Accessing mental healthcare in Japan

While Japan (日本, Nihon/Nippon) has one of the world’s most efficient healthcare systems, it still lags behind in its attitude towards mental health services (WHO Mental Health Atlas, 2020). Barriers to treatment tend to be societal rather than clinical. As such, there’s generally a low counseling take-up despite appropriate services being available.

Learn how to find support for your mental health in the following sections:

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Mental health in Japan

Japan’s mental health statistics paint a complex picture. The country has a low recorded depression prevalence rate of 10% compared to 20 to 30% across Europe and the United States. Moreover, only 6% of the Japanese population has reportedly accessed counseling. Yet the country has the highest suicide rate of any other G7 nation and even has a specific word for death by overwork (過労死, karoshi).

While Japan has done a lot to combat the alarming suicide rates (自殺率, jisatsu ritsu) of the early 2000s over the past few decades, it remains a pressing social issue.

The most common mental health issues involve anxiety (不安障害, fuan shogai), substances (薬物乱用, yakubutsu ranyo)(e.g., alcohol abuse (アルコール依存症, arukoru izonsho) and dependence (依存症, izonsho)), and mood disorders (気分障害, kibun shogai). Other typical behaviors with mental health ramifications include severe social withdrawal (引きこもり, hikikomori) and workplace bullying (パワー・ハラスメント, pawa harasumento).

Japan’s traditionally unforgiving and stressful workplace (a.k.a ブラック企業, burakku kigyo) exacerbates much of this, and appropriate mental health services to address these problems still lag behind, partly due to stigmatization.

Japanese attitudes to mental health

Japan has traditionally stigmatized mental health issues as taboo, preventing many from recognizing problems, talking about issues, and getting help. The general public has also historically shunned those with mental disorders, particularly severe problems like schizophrenia (統合失調症, togo shitcho sho) and bipolar disorder (双極性障害, sokyokusei shogai). Poor public mental health education, misconceptions about willpower, and shame have fueled these negative beliefs further. 

Fortunately, mental health attitudes are changing. For instance, there is a positive trend towards more open public discourse about depression (うつ病, utsu byo) and mood disorders following targeted public health education on suicide prevention. An effective campaign describing depression as “a cold of the soul” (心の風邪, kokoro no kaze) boosted the uptake of anti-depressants. While this simplification led to over-medication, it has made mental health more visible in Japan. 

Mental healthcare services in Japan

Mental healthcare services (メンタルヘルスケアサービス, mentaru herusu kea sabisu) in Japan consist of two general fields: psychology (心理学, shinri gaku) and psychiatry (精神科, seishinka).

Psychology is a non-medical profession that offers face-to-face counseling and cognitive therapy (認知療法, ninchi ryoho). This takes place outside of the universal healthcare system. By contrast, psychiatry is part of the country’s medical profession and covered by Japanese National Health Insurance (NHI – 国民健康保険, kokumin kenko hoken or Kokuho).

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Psychiatric treatment includes prescribing psychotropic medications (向精神薬, ko seishin yaku) to manage serious insomnia, depression, eating disorders, and other severe mental or mood disorders. However, doctors with a background in traditional medicine (漢方, kampo) will treat patients holistically before medicating.

To recap, Japan’s health insurance only covers psychiatry, but health professionals may recommend or refer patients for psychological counseling at a fee.

How to access Japanese mental health services

New arrivals in Japan should familiarize themselves with the healthcare system (医療制度, iryo seido). Most residents will contribute to universal health insurance through their employment (雇用, koyo). Students (学生, gakusei), self-employed (自営業, jiei gyo), unemployed people (無職, mushoku), and pensioners (年金自給者, nenkin jukyusha) are all covered, too.

Short-term residents must take out private insurance (民間保険, minkan hoken) to qualify for treatment (治療, chiryo) until they are part of the employment system. With a health insurance card (健康保険証, kenko hoken sho), you only pay a small percentage (30%) of the medical costs (医療費, iryohi).

Japan has no network of general practitioners or family doctors, so the first port of call is always an internal medicine doctor (内科, naika). Doctors may first perform medical tests to rule out any physical cause for the mental health issue. However, if they diagnose a mental disorder, they will refer patients immediately for psychiatric treatment at a specialist ward or clinic.

First-time psychiatric appointments are more costly as they involve many tests. By contrast, private counseling is self-referred and can accessed as needed. Prices range widely from ¥5,000 to ¥20,000 per session.

Of course, the language, cultural, or expense barrier can make it more challenging to seek help as an international. Luckily, organizations like the Tokyo English Life Line (TELL) support expats with fee-for-service counseling. 

Insurance for mental healthcare in Japan

Mental healthcare is not fully covered under Japan’s universal healthcare insurance system. 

Therefore, patients must go private for cognitive therapy and counseling covered by their private health insurance. You would most likely need to take out an additional package to cover psychological services. Reputable insurance providers in Japan include:

• Allianz Care
• Cigna Global

Given the language barrier, many expats choose online services and therapy apps with international reach. More importantly, a psychologist (心理学者, shinri gakusha) cannot prescribe medicine in Japan, so internationals with existing prescriptions can only access medication through a psychiatric consultation.

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In contrast, psychiatric treatment is generally covered under Japan’s NHI. You can access these services at a local clinic or practice. Here, internal medicine doctors can also prescribe medication or fill prescriptions. Some public therapy services are also available on a sliding scale depending on the clinic. As such, the patient pays only a proportion based on their income.

Psychologists, psychiatrists, and therapists

The Japanese Society of Psychiatry and Neurology (日本精神神経学会, Nihon Seishin Shinkei Gakkai) is the professional body for psychiatrists (精神科医, seishinka i) and part of the general healthcare system. They specialize in treating many mental health problems as trained health professionals. However, a psychiatric consultation tends to be brief, and waiting lists are long as the system is overstretched.

Patients need a referral (紹介状, shokai jo) from an internal medicine doctor at a local healthcare clinic or hospital before booking an appointment with a psychiatrist. It is recommended to translate all your existing prescriptions into Japanese before you see the doctor. Some prescriptions are prohibited or controlled in Japan (2021) and may need additional paperwork on import. Patients also undergo a pre-screening interview (in Japanese) before this appointment.

Because the universal healthcare system does not cover psychology and therapy (セラピー, serapi), you don’t need a referral to book an appointment. While this makes it easier to seek treatment, it is more expensive. The quality of service can also differ as Japan has no central licensing system. Therefore, look for practitioners with recognized accreditation and training from international bodies.

The International Mental Healthcare Professionals Japan (IMHPJ) provides an English-language directory of healthcare professionals and therapists. Tokyo Mental Health also offers English-language therapy, counseling, and treatment in Tokyo (東京) and Okinawa (沖縄) specifically.

Drug and alcohol services in Japan

Japan’s unique business drinking culture, known as nomikai (飲み会), where companies expect employees to participate in parties, may have normalized alcohol abuse and dependency. Still, some may view that as a debatable argument. There is even a controversial government campaign encouraging young people to consume more alcohol – called Viva Sake! – to stimulate sales after the Covid-19 pandemic. However, this has been met with societal opposition.

Still, of the estimated 1 million people with an alcohol use disorder in Japan, less than 10% seek treatment, even though several public and private support services are available. Referral times and delays are comparable to other mental healthcare treatments in Japan.

Recognizing addiction issues as an expat is the first step to seeking help.

National psychiatric bodies favor abstinence alongside therapy and counseling. While treatment can be costly, Japan also has several self-help groups like the All Nippon Abstinence Association (全日本断酒連盟, Zen Nihon Danshu Renmei). Services are in Japanese (日本語, Nihon go). However, there are English-language support groups, such as Alcoholics Anonymous Tokyo.

You can also privately access rehabilitation centers and intensive treatment in Japan but these services may be lacking compared to many other countries worldwide.

Japan’s harsh drug laws likely contributed to having one of the world’s lowest reported consumption rates for illegal drugs (違法薬物, iho yakubutsu), but actual usage may be underreported.

Services dealing with eating disorders

Pressure and expectation of being thin seem to be prevalent across the world. Like other countries, Japan’s media often presents an unattainable image of the perfect body. This may have contributed to the rise in the numbers of those struggling with eating disorders (摂食障害, sesshoku shogai), such as anorexia (拒食症, kyoshoku sho) and bulimia (過食症, kashoku sho). Like many other mental health problems, eating disorders are also under-represented in statistics, but the recorded data shows an increase in prevalence.

Unfortunately, support services are limited, and many cannot access the help they need. For example, Japan has no dedicated facilities for treating eating disorders.

If you are living with an eating disorder, it is crucial to speak to a medical or mental health professional and seek treatment. Help is available via psychiatric referrals or private therapy, also for expats. For example, Tokyo International Psychotherapy (東京インターナショナルサイコセラピー, Tokyo Intanashonaru Saikoserapi), among other practices, even offers bilingual (i.e., English and Japanese) therapy options.

Self-help groups like the Nippon Anorexia and Bulimia Association (NABA – 日本アノレキシア・ブリミア協会, Nippon Anorekishia Burimia Kyokai) continually advocate for better public awareness and support nationwide. 

Help for people with severe mental health problems

Severe mental health problems refer to debilitating psychological issues affecting a person’s ability to lead an independent and productive life. In Japan, these include schizophrenia and bipolar disorder.

The general advice is to seek psychiatric treatment to manage serious psychological disorders with appropriate medication and therapy. However, in extreme cases, patients can be hospitalized for weeks in psychiatric wards (精神科病棟, seishinka byoto). Be aware that staff may use controversial methods like restraining patients or denying visitation requests. 

If you – or a family member – have been diagnosed with a serious mental health problem or disorder, and you have booked a psychiatric consultation, have all your medical records and existing prescriptions translated into Japanese to aid a more effective treatment plan.

Mental healthcare for children and young people in Japan

Children’s healthcare in Japan is highly rated, yet it lacks sufficient child and adolescent mental health services (CAMHS). Also, its official 2022 suicide rates included an alarming number of children and teenagers, and one in five children is reported to live with mental health issues. This may be partially why the United Nations Children’s Fund ranks the country’s youth mental health as one of the worst among rich countries worldwide.

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Historically, schools are slow to identify indications of anxiety, stress, or depression in children. In response, the Health and Global Policy Institute (HGPI – 日本医療政策機構, Nihon Iryo Seisaku Kiko) proposed policy changes – based on research – to implement effective mental health programs across all schools.

Collaborating with the Japanese government, the HGPI launched the Mental Health Project in 2020. Following the positive results and recommendations, the government is again including mental health education in the 2022 national curriculum to address these concerns and offer students more support in schools.

Pediatricians (小児科医, shonika i) will also refer children for psychiatric help, and where the public health system is less effective, private therapy and clinics in Japan can fill the gap.

Organizations like TELL and Tokyo Mental Health also have programs dedicated for young clients with anxiety, depression, or behavioral issues.

Mental healthcare services for special groups in Japan

Support and services are available for various groups in Japan, particularly expats and non-Japanese-speakers. These cover self-help communities and fee-for-service counseling. Here are just some of these groups:

• Marcé Society: the Japanese branch of the Marcé Society for Perinatal Mental Health
• Yotsuya Yui Clinic (四谷ゆいクリニック, Yotsuya Yui Kurinikku): a facility in Shinjuku that provides mental health advice and counseling in English, Spanish, Korean, Portuguese, and Chinese dialects 
• Yorisoi Helpline for Foreigners (よりそいホットライン, Yorisoi Hotto Rain): a multilingual, free telephone, chat, and Facebook counseling service for internationals living in Japan
• Ikizurasa Japan (生きづらさJAPAN, Ikidurasa Japan): a support group for social minorities – Japanese-language only

Japanese mental health prevention and education programs

Japan is working towards improving mental health awareness in its society. And, as discussing mental health becomes less taboo, the number of programs for prevention and education also grows.

Current programs include:

• The Nippon Foundation Suicide Prevention Project (日本財団子どもの生きていく力サポートプロジェクト, Nippon Zaidan kodomo no ikiteiku chikara sapoto purojekuto): works with local municipalities to generate community-minded campaigns. For example, it helped to formulate new community-based counseling initiatives in both Nagano and Tokyo’s Edogawa wards.
• Gradual approach, Resilience, In a school setting, and Prepare scaffoldings (GRIP) (学校における自殺予防教育プログラム, gakko ni okeru jisatsu yobo kyoiku puroguramu): the national in-school suicide prevention program. With booklets, videos, and games, it promotes peer mentoring in schools to improve children and adolescents’ emotional expression and self-esteem.
• TELL in the Community (TELLカウンセリング, Teru Kaunseringu): organizes many public outreach programs. These include workshops and outings across Japan, from mindfulness workshops for children to fun pub quizzes for adults
• Gatekeeper for Life (命の門番, inochi no monban): part of the government’s General Principles of Suicide Prevention Policy and one of Japan’s most active suicide prevention programs. It trains non-mental health professionals to improve the detection and referral of at-risk persons in the community.

Emergency support and crisis lines

If you or a loved one has suicidal thoughts, know that help is available. In an emergency (緊急, kinkyu), you can call 119 for an ambulance or the fire service and 110 for the police.

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Other crisis lines include:

Useful resources

• TELL (Tokyo English Lifeline) – English-language mental health resource with a crisis hotline, online chat service, and bookable counseling services
• Better Help – licensed online therapy, accessed from anywhere in the world
• Tokyo Mental Health – a mental health care service founded by international therapists in Japan with counseling, therapy, and psychiatric services readily available in English and other languages
• The University of Tokyo Hospital (東京大学病院, Tokyo Daigaku Byoin) – English-language service for comprehensive medical and mental healthcare, including psychosomatic medicine