By Kiri Falls / Japan News Staff WriterAbout 50 percent of callers to an English-language telephone counseling service that serves the international community in Japan are Japanese nationals, the director of the service said in a recent interview with The Japan News, a reflection of the need for further improvement in mental health services across the country.
There are Japanese people “who are just desperate to speak to anyone” said Vickie Skorji, the director of the long-established TELL Lifeline. Some Japanese citizens who live overseas for a period of time come back and “really struggle with cultural readjustment,” she said.
The lifeline currently receives a total of about 700 calls a month from people including Japanese citizens.
Certain Japanese also appear to feel “it’s more acceptable to talk about these struggles or failures in a foreign language,” Skorji added.
Turning point in 2003
When nonprofit organization TELL launched its lifeline in Tokyo in 1973, its mandate was to support the foreign community in Japan. But around 2003, following the Asian financial crisis, the number of Japanese callers spiked — and it hasn’t dropped back since, according to the director.
Behind the increase in Japanese callers, Skorji sees a lack of access to services around the nation. “If you go and see a psychiatrist in Japan, because they’re so inundated with the number of people, they’re not really able to do therapy with you, so it’s treated very much on a medication basis,” she said. “While the medication is really important, patients are not really learning coping strategies or understanding how to get better.”
The director also noted that the various lifelines in Japan are not linked together to provide nationwide coverage — most centers have separate phone numbers as a result of funding being handed out at the prefectural level.
In addition, many cannot operate 24 hours a day, meaning there are periods of time when they are unavailable to callers.
TELL is only able to operate its lifeline from 9 a.m. until 11 p.m., with “chat” available until 2 a.m. on Fridays, Saturdays and Sundays, due to the constant challenge of getting enough funding.
“Our goal is to have a 24/7 lifeline and chat service,” Skorji said.
The organization’s activities have three arms: crisis intervention on the phone; ongoing support through its counseling center; and raising awareness about mental health in the community through outreach programs.
In addition to the Tokyo phone room, TELL now has a satellite phone room in Osaka, runs counseling sessions in Yokohama and has just opened a clinic in Okinawa.
“Our goal is to be Japan-wide,” Skorji said. “We really want all of the country to know, if you’re in trouble or you’re struggling, we’re here, at any stage.”
Community-based care essential
Japan’s suicide rate has dropped steadily in recent years, from 18.8 per 100,000 people in 2000 to 14.3 in 2016, according to World Health Organization data.
But it remains relatively high for a developed country, ranked sixth-highest among 41 countries by the Organization for Economic Cooperation and Development.
Recent changes in government policy are offering hope that the rate will drop further. Skorji hopes the introduction of a national licensing system for psychologists in 2015 — for which the first examination was held in September this year — will go some way toward improving quality of care.
Yuko Kawanishi, a psychological counselor at Wisconsin-based Lakeland University’s campus in Tokyo, told The Japan News that while the system is still in its early days, having a single standard for entry into the field of psychology brings Japan closer to accepted international practice.
The government has also shifted its focus from hospital-based care to community-based care in recent years, Tsuyoshi Akiyama, general director of neuropsychiatry and psychosomatic medicine at NTT Medical Center Tokyo, told The Japan News.
According to Akiyama, the high number of psychiatric deaths in Japan began to decrease as the government classified mental illness as one of five major diseases in fiscal 2013 and issued a plan making clear the need for community care.
He also noted that the recent amendment to the law for the promotion of employment of persons with disabilities may bring about change, as it stipulates that workers with mental illnesses must be included in hiring quotas for people with disabilities.
“People talking about mental illness does not necessarily improve stigma among the population,” Akiyama said. “It is direct social contact — such as working alongside a colleague with a mental illness and thus understanding that people suffering from mental illness are normal — that has been proved to reduce stigma most effectively.”