The environment surrounding psychiatrists continues to be more diversified beyond the boundary of medicine every year, thus it is expected that psychiatrists play an active role in a wider range of fields than ever before. It is possible by way of the training at departments of psychiatry at general hospitals to improve; 1) communication skills to facilitate the multidisciplinary approach and to act in line with group dynamics; 2) skills to ascertain what the consultees are truly in need of and to grasp their concerns; 3) skills to understand the circumstances surrounding the backgrounds of the consultees. The significance of training at departments of psychiatry at general hospitals involves development of skills required of psychiatrists beyond the narrow scope of “psychiatric care” to respond to real concerns and needs in various fields of society. However, it is difficult to understand fully the bright side of working at general hospitals without actually having the experience; thus, it would be important for younger psychiatrists to go through the training at general hospitals so they would be able to acquire skills required of the psychiatrists of today.

Reform of Japanese graduate medical education system in psychiatry will take place in 2018. To become a well-balanced professional psychiatrist, it is crucial for a resident to experience more practice based learning in a training program, accompanied with lively conferences and supervisions between residents and mentors. Likewise, much more emphasis should be placed on psychotherapy such as psychodynamic psychotherapy or cognitive behavioral therapy. However, human resources are in short supply for psychiatry education, and the author thinks that one of the primary causes of this is poor financial foundation. In contrast, in the U.S., a sponsoring institution receives approximately 120,000-130,000$ for each resident each year from graduate medical education funding, which enables psychiatric training programs to be comprehensive and sustainable. To ensure high quality of education, the Japanese Society of Psychiatry and Neurology and its affiliates should make efforts to raise funds to subsidize sponsoring institutions in some way or other, and the author suggests a few plans to realize it.

Consultation-Liaison Service (CLS) plays an important role in general hospitals to provide care to inpatients who have both mental and physical problems. We have been providing CLS by using the “Goyoukiki” way since 1983. Once a week, we visit all wards to ask ‘Is there anything I can do for you?’, regardless of whether there is a request or not. We can provide not only regular psychiatric consultation services but also routine guidance and supervision for ward stuff in charge of physical disorders to make preventive interventions at an earlier stage. It is also a useful method for education, and we expect that similar efforts will spread nationwide.

Cancer cooperation hospitals have been developed in Japan, and uniform cancer treatment has been promoted by national initiatives. As a result, establishment of "palliative care team" has been required at cancer cooperation hospitals with the aim of providing standard palliative care for cancer as early as possible after diagnosis. The palliative care team consists of doctors, nurses, pharmacists, clinical psychologists, nutritionists, etc, and psychiatrist are stipulated as an essential requirement for the personnel of the team. Participation by psychiatrists has great significance in the management of palliative care teams and the range of their activities is wide. However, it is difficult to determine whether psychiatrists are satisfied at cancer base hospitals nationwide. In addition, cancer patients and their families have psychological conditions and problems specific to the disease, and psychiatrists who are proficient in practice of oncology are required.

Hair-pulling disorder (HPD: trichotillomania) is a psychological condition that generally starts in childhood, and results in hair loss or thinning. Some behavioral approaches, including habit reversal training, are known to be effective for pediatric HPD, as they result in decreased hair-pulling behavior. However, very little is known about the treatment for those with chronic pediatric HPD who do not respond to behavioral approaches. In order to investigate better treatment approaches for pediatric HPD, we assessed the characteristics and the treatment of 9 school-aged outpatients, 6 months after their initial visit to the department of child psychiatry. Supportive and behavioral approaches including psychoeducation were shown to be effective for 4 patients without ASD (autism spectrum disorder). For one patient with ASD, a multi-dimensional approach was needed, which included collaborative care at school as well as for family support, and play therapy. The remaining 4 chronic HPD patients (two patients with and two without ASD) also needed a multi-dimensional approach. Our study suggested that essential treatment strategy for pediatric HPD should be supportive and behavioral at the beginning of treatment. For those with chronic HPD, the comorbid ASD should be assessed along with providing a multi-dimensional approach, including collaborative care with educational or welfare staff.