Many patients with mental health concerns do not engage with consultation-liaison psychiatric services. Most of these are patients with chronic physical diseases treated in small- or medium-sized hospitals or in medical or surgical clinics, where there are no psychiatrists. In order to improve the availability of mental health support to these patients, it is essential that liaison psychiatrists of core hospitals provide an outreach service that helps non-psychiatric doctors and co-medical staff to improve their ability in mental care and treatment. Various plans can be proposed; one of the most effective is the application of "collaborative care" to "community-based liaison services."

The integration of physical and mental health care is an important aspect in medically ill patients. Collaborative care programs are an efficient and effective approach for integration in which physical health providers, case managers, and consultation psychiatrists work together to provide care and monitor patients’ process. These programs have been shown to be clinically and economically valuable. A multidisciplinary team approach with co-medical staffs is necessary to supply efficient and effective care in medically ill patients in Japan.

Cancer patients and their families who suffer from psychiatric symptoms are latent in the region. Many medical staff members in the region are facing difficulties in the care of psychiatric symptoms of cancer patients. We conducted a questionnaire survey with the medical staff of the western part of Kanagawa Prefecture. More than 90% of the staff was facing difficulties in the administration of psychological care. Nearly 80% of patients wanted home-visits from psycho-oncologists. We had begun home-visits from palliative care team that focused on psycho-oncological symptoms in 2011. We were consulted in fifty cases over the course of three years. We cooperated with 43 medical staff establishments in the region more than 100 times. Psychiatric symptoms were delirium (70%), insomnia (60%), and so on. A variety of psychiatric symptoms were also expressed in the family. Hypoactive delirium had been overlooked in all cases. Appropriate education on the topic of delirium is an urgent matter. Through our home-visits, the anxiety decreased in approximately 70% of medical staff members in the region. It is necessary to devise a plan to increase the level of satisfaction in predictions and staff care.

Perinatal mental illness is common in Japanese primary care, although poorly identified and treated. Improved perinatal mental health depends on liaison psychiatric service in the community that reflects a focus on promotion, prevention, and early intervention, while facilitating improved referral pathways between primary maternity health and mental health services. Science 2000, a community-based screening system for postnatal depression, has been developed among the pre-existing community-based services in municipalities. The screening model is delivered primarily by public nurses for maternal and infant health without the use of a psychiatric consultation liaison framework and therefore, this screening system did not work effectively in many municipalities. In these circumstances, it will be important to provide specialist mental health assessment and brief intervention in collaboration with the obstetricians, midwives, public health nurses, and specialists of social welfare services who remain the primary health providers. This review summarizes the developing individualized care plans for management of mental health in the perinatal period in the primary case sector using the vignettes.

Previous studies suggest that collaborative care is useful in integrating psychiatric and primary health care. However, no study has investigated collaborative care in Japan. The present study reports on collaborative care practice in Japan using two case studies. In collaborative care, a case manager provides behavioral intervention to the patient and supports the depression medication treatment initiated by primary care physicians. Clinical psychologists supervised the case manager and provided telephonic intervention. The psychiatrist supervised the case managers periodically. We reported the collaborative care practice using two cases of patients who reported anxiety related to medication and its side effects. Finally, we considered the support provided by collaborative care managers.

In Japan, a sufficient legal framework has not yet been established for the “consent” of a patient with impaired judgment due to psychiatric symptoms who undergoes physical treatment. In particular, from an ethical perspective, careful consideration should be given when providing invasive medical interventions including surgery and chemotherapy. In this paper, we presented 4 cases in which the patients’ psychiatric symptoms had seriously affected their consent to physical treatments, objectively assessed each patient’s ability to consent, and discussed the issues. Additionally, proxy consent by family members, which has conventionally been given in Japan, lacks legal basis. Therefore, we introduced a case in which we had requested the University Ethics Committee to review the validity of the consent. Finally, we compared and examined the current status concerning proxy consent in various foreign countries and raised issues for the future establishment of regulations in Japan.

The physical disease that could induce the psychotic symptoms was included many kinds of pathological conditions such as neurodegenerative disease, neuronal infection, endocrine disease and metabolic disease. We reported a case of Wilson's disease associated with psychiatric symptoms. A 35 years old male was admitted to our hospital due to severe liver dysfunction with ascites and peritonitis. During the treatment in the internal medicine ward, he had been showed severe psychotic symptoms including paranoia and impulsive action. Then he was needed to be changed to the psychiatric ward because of requiring close supervision mentally. He was diagnosed as organic mental disorder from the point of clinical course and neuroimaging tool. In clinical settings, we should know that Wilson's disease might causes various psychiatric symptoms.