Characteristics and Issues of Long-Term Inpatient Transition from Psychiatric Hospitals to Communities in the Tokyo Metropolis: Using M. Serres’ Extitution Model

Abstract

This paper presents a new idea for psychiatric care reform in Japan, referred to as “transition to the community,” invoking M. Serres’ notion of “extitution,” the opposite concept of the facility system, which contrasts being “inside” and “outside” hospital facilities and medical systems. Transition to the community is a pluralistic process by which long-term inpatients transfer from a “closed” ward to an “open” ward, the vicinity of the hospital, and then their former residences with assistance from those who are part of systems outside hospitals such as social workers. Long-term hospitalized patients regain their dignity as human beings and reduce trauma by becoming accustomed to the outside everyday world.

However, transitioning to the community involves back-and-forth progress and takes more time than the government’s estimated support period. A shortage of social workers who can take part in the transition to the community continues. Each local government responds differently. Furthermore, psychiatric hospitals are distributed unevenly. A transfer system making use of the uneven distribution exists in the Tokyo metropolitan area. Transition to the community can be achieved in local areas by relying on the efforts of long-term inpatients and on social workers and“ accidental” situations.