Hospital in Setagaya.
Counselling/Psychotherapy
We might think that psychotherapy is the preserve of the people with “real” problems and maybe that our problems are “not bad enough” to talk to a professional, or that we have our friends, family or partner who are there for us. Firstly, what are “real” problems? We are all dealing with issues in our lives all the time. While the people we are close to can be incredibly supportive and help us work through what we are going through, they are also stakeholders in the relationship and therefore not always willing or able to be 100% honest with their opinions, or maybe they are not always equipped to support us in the way we need.
There can be barriers to being able to see a professional psychotherapist, whether they be financial, related to our location, not being able to find someone that feels like a good fit etc etc but if we are able to access counselling, this space can be a place where the focus can be entirely on us and what we want to discuss without the social niceties of having to share the conversational spotlight and where we are literally paying someone for their time to listen to us and talk to us. This is the therapist’s job. Therefore we don’t have to have the same concerns about whether the therapist feels burned out by talking through the issue with us, and they are not worrying about how being honest with us will affect the ongoing relationship.
There are lots of different therapeutic approaches and some may feel like they are a better fit for us than others. In general, regardless of the therapeutic approach that the therapist is trained in, finding someone that we trust and feel safe and comfortable with is the biggest factor in a successful therapeutic relationship.
Sometimes we might also worry about therapy being a never ending process. While working with a therapist for weeks, months or years may be great for some people, it doesn’t have to work out that way. We are all unique individuals with different responses and feelings about our lives. Sometimes spending a few weeks working on techniques for managing the situation we are in can be super helpful. Other times, we might take time to process things with someone over a series of months and then take a break. We might be able to get the costs covered for 6 sessions and then not be able to fund further sessions out of pocket so have to wait a while before we can continue working on things. We might find that working with one therapist has been great but now we no longer feel that it is helping so much, so after some discussion, we might end up changing therapeutic approach, or even changing therapists as someone else is now a better fit for what we need.
It may also be possible to access counselling support through work via an Employee Assistance Program, or there may be workplace or school counsellors available that you can talk to.
EAPs
Some workplaces may offer an Employee Assistance Program (EAP) to their employees. This allows organisations to provide confidential professional counselling at no cost to their employees (and sometimes to immediate family members of the employee). EAPs are not necessarily limited to workplaces, but may also be available at other organisations, such as universities.
In general, if an organisation provides an EAP, this means that they will cover the cost of a fixed number of counselling sessions within a yearly period. Employees are provided with information as to how to access the service and sign up for sessions. Employers may monitor the number of employees who are accessing the support but should not be informed about specific details concerning who is using the service or the issues they are dealing with.
If after the fixed number of sessions is completed the employee would still like to continue working with the counsellor, there are different options, depending on the individual agreement the organisation has with the provider. Depending on the individual situation, the employer may choose to provide a number of further sessions, or, if this is not possible, the employee may be able to continue sessions paying out of pocket.
Helplines
While a lot of psychotherapists offer sliding scale fees, it may still be out of reach financially or just not be something that we feel ready or able to start yet. Another option to talk things through could be a crisis line or specific helpline. Crisis lines may deal with specific issues or be a generalist service where you can talk about whatever is on your mind. TELL’s lifeline is available toll free by phone and chat and you can talk to the trained volunteer support workers about whatever you are going through. As the service is anonymous, if you contact more than once, it’s unlikely you would speak to the same person each time, and as with paid for psychotherapy, the relationship is not a friendship so the support worker won’t share about themselves and the focus of the conversation will be on you. Additionally, they won’t be able to give you advice about what you should do or even share their opinion about the situation.
So, you might think, what’s the point? Just telling someone else about how tough things aren’t won’t change anything, right? As discussed above, the act of talking about your situation can be beneficial in itself, in addition to potentially giving you new perspective and while the the support worker can’t give you advice or share their own views, they can ask questions, help you work through your options and help you focus on what you want and need to do next. They are also likely to focus on your feelings, helping you name and identify the emotions and maybe also why you are feeling the way you are.
Resources:
Finding Psychiatric Care
Medical Information Services
AMDA (Association of Medical Doctors Asia):
Telephone: 03-6233-9266
Telephone consultation hours: 10:00am – 4:00pm Monday – Friday
Area of coverage: nationwide
Languages available: English; Mandarin; Korean; Spanish; Thai; Portuguese; Tagalog; Vietnamese; Ukrainian; Japanese
Website: https://www.amdamedicalcenter.com/welcome/english
Navii:
Telephone: 03-5285-8181
Telephone consultation hours: 9:00am – 8:00pm daily
Area of coverage: Tokyo
Languages available: English; Mandarin; Korean; Spanish; Thai;
Website: https://www.iryou.teikyouseido.mhlw.go.jp/znk-web/juminkanja/S2300/initialize
Counselling/Psychotherapy
TELL Counselling
Monday – Sunday 8am – 7pm, Online or in person appointments available (In person in Tokyo or Okinawa only)
Counselling services can be provided in English, Japanese, Spanish, Portuguese, Cantonese, Urdu, and Hindi
Counselling fees are determined on a sliding scale basis, so you will be charged on a scale according to your household income.
Japanese national health insurance cannot be used to pay for therapy. TELL Counselling does accept various forms of private health insurance though. Please inquire for specific details or see the website.
International Mental Health Professionals Japan (IMHPJ)
A directory of licensed and accredited mental health professionals working in Japan
Helplines
TELL Lifeline
- Generalist crisis line, you can talk about any subject, whatever you may be going through
- Services are split across phone and chat platforms; availability of each platform varies day to day, you can see the precise schedule each day here
- Available Saturday 9:00am – Monday 11:00 pm continuous service; Tuesday – Friday 9:00am – 11:00pm daily; Friday 9:00am – 2:00am
- Phone: 0800-300-8355 toll free
- Chat: https://telljp.com/lifeline/
- Languages available: English only
- Conversations are with trained volunteers. You can access the service anonymously.
Yorisoi Hotline
- Generalist crisis line, you can talk about any subject, whatever you may be going through
- Services available via telephone helpline; Facebook messenger and chat messaging
- 10:00am – 10:00pm daily
- Phone: 0120-279-338
- Languages available: English、Mandarin Chinese、Korean、Tagalog、Portuguese、Spanish、Thai、Vietnamese, Nepali 、Bahasa Indonesian
- Specific hours for phone and Facebook Messenger service in particular languages, you can check the weekly service hours here
- Wednesdays and Thursdays 3:00pm – 9:00pm specially for female users to access the chat platform – responses will be sent in real time if you consult during these hours
Curetime
- Chat messaging for people wanting to talk about sexual violence
- 17:00 – 21:00 daily
- Open to all ages and genders
- Can chat anonymously
- Languages available: Japanese; English; Tagalog; Thai; Spanish; Mandarin; Korean; Portuguese; Nepali; Vietnamese; Bahasa Indonesian
- Email consultation: Japanese language only
Other Services:
While accessing mental health support can be really helpful, sometimes other issues are the cause of, or are contributing to the stress and mental pressure we are dealing with. Accessing services wokring in specific fields, such as domestic abuse, sexual violence, child protection etc may be really valuable. We may also need to access experts about legal issues, housing, workplace issues etc. There is a lot of information about a variety of services and organisations on the TELL website through wikitell.