Recent Developments in Community-Based Mental Health Care in Japan: A Narrative Review.

Background: Since the 1950s, mental health care in Japan has been hospital-centered. A set of legislative initiatives were undertaken in 1995, emphasizing the importance of community-based mental health care. However, despite these attempts to develop a community-based mental health care system, the rate of inpatient-based treatment has remained high and the shift from hospital-centered care to community-based has still not fully materialized.

Development and Validation of a Japanese Fidelity Scale for Supported Employment.

The Individual Placement and Support (IPS) model of supported employment is an evidence based practice. Although several agencies have been trying to implement the IPS-model since 2005 in Japan, there was no tool to assess the quality. This study developed a Japanese version of the 25-item Individualized Supported Employment Fidelity Scale (J-ISEF), a new Japanese fidelity tool for supported employment based on the IPS model.

Efficacy of a Peer-Led, Recovery-Oriented Shared Decision-Making System: A Pilot Randomized Controlled Trial.

Objective: The effects of a comprehensive shared decision-making system based on the CommonGround approach and incorporating peer support and a computerized decision aid were investigated.

Methods: A pilot randomized controlled trial with six-month follow-up was conducted in Japan. Fifty-six outpatients with mental illness were randomly allocated to a shared decision-making system (intervention) group or treatment as usual (control) group.

Does improvement of cognitive functioning by cognitive remediation therapy effect work outcomes in severe mental illness? A secondary analysis of a randomized controlled trial.

Aim: The aim of this study was to clarify whether improvement of cognitive functioning by cognitive remediation therapy can improve work outcome in schizophrenia and other severe mental illnesses when combined with supported employment.

Methods: The subjects of this study were persons with severe mental illness diagnosed with schizophrenia, major depression, or bipolar disorder (ICD-10) and cognitive dysfunction who participated in both cognitive remediation using the Thinking Skills for Work program and a supported employment program in a multisite, randomized controlled study. Logistic and multiple linear regression analyses were performed to clarify the influence of cognitive functioning on vocational outcomes, adjusting for demographic and clinical variables.

Association between stigmatisation and experiences of evidence-based practice by psychiatric rehabilitation staff in Japan: a cross-sectional survey.

Background: Mental health professionals are one of the groups holding harmful stigmatisation towards people with mental illness.

Aims: To investigate the association between the performance of evidence-based practice (EBP) and the staff's level of stigmatisation in Japan.

Methods: The study enrolled 179 staff members in psychiatric day-care, psychiatric community outreach teams, and psychiatric rehabilitation teams at 14 psychiatric hospitals.

Community outreach for patients who have difficulties in maintaining contact with mental health services: longitudinal retrospective study of the Japanese outreach model project.

Background: Japan still has the highest ratio of beds devoted to psychiatric patients in the world. In 2011, in order to reduce re-hospitalization of patients who became disconnected from regular contact with outpatient medical services, the Japanese Ministry established the Japanese Outreach Model Project (JOMP). In this study, we will explicate the JOMP project protocol and investigate the rate and length of hospital admission, impairments of social function and problematic behavior at the follow-up period (6- and 12-month) and time of services provided by JOMP.

[The therapeutic structure and clinical staff skills that is needed for establishing the community-based treatment of the people with schizophrenia: the short report of recent reform process of "day care" and outreach team in National Center of Neurology and Psychiatry].

As aging and disease structure has changed mainly in accordance with adult disease, general medical treatment has been expected to take a role as a part of the"Comprehensive Care" that contributes to improve the quality of life. The similar paradigm change is needed for the treatment for the people with severe mental illness. The goal of this change is to realize the dissemination of prevention, early intervention, and comprehensive treatment in the community for the people with severe mental illness.

[Survey of actual condition of outreach activity of multi-disciplinary team in Japan].

In Japan, some agencies have begun to provide a multi-disciplinary outreach team for people with severe mental illnesses. A medical fee system specially designed for the outreach team has not been developed, so existing fees cannot cover all activities of the team. This undeveloped legal system for the outreach team and inadequate finances are the main obstacles to dissemination in Japan.

A randomized controlled trial of individual placement and support in Japan.

Objective: The individual placement and support (IPS) model of supported employment has been implemented throughout North America and Europe, with multiple randomized controlled trials documenting its effectiveness, but it has not been widely implemented in Asia. To date, no rigorous evaluations of IPS have been conducted in Japan. We sought to evaluate whether IPS could be implemented in Japan and produce superior competitive employment outcomes compared with conventional vocational services.

Preliminary outcome study on assertive community treatment in Japan.

Aims: The beneficial effects of assertive community treatment (ACT), which has been widely acclaimed as being successful in several foreign countries, must also be objectively evaluated with respect to the transition from inpatient to community-based mental health treatment in Japan. This was the first study that examined effects of the ACT program in Japan using pre/post design data of the pilot trial of the ACT program in Japan project.

Methods: The study included 41 subjects hospitalized at Kohnodai Hospital, National Center of Neurology and Psychiatry between May 2003 and April 2004 for severe mental illness and who met inclusion criteria for entry regarding age, diagnosis, residence, utilization of mental health services, social adjustment, and ability to function in daily activities.

[What kinds of skills are needed to develop the outreach services in the context of community-based mental health?].

Outreach services in the context of a policy, "from hospital based to community based", are intended to know more about community living situation of patients, and provide supports so that they can bring their life back as citizens. Therefore, these outreach services are completely different from traditional monitoring based outreach services. These supports require skills which are different from those in psychiatric hospitals.

Family support in assertive community treatment: an analysis of client outcomes.

Assertive Community Treatment (ACT) is an outreach-based case management model that assists people with severe mental illness through an intensive and integrated approach. In this program, a multidisciplinary team provides medical and psychosocial services. The purpose of this study was to examine the effectiveness of the following two ACT intervention strategies: "replacement" (supporting the clients) versus "backup" (supporting family members who provide care to clients).

Changes in antipsychotic medication in clients of assertive community treatment in Japan: a one-year follow up.

The purpose of the present one-year follow-up study was to describe and investigate the change in the amount of antipsychotic drugs prescribed for ACT (assertive community treatment) clients in Japan. Subjects were 52 clients of ACT from January 2009 to December 2009. Prescription data were collected each month from the time the clients entered into ACT.

Family needs and related factors in caring for a family member with mental illness: adopting assertive community treatment in Japan where family caregivers play a large role in community care.

Aim: In Japan the family plays a large role in community care for persons with mental illness; therefore the aim of the present study was to describe the needs of family caregivers related to assertive community treatment (ACT) and to analyze the relationship of these needs to underlying factors.

Methods: Participants were recruited from the membership of three family associations of persons with mental illness. Of the 224 family members, 152 (67.

Development of the Nurse Attitude Scale short form: factor analysis in a large sample of Japanese psychiatric clinical staff.

The Nurse Attitude Scale (NAS) measures nurses' Expressed Emotion. A short form of the NAS was developed and its reliability and validity examined. After performing factor analysis using 1252 samples, three factors were extracted.

The quality of life among persons with severe mental illness enrolled in an assertive community treatment program in Japan: 1-year follow-up and analyses.

Background: Toward effective community care for persons with severe mental illness and deinstitutionalization in Japan, we assessed the impact of the first trial of an assertive community treatment program on the lives and subjective perceptions of persons with mental illness without closing hospitals.

Methods: Forty-three subjects were enrolled from the newly admitted patients of a hospital, who met our criteria of problematic hospital use, severity of psychiatric disorders, and behavioral problems. The intervention team aimed to intensively support them in various life domains in their communities to decrease clients' admissions.