Initiative to Build a Community-Based Mental Health System Including Assertive Community Treatment for People With Severe Mental Illness in Japan

In Japan, although the locus of care is still predominantly in psychiatric hospitals, a growing number of mental health service providers have become engaged in promoting community integration of people with severe mental illness. This paper describes an ongoing initiative to build a mental health and social services system, which is viewed as a model for other Japanese communities in creating support for people with severe mental illness. This initiative consists of two projects: development and evaluation of an assertive community treatment (ACT) team located in a suburb of Tokyo and a broader community support project in this same community. A pilot evaluation of consumer outcomes for the ACT team demonstrated that ACT is feasible and effective in the Japanese social and cultural context. The community support project was successful in start-up demonstration programs of case management, residential, and supported employment services. Challenges to the expansion of ACT and other community-based services in Japan are discussed.