During the Edo period in Japan (1603–1867), people with mental illness were not excluded from society. Upon the introduction of European psychiatry around the 1870s, Japanese society became more discriminatory, however. In 1900 a primary law was introduced to regulate the custody of patients. In 1919 another law was approved to facilitate the establishment of public psychiatric hospitals. In 1950 the Mental Hygiene Law was enacted to prohibit home custody. However, these regulations did not assure quality of care or protect service users’ rights. Also, after the Second World War, many private psychiatric hospitals were built, but this expansion of the sector was not well thought out or well coordinated. In Japan, the government regulates the private health sector only insofar as it sets standardised fees for treatments and carries out basic quality assurance.
In 1984 a scandal involving the murder of in-patients by nursing staff was reported at a psychiatric hospital. This prompted huge international pressure and the Japanese government passed the Mental Health Law in 1988. In 1995 this law was further revised to include welfare support.
Japan operates a unique medical system in which payment for treatment is met via nationally standardised insurance; service users enjoy free access to the treatment facility of their choice. This financial assurance has sustained high accessibility to care, especially for those who fall under the Services and Supports for Persons with Disabilities Act. In consequence, numerous psychiatric clinics have emerged and in-patient treatment, including an emergency service, is available throughout the country. There are also many mental health and welfare centres, as well as rehabilitative facilities (including day treatment centres, work factories, group homes and community centres). With some variations these services are standardised and available throughout the country.
There has been a steady shift from in-patient to out-patient treatment in psychiatry in Japan. According to the World Health Organization (2005) there are 28.4 psychiatric beds per 10 000 population in Japan. There remains a huge population of elderly patients who have been in hospital for many years, but for newly admitted in-patients the average length of stay is around 2–3 months.