Aya MishinaIn a country with high life expectancy and advanced medicine, Japan has a major deficiency in its approach to mental health issues. “People are dying from illnesses we have treatments for,” Vickie Skorji, Director of TELL Lifeline, says.
WHO (World Health Organization) emphasizes the importance of mental health because good mental health is related to mental and psychological well-being. Everyone anywhere should have the right to access to quality mental health care. The topic, however, has not been discussed often enough in Japan. Moreover, there seems to be limited access to the necessary information, care and support when it comes to mental health.
Zenbird wanted to dig deeply into this issue and find out what can be done to improve the situation. We turned to Vickie Skorji who shared her knowledge on this topic through her work at TELL Lifeline and as a former counselor with a background in neuropsychology.
TELL, formerly know as English Inochinodenwa, is a nonprofit organization which provides effective support such as lifeline and counseling services to Japan’s international community. The organization is dedicated to address the country’s growing mental health care needs. TELL has been responding to lifeline calls for the last 45 years since its inception, saving countless lives since. Initially, it was just a lifeline that provided support in English, but it now has multiple clinics across the country, as well as outreach services in multiple languages to other prefectures beyond Tokyo in their efforts to serve wider regions and demography.
Zenbird: Who has been reaching out to TELL and what do they seem to be struggling with?
Skorji: Initially, I was very surprised just how many Japanese people were calling the line. Around 50% of our callers are Japanese, even though it is an English-speaking line.
For example, we hear from Japanese who have gone overseas and come back. They had gone to university or had worked abroad and have all these ideas and this hope for the future, but that’s not what their family or society wanted from them when they return. They feel very alone, lost and disappointed—their dreams were crushed.
We also hear from Japanese who had to return to their hometowns in the countryside to look after a family member. They may have lived in Tokyo for most of their life, and they were quite used to dealing with the foreign population. They feel isolated and that the people in rural areas don’t really understand them.
Others may be married to a foreigner or are of mixed race and have a foreign parent, and they think that we might understand their unique concerns.
We also have a number of elderly Japanese people who call our line in English because it is easier to get through than some of the Japanese lines. We might be the only people that talk to them in their day.
We certainly hear from sexual minorities as well. Initially, we were struggling to get younger people to call our line, but since we’ve been operating the chat service, we’ve been hearing more from young people, 30 and under. Some talk about difficulties related to sexual identity or being a sexual minority.
We also hear from people who have married a Japanese person and come to live in Japan. Because of the language barrier, they end up teaching English. Not earning the same sort of income they had been making back home, they often feel demoralized and that they are not contributing as they should. They are a very vulnerable population that are not given enough support or attention from the community.
In Tokyo and the big cities, people might be frustrated with the services they have, but they have many more options than those in rural areas and small prefectures. There is such a big need all across the country, and our mission has been to support those individuals where there are limited services. The TELL Lifeline was the first mental health services to try to extend services beyond Tokyo.
Around 2004, the suicide rate in Japan was at its highest, there was an awful lot of people calling because they were really stressed and feeling suicidal. Now, we still hear from people who are depressed and anxious, but, thankfully, the number of suicide calls is not as high as it used to be.
What have been the challenges? Where is Japanese mental health care lacking?
One in four of us will have a mental health problem at some point in our life and that doesn’t matter where you live. So, I wouldn’t say necessarily that Japan has more mental health problems than other countries. However, I think there is more stigma about mental health in Japan and that delays people getting support.
When it comes to mental health in a Japanese workplace, people do not talk about it. Because of this, when a team member has a mental health problem, they will bring down the whole team. The whole team will become exhausted trying to deal with this person’s mental health problem, without talking about the real issue. People deal with a tremendous amount of stress in Japanese workplaces as a result.
The other problem in Japan is, there are less treatment options. People can’t receive counseling on the national health insurance scheme. They can only see a psychiatrist. The psychiatry departments are flooded; they can’t handle the demand. A patient typically only gets seen for 10 minutes. Their way to deal with that is to treat patients through medication. In Japan, patients are often over-medicated, and they’re not getting counseling support which would give them strategies to get stronger and be more resilient.
It gives a bad name to psychiatry in Japan. People will look at the situation and say, “I don’t want to go to a psychiatrist because I’m just going to be drugged out and be in a zombie-state. I don’t want to do that.” That’s not treating the core problem, which means that people are struggling with the issues longer.
Medication is important. Without that, more people would consider suicide, but medication by itself is not enough to help people be more functional. To get well, patients need a combination of medication and counseling. That’s the proven method.
What aspects of mental health require more awareness?
Everyone needs to know about mental health just like they know about physical health. It’s important to know that 50% of all mental health problems happen by the time we are 14 years old; 75% by the time we’re 24. So, a majority of all mental health concerns occur by the time we’re 24. Parents need to know what that looks like; educators need to know what that looks like.
Some research indicates as much as one in three university students face a mental health problem. It is a worry that we are seeing a growth in mental health problems in young people. Another study suggests that most young people will try to hide they have a mental health problem. They won’t go to their parents, and won’t talk about it for at least 12 months. Even when they do come out and talk about it, they get a lot of negative reactions from those around them.
The really sad point is that if people address their mental health problems quickly, within 3-6 months, most of these problems can be turned around so that the person can function and move in the right direction. The problem is that people delay it for so long that it’s harder to function again. It does double damage because it affects a person’s self-esteem and sense of worth as well.
How do we fight stigma and misconceptions about mental illnesses?
If I gave the analogy of someone with cancer, you would never say to the person, “Don’t take that medication.” We know it has horrible side effects, but we would never do that. The medication for mental illnesses has nowhere near the side effects of medications prescribed for someone with cancer, and it can save a persons life. But we often advise a friend or a family member not to take medication for their mental health issue, and nearly a million people die from a mental illness every year.
Because we are not adequately caring for people with mental health problems, it’s no wonder that we have these high suicide rates around the world. We ask them to deal with an illness all by themselves. On top of that, they are made to feel ashamed for having this illness.
What are the changes you hope to see? What are the hurdles?
We all have a role in changing our attitude about this issue. All of us need to understand that a person with a mental health problem is no weaker, no lesser and no different from any other one of us. We need to change our attitude in order to better support those with mental health issues.
In 2004, the number of suicides in Japan was 32,000, approximately a hundred people a day. It’s currently down to 20,000, so it’s come down over 10,000 people since that time. That should be celebrated; it’s an amazing achievement. However, it can go all the way down to zero because 95% of all suicides are related to mood disorders such as depression or bipolar disorder.
People are dying from illnesses that we have treatments for. They’re dying because of the stigma, shame and misunderstanding in education about these conditions. We wouldn’t let a person with cancer die without treatment. Yet, we’re letting nearly a million people around the world die every year from illnesses that are treatable. We might not like the treatment, but we don’t like the treatment for many illnesses. And the treatments are getting better all the time.
Even if we get over the stigma, how do people get counseling in Japan? They must pay for it on their own, and for many they cannot afford to. It needs to be part of the national health insurance scheme. In order to do that, we need to get psychologists properly registered and licensed. This process has begun, so hopefully in the next four to five years, we will see this happen. Japan also needs clinics all around the country, not just in big cities.
Japan also needs peripheral resources, such as support groups, halfway houses or other care systems that make it easier so that the burden is not placed exclusively on the medical profession. There are so many great models in other countries. Learning about all those other levels of support that people might need is necessary.
For the last couple of years, TELL had some funding from the Tokyo Metropolitan government and that’s been wonderful. However, we can only receive this funding for three years in a row. We then have to stop receiving funds for a few years, and then we can apply to receive funds again. Many NGOs are in similar situations and it makes it incredibly hard to plan our services and supports year by year and for the future.
We have two major fundraisers, our Tokyo Tower Climb and our Charity Wine Auction. And we were just about to have our wine auction, but it was cancelled due to the coronavirus. We also run a clinic, and if there is a little money left over from the clinic’s operation, this goes to help our Lifeline operations. Two years ago, we thought we were going to cease to exist. We were lucky and have restructured things and we’re still here. Funding for all NGOs in Japan is very difficult.
TELL runs many outreach programs. Could you tell us about that?
At the moment, we run the exceptional parenting workshop series for parents of children with special needs. We also have a parent support group for those dealing with a child with special needs. We do a lot of workshops with educators and visit schools as well to talk about a whole range of topics, from sexual consent to diversity and gender issues to mental health. We also provide services for businesses and embassies.
It would be good to work more with the elderly. We also would love to run support groups for depression, anxiety, grief and loss. We would also love to provide more of these services and support across the country, but funding is what stops us.
How can individuals contribute?
There are lots of ways that you can help. You can make a donation on our website. Your donations really make a difference and they go directly into helping other people’s lives. You can join our Tower Climb in September, you can support our Charity Wine Auction. You can also volunteer on our Lifeline. Everything we do at TELL helps others in the community. Your contributions help us keep other people alive; together we save lives.
Editorial notes
Mental health is one of the issues Japan must tackle. We need to understand though that the problem here is not the mental health problem itself, but the lack of care and support when people encounter these issues.
The bright side is that Japan will be able to provide higher quality mental health care for all if each of us do our part. Mental well-being touches everyone. Everyone needs to start caring in order to move forward and, most importantly, to save lives.
TELL has professional advice and helpful tips for coping with the global pandemic, Coronavirus COVID-19. Read more information here.
If you or your loved ones need someone to talk to, please reach out.
TELL’s Lifeline number: 03-5774-0992
