日本精神醫療體系：一些觀察

What is Happening in the Mental Health System in Japan: Some Observations

日本精神醫療體系，在最近三十年來，歷經重大的變化。這些變化包括由醫院為主的住 院精神醫學治療，變為社區為主的社區治療；其他非精神科醫師的專業人員的成長，尤其是 精神醫學社工師的增加；日本在精神醫療的政策改變；對精神病人之人權改善的關注； 從 2002 年起，日本精神及神經醫學會，開始注重與國際交流等。由於服用新的、較有效的精 神科藥物，使病人能夠接受社區為主流的精神醫療。但是，日本精神醫療體系所經歷的途徑 與眾不同：自從1960 年代以來，日本增建了許多私人擁有的精神病醫院，而使日本成為全 世界精神病病床最多的國家；鄰近的韓國也是一樣，擁有很多的精神病病床；因此這兩個 國家被稱為「亞洲精神醫療體系的例外」。最後，我將會依照日本精神醫療體系的變化經 驗，來討論一些東亞國家的精神醫療體系有關的變化。

In the past three decades, there have been a major shift in psychiatry and mental health services in Japan. They are a shift from hospital-centered services to community-based services, an increase in number of co-professional mental health manpower especially in the categories psychiatric social workers, a development of national mental health policies, paying more attention to human rights of persons with mentally ill, an increase in interchanges from Japanese Society of Psychiatry and Neurology with international psychiatric colleagues since 2002, etc. The introduction of new psychotropic drugs has contributed for community based psychiatry to become the main stream of services. The path has been somewhat different in Japan. In addition, Japan has built an enormous number of privately owned psychiatric hospitals since late 1960s. Japan at present owns the biggest number of psychiatric beds in the world. The bed number in South Korea has also rapidly been increased in recent years. They are often called as “Asian exception in psychiatry.” Finally, I shall discuss some important improvement in the context of those described changes in Japanese psychiatry.