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Lessons from and for Japan on service delivery

  • Peter Kennedy (a1)
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On a recent visit to Japan, I saw some good quality care of patients with chronic schizophrenia in a rural mental hospital. The Japanese staff were keen to hear about community care alternatives being developed in Britain. However, being a strong protagonist of community care, who has managed the closure of three English mental hospitals, I found myself recommending caution. There are lessons for Japan from the mistakes we have made; and there may be lessons for us in the ways Japan manages delivery of its mental health services.

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This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
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Curson, D.A., Pantellis, C., Ward, J., et al (2002) Institutionalisation and schizoprenia 30 years on. Clinical poverty and the social environment in three British mental hospitals in 1960 compared with a fourth in 1990. British Journal of Psychiatry, 160, 230241.
Department of Health (1999) National Service Framework for Mental Health. London: Department of Health.
Department of Health (2001) NHS Plan. London: Department of Health.
Doi, T. (2001) The Anatomy of Dependence. London: Kodansha International.
Oshima, I., Mino, Y. & Inomata, Y. (2003) Institutionalisation and schizophrenia in Japan: social environments and negative symptoms: Nationwide survey of in-patients. British Journal of Psychiatry, 183, 5056.
Wing, J. & Brown, G.W. (1970) Institutionalism and Schizophrenia. A Comparative Study of Three Mental Hospitals. London: Cambridge University Press.
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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Lessons from and for Japan on service delivery

  • Peter Kennedy (a1)
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eLetters

Unrecognsed resilience of long-stay ward patients

David Abrahamson, Retired consultant psychiatrist
25 August 2005

It is suggested In this interesting and informative article that moreinformal, as well as organised, social interaction between patients might explain why Oshima et al (2003) found the length of stay in Japanese mental hospitals was not correlated with increasing negative symptoms, ‘ashas often been found in the UK’. Wing & Brown, 1970 & Curson et al, 1992. are cited as UK studies. But Wing (1986;1987) has made it clear that the studies which were reported in 1970 did not support a simple relationship between length of stay and negative symptoms, and particularly not a causal relationship; whilst Curson et al., (1992) who attempted to replicate the Wing & Brown studies, found no relationship.

I have argued that cross-sectional studies may misrepresent the association between understimulating hospital environments and negative symptoms, both in the direction of false negative and false positive results. Amongst the reasons for this is failure fully to distinguish between patients’ sensitivity to contemporaneous social circumstances and their resistance to cumulative effects: courses tend towards stability orimprovement in the long-term in hospital as elsewhere. (Abrahamson, 1986;1987). This disjunction between contemporaneous and long-term effectswas an important aspect of long-stay patients' unrecognised resilience and offered possibilities of sustained treatment that were not sufficiently capitalised on in the large mental hospitals.

The authors' point about interaction between patients is nonetheless important since interaction and peer support were unfortunately also not promoted in the era of the large hospitals, in contrast to the nineteenth century moral treatment era, which likewise promoted the inspired, small scale architecture referred to later in the article.

References

Abrahamson, D. (1986) Chronic schizophrenia and long-term hospitalisation. British Journal of Psychiatry, 149, 382 & ibid (1987)151, 708.

Curson, D.A., Pantellis, C., Ward, J., et al (1992) Institutionalisation and schizophrenia 30 years on. Clinical poverty and the social environment in three British mental hospitals in 1960 compared with a fourth in 1990. British Journal of Psychiatry, 160, 230-241.

Oshima, I., Mino, Y. & Inomata, Y. (2003) Institutionalisation and schizophrenia in Japan: social environments and negative symptoms: Nationwide survey of in-patients. British Journal of Psychiatry, 183, 50-56.

Wing, J. K. (1987) Chronic schizophrenia and long-term hospitalisation. British Journal of Psychiatry, 150, 129-133 and ibid (1988) 152, 144-145.
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