Mental health support for British nationals in Japan

Via Peters

1. Disclaimer

The information contained in this note is intended for your general guidance only, it is not a substitute for obtaining your own medical and legal advice. While all due care has been taken in compiling this information, accuracy cannot be guaranteed, and the applicable law and procedures may occasionally change. For these reasons neither Her Majesty’s Government nor any member of the British Consular staff can accept liability for any costs, damages or expenses which might be incurred.

The Foreign, Commonwealth and Development Office holds and uses data for purposes notified to the Information Commissioner under the Data Protection Act 1998. Such personal data may be disclosed to other UK Government Departments and public authorities.

2. FCDO consular support

Whenever possible we will seek your permission before taking any action on your behalf.

We can:

  • listen to you and help you look at your options
  • help you find out about support for mental health needs
  • help you to contact friends and family members, if you want to
  • visit you in hospital or prison, if relevant in line with our standard procedures
  • raise any concerns about your treatment or welfare with the responsible authority (such as a hospital or prison)
  • help medical staff in Japan contact medical staff in the UK who may be able to provide advice on your medical history and give information about local medication suppliers
  • offer you advice if you choose to remain in Japan
  • offer you information if you plan to return to the UK
  • liaise with your travel representative or travel insurance company, if you want us to

We cannot:

  • give advice on mental health issues
  • buy or supply medication for you
  • withhold or remove your passport
  • hold on to or take responsibility for personal belongings
  • stop you from travelling abroad
  • force you to return to the UK against your will
  • pay for your return to the UK
  • pay for your food, accommodation or medical bills
  • get you better treatment in hospital than is given to local people
  • act as an interpreter between you and the hospital

3. What to do if you need help

3.1 Emergencies

In an emergency, you should:

  • call 119 for the medical emergency hotline if you are in need of urgent medical assistance
  • call 110 for the Police in case of self- or external danger (Tokyo Police have English-speaking officers available from Monday to Friday: 8:30am to 5:15pm at +81(0)3-3501 0110)

For emergency medical interpretation service in English/Spanish/Chinese/Korean/Thai, you can call +81(0)3-5285-8185 (Monday to Friday: 5pm to 10pm; Saturday, Sunday and Holidays: 9am to 10pm).

3.2 Less urgent care

For less urgent requirements, contact the nearest general or private hospital. They should be able to make an initial assessment, provide some support, and signpost you elsewhere if they feel it is necessary.

You can also make an appointment with a psychologist or a psychiatrist in a private practice. Doctors in most hospitals should be able to recommend one, or you can contact one directly.

When exploring your options, refer to JNTO’s guide to accessing medical facilities in Japan.

3.3 Overview of mental health treatment in Japan

Despite the fact that hospitals and clinics are well equipped and staff are highly trained, Japan is still lacking when compared to other advanced countries in terms of mental health care services.

Medical/counselling facilities are generally good, but the cost of treatment is high. There are very few British doctors and counsellors practicing in Japan, but some Japanese doctors and counsellors may speak English.

When you want to receive mental health treatment from medical facilities, in most cases you are required to have a stable income or significant savings. The cost is relatively high, and language might be a challenge.

In Japan, there are 3 major types of mental health care providers: psychiatry, clinical psychology and psychosomatic medicine.

  • Psychiatry (精神医学 sei-shin-igaku): Psychiatrists usually work at the psychiatry department in hospitals or clinics. They specialise in the diagnosis and treatment of various mental health problems such as depression, insomnia, anxiety, eating disorders, obsessive compulsive disorder etc. Generally, you should expect a short counselling session no more than 30 minutes. They can prescribe mental health care medication if necessary. Psychiatric services are covered by Japanese Health Insurance.

  • Clinical psychology (臨床心理学rin-shou-shinri-gaku): Clinical psychologists can deal with a wide range of mental health issues. While they can perform psychological tests, they cannot prescribe medication. As there is no national licensing system (like the one for medical doctors), depending on their skills, the treatment you may receive might differ from one to the other. Treatment by clinical psychologists is not be covered by Japanese Health Insurance. Generally, their counseling fee will cost 5,000 yen to 10,000 yen or more per 50 mins.

  • Psychosomatic medicine (心身医学 shin-shin-igaku): Psychosomatic medicine doctors usually work in local clinics and mainly treat patients with physical problems caused by psychological stress. They can prescribe medication and in most cases their services are covered by Japanese Health Insurance.

If you cannot find a hospital suitable for your needs, or would like to have more information on healthcare and welfare systems in Japan, you may find further help via AMDA International Medical Information Center or Japan Health Info.

If you wish to seek anonymous and confidential support remotely or are worried about someone, TELL provide support and counselling services to Japan’s international community. Check their website for daily service hours for both chat and phone services for the free TELL Lifeline service.

If you would like to speak to volunteers in the UK instead, see information on available 24/7 UK helplines (Samaritans UK).

More information on support resources can be found below.

4. Prescriptions: on holiday or recently moved

If you are on holiday or have recently moved to Japan and need a repeat or replacement prescription, you should contact a local psychiatrist (seishinka-i 精神科医) so they can issue you a prescription you can fill at the nearest pharmacy. You can read JNTO’s guide to accessing medical facilities in Japan, or list of medical facilities in Japan for English-speaking psychiatrists. You may want to check ahead of time if the clinic can prescribe medication.

Carrying a copy of your UK prescription while on holiday, or after your move to Japan, can help doctors find local medication that has the same or similar effect as your UK prescription medicine. Many foreign brands of medication are not available or legally sold in normal pharmacies in Japan.

You should also ensure that you have up-to-date prescriptions for any medicine that you are bringing into Japan. If you’re travelling with prescription or over-the-counter medicine, read this guidance from NaTHNaC on best practice when travelling with medicines.

Drug laws in Japan are very strict and so caution must be taken even with medication that you have been legitimately prescribed within your home country. The use or possession of some common prescription and over-the-counter medicines are banned under Japan’s strictly enforced anti-stimulant drugs law. This includes Vicks inhalers, medicines for allergies and sinus problems and even some mild painkillers like those containing codeine. Customs officials may not be sympathetic if you claim ignorance.

For further information on the legal status of a specific medicine, you’ll need to contact the Japanese Embassy or Consulate in London and Edinburgh before travelling to Japan.

You may also want to check the Japanese Ministry of Health, Labour and Welfare webpages on advice if you plan on bringing medicine into Japan, a general Q&A on procedures, as well as a list of banned items. Information on import permits required for a select list of medication (see Q&A above) can be found on the Kanto-Shinetsu Regional Bureau of Health and Welfare website and the Narcotics Control Department website.

5. Compulsory hospitalisation

In Japan, people with mental health needs may be hospitalised and detained without giving their consent, for example, if they are considered to be behaving in a threatening manner or need treatment urgently and are unable to make decisions themselves.

In an emergency, a police officer or doctor may take this step. There are 3 types of involuntary hospitalisation:

  1. Medical protection hospitalisation (iryohogo nyuin医療保護入院)
  2. Emergency hospitalisation (oukyuu nyuin 応急入院)
  3. Compulsory hospitalisation (sochi nyuin 措置入院)

Regardless of the type, the judgment by at least one psychiatrist that the individual requires treatment and is unable to make decisions for themselves, is required.

Treatment by means of physical restraints, confinement, or seclusion of a patient are used in Japan when it is deemed necessary for the protection of the patient or other people.

6. Costs

With the exception of compulsory hospitalisation you will be expected to pay the whole cost of most treatment, even for involuntary hospitalisation. There have been cases where treatment has been delayed whilst medical facilities check the legitimacy of the insurance held by patients.

Before you travel, make sure you have comprehensive insurance covering healthcare and medical evacuation/repatriation to the UK or your normal country of residence for the duration of your stay. Please view our guidance on foreign travel insurance, which outlines what your insurance policy should cover you for.

Residents in Japan will be required to enrol in either Employee or National Health Insurance.

7. Guardianship

Japanese Family Courts have the authority to appoint a legal guardian for people who are no longer able to make decisions or take care of themselves. Guardians can also be appointed for minors (under eighteen) in cases where the parents are no longer able to exercise their parental authority.

A guardian can make legal decisions on behalf of individuals who need their support. This includes making decisions over finance/asset management, and access to medication and welfare of the individuals concerned. A guardian has to consider the benefits of the individual concerned as the priority, and they should be able to make sound judgements on their behalf.

Therefore, it is common for those with specialist skills such as a lawyer, judicial scrivener or social worker, to be appointed as a guardian. The court-appointed guardian would be supervised by a family court, or an adult guardianship supervisor.

The process of appointing a guardian could take up to six months or longer.

If you are interested in appointing a guardian, you should consult a local lawyer.

8. Return to the UK

Repatriation under medical supervision is possible in many cases, but can be costly and take a long time to organise. This is normally done through a medical repatriation company and costs are normally covered by travel insurance or personal funds.

The British Embassy can assist with complex repatriations by linking up with Travel Cares and other Chaplaincies in the UK. These organisations, based at UK airports, specialise in assisting vulnerable customers on arrival in the UK. They provide effective signposting to the UK social services and work closely with Embassies and Consulates around the world to ensure a safe arrival in the UK.

Additionally, if you are bringing medication from Japan back to the UK, check ahead if they contain controlled drugs/substances and take any necessary steps if so.

Travel Care can be found at Heathrow and Gatwick Airport. There are Chaplaincies at Birmingham, Edinburgh, Glasgow, Luton, Manchester and Stansted Airport.

9. Support from other agencies and organisations

9.1 Japan

Organisation Telephone Role
AMDA Medical Information Center   Provide foreigners with medical information in Japan. Also offers telephone interpretation services free of charge. Click here for useful documents in English related to consultation procedures.
Emergency Assistance Japan   Provide emergency medical assistance to foreign travelers in Japan for (not free)
International Mental Health Professionals Japan (IMHPJ)   Database of Japan-based therapists
Japan Hospital Search   Provide information useful to international patients on hospitals in Japan where they may receive medical services, and information on travel assistance.
Japan Healthcare Info (JHI)   Provide a wide range of healthcare consultancies and support services for (not free)
TELL Japan +81-(0)3-5774-0992 Free English hotline service for confidential support for people experiencing feelings of distress or despair. Japan-based organisation.

9.2 UK / International

Organisation Telephone Role
Anxiety UK +00 3444 775 774 Provide support to those diagnosed with an anxiety disorder.
Bipolar UK   Provide support to those diagnosed with a bipolar disorder.
CALM 0800 58 58 58 Campaign Against Living Miserably – A charity providing a mental health helpline and webchat.
Intervoice   International network of groups supporting those who hear voices and experience other hallucinations or delusions.
Men’s Health Forum +44 330 097 0654 24/7 stress support for men by text, chat and email.
MIND +44 300 123 339 Provide information about mental health problems. Website includes useful information on many topics such as diagnoses, treatments, law.
NHS: A to Z list of mental charities   General information on mental health problems and a list of mental health agencies operating in the UK.
Samaritans UK 116 123 (free 24-hour helpline) Hotline service for confidential support for people experiencing feelings of distress or despair.
SANE +44 7984 967 708 Emotional support, information and guidance for people affected by mental illness, their families and carers.
World Health Organization (Mental Health)   Contains profiles detailing mental health provision in individual countries.
Youngminds Parents’ helpline 0808 802 5544 (Weekdays 9.30 – 16.00) Information on child and adolescent mental health. Services for parents and professionals.

https://www.gov.uk/government/publications/mental-health-support-for-british-nationals-in-japan/mental-health-support-for-british-nationals-in-japan

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