Abstract
In order to study a psychiatric rehabilitation framework in national mental hospitals, we looked into the details of the rehabilitation programs, their system and budget in twenty psychiatric hospitals in 1987 and 1988. It appeared that the concept of psychiatric rehabilitation has clearly changed. Formerly it meant that it was for helping the “long-stay” patients to enable them to resettle more easily or to provide a habit or social skill training for deteriorating patients. Today it is more realistic to look at the patient as a disease process and a person with its remaining disabilities. Accordingly it has been considered that psychiatric rehabilitation program should begin with the onset of the disease and the activities should extend from the ward to the program in the community facilities.
Our survey included out-patient clinics, hospitals in-patient treatment, programs in day-hospitals and night care facilities and collaboration between local health and hospital authorities and others.
The results in the present study were as follow:
1. It was revealed that the mental hospitals surveyed are critically short of staff, particularly co-medical professionals. To maintain the liaison with community resources, it is quite necessary to have sufficient numbers of psychiatric social workers.
2. The data showed that in only 40% of the wards the doors were open. Unlocking the doors was not enough by itself. Since living in unlocked wards is quite necessary for psychiatric rehabilitation, the policy of unlocking should be encouraged.
3. The schizophrenic patients have occupied 60% of the whole psychiatric beds. It was estimated that about half of these patients had been in the hospital for five years or more and could be released if they would have had appropriate community resources. It was found that 44% of the in-patient was on the voluntary basis. As the new Mental Health Act encourages the voluntary admission, it is expected to have more cases of this type of admission.
4. The numbers of the out-patients increased by 50% during the past ten years. In order to expand the out-patient services it is necessary to have the sufficient numbers of the staff.
5. As far as the budget of the rehabilitation program is concerned, we have suffered from poor budget. It was roughly estimated that it would need at least two million yen per one psychiatric bed per year by the study.
6. Although each national mental hospital has their own rehabilitation system, it appeared that their program did not fulfil its function effectively and properly.
