Abstract
Japan has experienced a dramatic increase in psychiatric beds from a level of 32.4 per 100,000population in 1953 to 254.1 in 1977. The number of inpatients has always paralleled this increase as the bed occupancy rate has remained above 100% during these years. The age specific resident patient rates of psychiatric patients were initially higher for the younger age groups but have gradually shifted to the middle age groups. Geriatric psychiatric patients over 65 years of age have had low rates and constitute only about 8.5% of the total at present. The increase in psychiatric beds has resulted in large part from the establishment of private hospitals each having about 200 beds. While the number of personnel per bed in psychiatric hospitals has slightly increased, the basic composition has remained the same for 20 years. The proportion of medical care cost devoted to psychiatric care has been estimated to have grown from 5.8% of the total in 1963 to 7.2% in 1976. However, the burden of inpatient psychiatric care has been obscured by the general increase in medical care costs. A futher increase in psychiatric beds would become necessary if the psychiatric sector is to play a major role in geriatric care.
| Original language | English |
|---|---|
| Pages (from-to) | 561-570 |
| Number of pages | 10 |
| Journal | Social Science and Medicine. Part A Medical Psychology and Medical |
| Volume | 14 |
| Issue number | 6 |
| DOIs | |
| Publication status | Published - 1980 Dec |
ASJC Scopus subject areas
- Medicine(all)
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In: Social Science and Medicine. Part A Medical Psychology and Medical, Vol. 14, No. 6, 12.1980, p. 561-570.
Research output: Contribution to journal › Article › peer-review
}
TY - JOUR
T1 - Growth of psychiatric beds in Japan
AU - Ikegami, Naoki
N1 - Funding Information: The Second World War played havoc with all medical facilities and the total number of psychiatric beds was said to be down to 4000 in 1945 1,15\]. Many hospitalized psychiatric patients had died of the inadequate food supply which was especially acute for the psychiatric patient who usually did not have relatives willing to supplement their diet. The post-war years showed a more enlightened attitude which was influenced by the liberation policies of the occupying forces. Responsibility for the mentally ill passed from the police to the public health department in 1947. The Mental Health Act of 1950 was the first comprehensive mental health legislation in Japan. However, although this defined mental health in the broad context with provisions for consultations and preventive measures, in practice the sections concerning procedure for commitment and their public fund support were of greater importance. This measure, together with the section abolishing private confinement, created a great demand for psychiatric beds. The need for an increase in psychiatric beds was repeatedly stressed in annual White Papers on Health and Welfare until 1966, after which it changed to a statement calling for the development of special psychiatric beds for geriatric, pediatric and alcoholic patients 1,-16-1. The policy of increasing the number of psychiatric beds had its clearest expression in the provision of administrative guidelines expressed as "'required number of psychiatric beds" made in 1964 1,17\]. This was partially based on the number of beds available in the Western advanced nations, but the main argument came from the epidemiological surveys of psychiatric disease undertaken by the Ministry of Health and Welfare. The first survey was made in 1954 and was designed to collect psychiatric data necessary to the formulation of a national mental health programme. From a census investigation of every household in a hundred areas randomly selected, 1.5~o of the population were found to have serious psychiatric disease. (Psychiatric diseases included the following: schizophrenia, epilepsy, organic brain disease, toxic psychosis (including alcoho-lisml, mental retardation and neurosis. Although this figure may seem very low, two factors have to be taken into consideration. Firstly, Japanese psychiatrists followed the German school in having very strict diagnostic criteria; and secondly the diagnosis was only given if the person was "seriously" incapacitated.) When this was extended to the general population the number of those with psychiatric disease was estimated at 1.3 million of which 430,000 required hospitalization 118, 19\]. (This was ten times the number actually hospitalized at that time.) A second survey took place in 1963 and though this was more sophisticated, the basic methodology was similar and the results showed an estimated 1.24 million with psychiatric disease of which 350,000 required hospitalization \[18\]. (280.000 in psychiatric hospitals and 70,000 in other facilities.) From these two surveys the required number of psychiatric beds was set in 1964 at 20 per 10,000 population by the year 1970. (This figure was mainly based on the first survey as the results of the second survey came too late for proper consideration.) Of the 430,000 needing hospitaliz- ation, it was thought that 70"0 would actually bc hospitalized in the future and in addition 30';~, would no longer be needing hospitalization due to medical advances. Thus, 417,000 x 0.7 x 0.7 = 205,000 or 20 per 10,000 was derived. (417,000 is the age adjusted number for 1970.) The prefecture was designated as the area in which the required number of psychiatric beds was to be calculated as an administrative guideline. (Japan is divided into 47 prefectures which serve as the basic administrative units.I For fiscal considerations, the demand for psychiatric beds was actually met by encouraging the building of private hospitals. If the number of psychiatric beds was below this object, financial support, usually low interest loan from the Medical Care Fund, was extended for the construction of private psychiatric hospitals. This policy was successfully achieved as far as the national figure is concerned. But, quite apart from the ambiguous method of calculation, the prefectural basis of calculation had several weaknesses. In 1964 there were already 6 prefectures which had more than the required number of psychiatric beds per population, and the greatest had triple the number of the least. Subsequent years have shown that although all the prefectures had increased their number, the range between them had also increased in 1975 from 14.7 to 45.7. Moreover, if the discrepancy between the demand and supply was to be felt in the prefectures with the least beds, one would conjecture that these prefectures would have a very high bed occupancy rate. However, it has been shown that the psychiatric bed occupancy rate for each prefecture had no corre-lationship with the number of psychiatric beds \[20\]. Instead the number had a strong correlation with the general supply of medical and social facilities. The number of resident patients appears to have expanded to fulfil the supply of psychiatric beds. The required number of psychiatric beds has since been increased to 25 per 10,000 when the goal was reached in 1970 \[16\]. Taking these factors into consideration, one is not justified in saying that as the goal of the number of phychiatric beds has again been met in 1976, the demand for inpatient psychiatric care has reached saturation point. These arguments may appear to be obsolete in the era of community psychiatry. But although the concept of community psychiatry has been introduced, it could not yet be said to have a significant impact on psychiatric care in Japan. The Mental Health Act underwent revision in 1965, providing for the construction of Mental Health Centres in each prefecture. Health Centres became the primary organs for the administration of mental health services with the functions of early detection and after-care. These centres, though similar in name to their American counterparts, were entirely different in concept as no direct service to the community was stated and their main function was to give technical assistance to the Health Centres and to conduct research surveys. Moreover the Centres were primary administrative bodies for public health and they had no trained personnel in psychiatric care. Even if the original intent were to create a new system of psychiatric care, the infrastructure was too weak and the financial support remained too inadequate. Copyright: Copyright 2015 Elsevier B.V., All rights reserved.
PY - 1980/12
Y1 - 1980/12
N2 - Japan has experienced a dramatic increase in psychiatric beds from a level of 32.4 per 100,000population in 1953 to 254.1 in 1977. The number of inpatients has always paralleled this increase as the bed occupancy rate has remained above 100% during these years. The age specific resident patient rates of psychiatric patients were initially higher for the younger age groups but have gradually shifted to the middle age groups. Geriatric psychiatric patients over 65 years of age have had low rates and constitute only about 8.5% of the total at present. The increase in psychiatric beds has resulted in large part from the establishment of private hospitals each having about 200 beds. While the number of personnel per bed in psychiatric hospitals has slightly increased, the basic composition has remained the same for 20 years. The proportion of medical care cost devoted to psychiatric care has been estimated to have grown from 5.8% of the total in 1963 to 7.2% in 1976. However, the burden of inpatient psychiatric care has been obscured by the general increase in medical care costs. A futher increase in psychiatric beds would become necessary if the psychiatric sector is to play a major role in geriatric care.
AB - Japan has experienced a dramatic increase in psychiatric beds from a level of 32.4 per 100,000population in 1953 to 254.1 in 1977. The number of inpatients has always paralleled this increase as the bed occupancy rate has remained above 100% during these years. The age specific resident patient rates of psychiatric patients were initially higher for the younger age groups but have gradually shifted to the middle age groups. Geriatric psychiatric patients over 65 years of age have had low rates and constitute only about 8.5% of the total at present. The increase in psychiatric beds has resulted in large part from the establishment of private hospitals each having about 200 beds. While the number of personnel per bed in psychiatric hospitals has slightly increased, the basic composition has remained the same for 20 years. The proportion of medical care cost devoted to psychiatric care has been estimated to have grown from 5.8% of the total in 1963 to 7.2% in 1976. However, the burden of inpatient psychiatric care has been obscured by the general increase in medical care costs. A futher increase in psychiatric beds would become necessary if the psychiatric sector is to play a major role in geriatric care.
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UR - http://www.scopus.com/inward/citedby.url?scp=0019122234&partnerID=8YFLogxK
U2 - 10.1016/S0271-7123(80)80063-0
DO - 10.1016/S0271-7123(80)80063-0
M3 - Article
C2 - 7209630
AN - SCOPUS:0019122234
SN - 0160-7979
VL - 14
SP - 561
EP - 570
JO - Social Science and Medicine. Medical Psychology and Medical Sociology
JF - Social Science and Medicine. Medical Psychology and Medical Sociology
IS - 6
ER -