From December 2015 the Ministry of Labor and Welfare’s new Stress Check law will go into effect. Businesses with more than 50 employees will be required to give the new stress check to all employees. I have been conducting the same kind of stress check at Toho University Sakura Hospital since 2010. My purpose for establishing this safety measure was to provide hospital workers in a high stress jobs with preventive primary care before developing work related mental illness and physical illness caused by stress. I will be explaining how the new Stress Check System can be best implemented in companies.

Addressing occupational mental health problems is an important social issue today. A similar situation is observed in nursing, as there are increasing concerns about nurses’ poor mental status due to the current situation of medical services. This situation requires measures to improve bed occupancy rates, such as shortening hospital stays, in addition to changes in clinical environments, represented by increased numbers of aged patients and those with concurrent diseases and the promotion of advanced, complex medical service systems. A favorable mental health status of nurses as professionals supporting others is a prerequisite for the provision of high-quality medical services; therefore, such problems should be addressed not only individually, but also systematically. Mental health support by the CNS in liaison psychiatric mental health nursing corresponds to the category of care by workplace health team staff. In the author’s facility, mental support is being provided mainly through individualized consultation services by ward managers, psychiatrists, and clinical psychologists in cooperation, while performing activities to enhance employees’ recognition of such services available within the facility. Considering that a large number of nurses using consultation services are immediately advised to take a rest from their jobs, it may be necessary to establish appropriate systems for self- and team care, in order to lead nurses to identify their own mental disorders and consult in the early stages.

This article describes the importance of mental health care for medical service workers from the perspective of Employee Assistance Program providers. While there is a great need for both physical and mental health management for medical service workers, they seem to have difficulty in taking proactive steps toward seeking assistance through counseling. Although the rate of introduction of EAP in private companies and public sectors is increasing year by year, that in medical service domains remains extremely low. One of the reasons for this is the persistent existence of the recognition that the management of health is a matter of self-responsibility. The consideration of 3 email/telephone counseling cases in the EAP service shows the importance of prompting self-care and awareness-raising, encouraging proper management of subordinates, providing consultation based on organizational analysis, and so on. The EAP service is an extra-organizational resource that provides support to both individuals and the organization. As the article explains the purpose of EAP, EAP is expected to greatly contribute not only to the health promotion of medical service workers but also to the prevention of errors associated with the provision of medical services.

Mental health care in occupational health has lately attracted considerable attention in Japan. The Partial Amendment to the Industrial Safety and Health Act in 2014 obliged companies to enforce stress checks by doctors and community health nurses. Lately presenteeism has been considered as the decline of occupational performance due to poor health conditions, has received attention in occupational health contexts, and has been considered to be severer than absenteeism which is loss due to absence at work. We must find a means to solve the problem of presenteeism in the health care activity of mental health departments in hospitals. The author approaches this research as an employee of Nishi Kobe Medical Center. It is anticipated that relationships at Nishi Kobe Medical Center will improve as a result of the author’s activity there. In the future, mental health promotion for presenteeism should be cooperatively developed and organized in the mental health division. Finally, it is believed that such health promotion activities will help to improve happiness in the workplace.

This article overviewed the diagnosis, etiology, and treatment for slight disturbance of consciousness and delirium. Clinicians especially pay attention to slight disturbance of consciousness, because it develops into delirium. We introduced the concept and definition of delirium proposed by two famous Japanese psychiatrists (Kenichi Harada and Joji Kandabashi) as well as DSM-5. We also referred to the reliability and validity of the delirium rating scale (DRS-R-98). We demonstrated that serum levels of MHPG, a major metabolite of norepinephrine, was significantly higher in delirious patients compared with those in healthy subjects, and surprisingly, serum MHPG levels in delirious patients were also higher before delirium had occurred. In short, over activity of noradrenergic neurons plays an important role for pathophysiology of delirium. Our series of previous studies elucidated that serum MHPG level is a biological marker for anxiety. Taking these findings into account, relief of patient’s anxiety might be an important factor in preventing delirium. Once delirium occurs, interventions with psychotropic drugs should be performed.

Objective: To investigate the incidence rate of steroid-induced mental disorders, and the relationship between mental disorders and steroid dose in inpatients who consulted the consultation-liaison service (CL) of Kyushu University Hospital. Method: In this study, we calculated the incidence rate of steroid-induced mental disorders among 1,106 CL-referred inpatients from all departments in the hospital from April 2008 to March 2011. In addition, we assessed medical records of 1,389 steroid-dosed inpatients from five departments in which steroid-induced mental disorders occurred frequently. (1) Using the chi square test, the relationship between steroid dose and administration method was analyzed in all steroid-dosed inpatients from the five departments (n=1,389), regardless of whether they were referred to the CL. (2) Multivariate logistic regression analysis was used to analyze the interaction between steroid-induced mental disorders (16/69) and clinical factors (sex, age, steroid dose and administration method, and referral client) in inpatients referred to the CL (n=69) from these five departments. Results: The incidence rate of steroid-induced mental disorders among CL-referred inpatients was 2.3% (25/1,106). The cumulative dose of steroids administered in the month prior to CL consultation was significantly higher in the inpatients diagnosed with steroid-induced mental disorders than in those who were not diagnosed with steroid-induced mental disorders. On the other hand, the peak dose administered over the same duration to the inpatients diagnosed with steroid-induced mental disorders was not statistically higher than that in inpatients without steroid-induced mental disorders. Conclusions: Our findings suggest that a high cumulative dose of steroids in the previous month may be a risk factor for steroid-induced mental disorders.