The COVID-19 pandemic has drawn attention to children’s mental health around the world. In May 2020, the United Nations released a report on children’s mental health in the context of the pandemic. According to the report, restrictions in several countries have been associated with changes in children’s concentration, emotional stability, and nervousness. In Japan, the National Center for Child Health and Development’s “National Online Survey of Children’s Well-being During the COVID-19 Pandemic in Japan (Part 4)” found that, out of all the respondents, 15% of elementary school students (grades 4–6), 24% of junior high school students, and 30% of high school students had symptoms of depression. The findings highlighted the effects of COVID-19 on children’s mental health and reiterated the urgency of the issue. In addition to mental health, the state of child and maternal health care has recently emerged as a major theme in healthcare policy issues. All pregnant and nursing mothers must receive seamless medical care, welfare, and support from pregnancy to child-rearing, and children, from birth to adulthood.

In order to promote this social momentum and to contribute to the health of children in Japan, we launched the Child Health Project in 2020. The project aims to stimulate discussion in collaboration with domestic and international stakeholders and to make policy proposals based on evidence generated through research. In 2021, we started an initiative on children’s mental health to build on the knowledge gained through HGPI’s Mental Health Project. The initiative, “Building a Mental Health Education Program and Support System that Respects Children’s Rights,” aims to develop and test the effectiveness of a program to help children, mainly elementary and junior high school students, recognize and cope with their own mental health challenges and be able to ask for help when needed. In addition, we will examine concrete measures to prevent mental health problems by taking children’s voices seriously and respecting their right to advocate for themselves.

In this expert meeting, various stakeholders will discuss the policy issues surrounding child health and children’s mental health, as well as potential solutions. In the first session, we discussed the importance of providing comprehensive support for children’s mental health following the life course approach.

 

・・・

Child Health Project:
Building a Mental Health Education Program and Support System that Respects Children’s Rights
The First Expert Meeting: A Life Course Approach to Children’s Mental Health
Report

 

■ Overview

• Time: Thursday, December 16, 2021 from 18:00-20:00
• Location: Zoom Webinar
• Host: Health and Global Policy Institute (HGPI)
• With support from: The Nippon Foundation
• Languages: Japanese only

■ Program (Titles omitted)
18:00-18:05 Opening remarks and explanatory introduction
 Eri Yoshimura (Senior Manager, Health and Global Policy Institute)

18:05-18:25 Keynote Speech (1) Realizing a Society that Puts Children First
 Hanako Jimi (Member of the House of Councillors / Pediatrician)

18:25-18:55 Keynote Speech (2) Perspectives on a Society that Nurtures Children’s Mental Health – The Life Course Approach
 Yoko Kamio (Visiting Professor, Institute for Education and Human Development, Ochanomizu University)

19:00-20:00 Panel Discussion “Building a Mental Health Education and Support System for Children – A Life Course Perspective”
Panelists:
 Shinichi Ishikawa (Professor, Faculty of Psychology, Doshisha University)
 Yasutaka Ojio (Researcher, National Institute of Mental Health, National Center of Neurology and Psychiatry)
 Ayako Kanie (Visiting Researcher, National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry / Senior Medical Advisor, JOLLY GOOD, Inc.)
 Masaki Kojima (Psychiatry Officer, Mental Health and Disability Health Division, Department of Health and Welfare for Persons with Disabilities, Social Welfare and Victim’s Bureau, Ministry of Health, Labor and Welfare)
 Yoko Kamio

Moderator:
 Eri Yoshimura (Senior Manager, Health and Global Policy Institute)

 

Opening remarks and explanatory introduction
 Eri Yoshimura (Senior Manager, Health and Global Policy Institute)

Health and Global Policy Institute (HGPI) is an independent, non-profit, non-partisan health policy think tank with the mission of “achieving citizen-centered healthcare policy.” We bring together domestic and international multi-stakeholders from many different positions to hold global opinion exchanges while promoting discussions on level playing fields and working to generate feasible policy recommendations.

Recently, the situation surrounding children’s health in Japan, in particular children’s mental health, is growing more severe. The Coronavirus Disease 2019 (COVID-19) pandemic has only further aggravated this situation. Meanwhile, in the policy sphere, the enactment of the Basic Law for Child and Maternal Health and Child Development and news regarding the establishment of the Children and Families Agency are attracting a great deal of attention.[1] As a result, discussions on the best way of providing seamless support to children are growing more active. In response to this momentum, HGPI is also considering key policy agendas for children’s mental health. Starting last year, we have been conducting survey research and issuing policy recommendations for this issue.

Today, we are joined by people working actively at the forefront of this field. Together, I would like to deepen the discussion on how society can best support children’s mental health over the life course from pregnancy, early childhood, and to adulthood in each field including education, healthcare, and policy; in communities; and through cross-sectional collaboration.

 

Keynote Speech (1) Realizing a Society that Puts Children First
 Hanako Jimi (Member of the House of Councillors; Pediatrician)

• To address issues surrounding children’s mental health, major challenges have included centralizing the Government agencies handling those issues and securing an applicable budget

Although there are many issues involving children in Japan, one item that has been raised is the fact that various issues are handled by different Government offices and there is no centralized entity to direct them. The number of child suicides in 2020 was 499 – the most since such statistics were first collected. In children’s mental well-being, Japan ranks 37th out of 38 OECD members. Despite these circumstances, the budget for items related to children in Japan is only half the level of Denmark, Sweden, and the U.K.

• To achieve Children First policies, discussions on establishing the Children and Families Agency did not only involve experts; they were held with many parties from the general public and local communities

In May 2018, the non-partisan Diet Member’s Federation for the Promotion of the Basic Law for Child and Maternal Health and Child Development (Chairperson: Hanako Jimi) was established, and the Basic Law for Child and Maternal Health and Child Development was enacted with exceptional speed later that year in December. That law put a spotlight on issues like mental health support for expectant and nursing mothers, suicide among adolescents, and the promotion of early prevention and detection of child abuse. It also identifies “the best way to structure administrative organs for comprehensive promotion” as an item that needs consideration. These developments will be linked to discussions on the establishment of the Children and Families Agency.

With the goal of establishing the Children and Families Agency, I launched the “Study Group on Creating a Children’s Agency that Puts Children First” in February 2021. We have met many times to hear lectures from Japan’s top leaders in this field and collect voices from ordinary citizens, local assembly members, and local government officials through questionnaires. These voices were then reflected in our recommendations, including in a request from the Governor’s Association. Reports detailing our study sessions, recommendations, questionnaires, and guests can be found on a website specially set up for sharing that information called “The Road to the Establishment of the Children and Families Agency.”

• Five items are important to resolve issues facing children: appointing a full-time minister, establishing a strong coordinating authority, establishing a central entity for formulating and securing budgets for children, drafting a comprehensive agreement on children’s rights, and developing evidence informed policy and practice

The five foundational concepts of our second proposal were: (1) establish a full-time minister; (2) name a strong coordinating authority (to lead research, set target issues, plan measures, and implement solutions); (3) formulate and secure children’s policy-related budgets in a centralized manner; (4) draft a comprehensive agreement on children’s rights; and (5) adopt Evidence Informed Policy and Practice (EIPP). It illustrated how to transition from a traditional, disjointed administrative organization (which is divided vertically, horizontally, and among generations) to an organization that functions as a platform for solving issues facing children that links prefectural, local, and municipal governments and age groups.

• Expectations for future efforts for achieving a Children First society

In June 2021, the Cabinet approved the Basic Policies for Economic and Fiscal Management and Reform 2021 (or “Big Boned” Policy), which included measures for the creation of “an environment that ensures peace of mind for children who will shoulder the future” as well as measures to address child abuse. Then, the Working Group on the Promotion of Children’s Policies headed by Chief Cabinet Secretary Kato was established in July. In September, the Cabinet Secretariat established its Expert Committee on the Promotion of Children’s Policies, which submitted its report to Prime Minister Kishida in November. It is likely that a Cabinet Decision on the basic policy for the establishment of the Children and Families Agency will be made in December 2021.

I would like to express my sincere gratitude to the Nippon Foundation, Health and Global Policy Institute, and everyone else who devoted themselves to these efforts for achieving a Children First society. I would like to continue doing my utmost to work toward a society in which all children can grow healthy, quickly, and strong, and express their individuality.

 

Keynote Speech (2) Perspectives on a Society that Nurtures Children’s Mental Health – The Life Course Approach
 Yoko Kamio (Visiting Professor, Institute for Education and Human Development, Ochanomizu University)

• Issues in children’s mental health are also key issues related to life in society during adulthood, and in recent years, and there has been a paradigm shift to a public health model that focuses on prevention and early response

The World Health Organization (WHO) defines mental health as something that affects people’s thoughts, feelings, and behaviors that, when in a state of balance, helps people deal with the stresses of everyday living, interact with others, and make their own choices.

In other words, mental health does not refer to a state in which someone is affected by a mental disorder, it is something that affects everyone – from children to adults. Past efforts for mental health used a healthcare-based model in which the focus was on treating severe cases. In recent years, however, thinking has undergone a big shift to a public health-based model that focuses on prevention and early responses for all.

Issues facing mental health for children are important issues related to daily life in society during adulthood. It has been reported that one out of every two people will experience a mental health-related issue in their lifetime and that one out of every five children is living with a mental health-related issue. Furthermore, approximately half of adults with depression or anxiety disorders first experienced symptoms as children, and it has been pointed out that if these disorders go unaddressed during childhood, such as in cases that are temporary and do not become severe enough to require clinical diagnosis, it may result in a wide variety of damage when the affected person is an adult. This damage is not only limited to mental health; it may include physical health effects, trouble with the law, financial troubles, difficulties in social life, and increased suicide risk.

We sometimes see the phrase, “No health without mental health” in the slogans for measures in developed countries abroad. Based on the data from studies like these, it may also be safe to say, “No life without mental health.”

• It will be important to understand mental health-related issues in the context of the biopsychosocial model and develop long-term measures centered around the affected parties and that cover prevention, early response, education, and other aspects

As genome medicine continues to advance, we have entered an era in which genetic diversity has become a common topic. Mental health, however, must be considered in terms of the biopsychosocial model of health, which was first proposed several decades ago. To summarize, it treats the biological, psychological, and social aspects of health as closely related and as items that must be considered in a comprehensive manner. This also makes it clear that fragmented measures create big hurdles.

In June 2020, I held a discussion with Dr. Miyoko Watanabe, former vice-chairperson of the Science Council of Japan, titled, “Mental Health Problems that Emerged During the COVID-19 Pandemic: The End of the Pandemic and Beyond.” During the COVID-19 pandemic, mental health issues surfaced after physical and economic issues, but during that talk, I emphasized that the mental issues which emerged while society was disrupted during the pandemic were issues that had already existed and were intensified among people in vulnerable positions, like women and children.

In addition to temporary measures like stimulus packages, we also need a system for responding to mental health in the long term with an evidence-based design. Without including long-term perspectives such as future prevention, early response, and mental health education (that provides scientific knowledge and helps eliminate stigma), such policies cannot align with the Sustainable Development Goals (SDGs). Rather than isolating each issue and dealing with it at its own government department, we require a mental health care system that includes multisector, multidisciplinary cooperation and is centered on the individual. Without such a system, services will be inaccessible even if they are available.

• In light of known issues facing mental health in primary care like delayed initial examinations, long wait times for consultations due to patient overload at specialized institutions, and insufficient multi-disciplinary cooperation, the importance of a life course approach is becoming increasingly clear

A nationwide survey on conditions surrounding initial consultations for child psychiatry in Japan (presented by the Japanese Society for Child and Adolescent Psychiatry, 2019) found that age at first consultation varied widely, from preschool age to middle- and high-school age, with delays to initial consultations being particularly long for women and girls. Comorbidities with developmental disorders were observed in many cases, demonstrating the importance of comprehensive diagnosis and treatment for mental health. It also found that healthcare institutions are overwhelmed with tasks like preparing written opinions and medical certificates to be submitted to schools.

Responses to mental health in primary care is a qualitative issue. A quantitative issue is that long waiting lists for consultations have become a chronic problem due to the high concentration of patients at specialized institutions. Segmentation in the field is also making it difficult to share information vertically and horizontally with other fields, like education and welfare.

The importance of providing evidence that spans the life course for children’s mental health was also pointed out in “Mental Health 2020 – Proposal for Tomorrow: Five Perspectives on Mental Health Policy,” presented by HGPI in July 2020. Furthermore, the September 2021 edition of the Japanese Journal of Clinical Psychiatry published a special feature titled, “Considering Mental Health Over the Entire Life Course.”

To understand mental health, two perspectives are essential: the spectrum (which is a horizontal continuum) and the life course (which is a vertical continuum). I would like for the basic policy of the Children and Families Agency to include “prevention” with the life course in view.

• In order to incorporate a life course approach into children’s mental health policies, it will be necessary to bridge the gaps among ministries and agencies, to introduce more mental health education in schools, and to promote the creation of a mechanism that enables communities to provide integrated support

One recommendation for future measures for children’s mental health is to bridge gaps in past child and adolescent mental health measures that were formed due to fragmentation among departments. Research initiatives have been conducted by the Ministry of Health, Labor and Welfare (MHLW), the Japan Agency for Medical Research and Development (AMED), and the Ministry of Education, Culture, Sports, Science and Technology (MEXT); maternal and child health policies and children’s mental healthcare training has been handled by the Maternal and Child Health Division; support measures for people with developmental disabilities (such as the Training Project for Improving Family Doctors’ Ability to Respond to Developmental Disabilities and the Project to Eliminate Waiting Lists for Medical Institutions Specializing in Developmental Disabilities) have been handled by the Welfare Division for Persons with Disabilities; and school mental health has been the jurisdiction of MEXT. To address this, it will be necessary to allocate limited resources in an efficient and evidence-based manner.

The “Recommendations for the Healthy Development of the Next Generation” (presented by the Subcommittee on Birth and Development of the Science Council of Japan’s Clinical Medicine Committee on August 21, 2014) pointed out that drawing public attention to children’s mental health issues and eliminating prejudice will be essential for promoting measures for children’s mental health. The introduction and promotion of children’s mental health in school curriculums is also necessary. It is also necessary to develop human resources for providing primary care, which can be expected to lower the number of referrals and prescriptions while decreasing healthcare expenditures (Cochrane Review, 2010).

It will also be necessary to advance the creation of a comprehensive research system to develop prevention and treatment methods (by building social consensus on how to best gather and share information and by utilizing big data) and an integrated community care network (spanning healthcare, welfare, and education) that can also respond to children’s mental health.

Role sharing and complementary cooperation among primary healthcare (family, preschool, and school doctors), secondary healthcare (diagnosis), and tertiary healthcare (specialized institutions) in child rearing, child development, and employment will make it possible to provide support efficiently. As one kind of collaboration between education and the healthcare economy, I think we should aim to establish a system in which care is provided in schools using evidence-based expertise without relying too much on services outside schools. It will also be necessary to have efforts that allow for the PDCA cycle to be applied even after people are admitted to healthcare institutions.

 

Panel Discussion
Building a Mental Health Education and Support System for Children – A Life Course Perspective

Provide Opportunities for People to Recognize Mental Health as an Issue That Affects Them
 Yasutaka Ojio (Researcher, National Institute of Mental Health, National Center of Neurology and Psychiatry)

• The Government’s new school curriculum guidelines released in recent years have expanded content regarding mental health throughout elementary, middle, and high school education, and starting in FY2022, “Prevention of and recovery from mental illness” will be covered in high school health education

The Government’s new school curriculum guidelines have expanded content regarding mental health throughout elementary, middle, and high school education. Starting in FY2020, guidelines for fifth-grade elementary school students will change from, “Enable students to understand mental development and how to respond to anxiety and distress,” to “While enabling students to understand [mental health, anxiety, and distress], empower them to take simple measures to respond to them.” In middle schools, the “Healthy Lifestyles and Disease Prevention” course was split in FY2021, so instead of only being conducted in the third year of middle school, it is now conducted during all three years.

Starting in FY2022, “prevention of and recovery from mental illness” will be covered during high school health education. An animated video series called “Sanita Mental Health Class” is already viewable on the web. Using an emotional approach that draws on elements of storytelling and documentaries, it aims to improve mental health literacy among adolescents while reducing stigma. Visitors to the Sanita website can also view interviews with people who have experienced mental disorders and hear their stories.

• At the same time, measures for improving mental health literacy among surrounding adults outside of schools and who can influence changes in behavior among children are also necessary

School education for building mental health literacy is likely to result in better knowledge regarding mental disorders and their management, to improve attitudes toward mental disorders and people who have experienced them, and to change behavior among students, such as by helping them ask for advice in times of trouble to reach out to those around them when they are experiencing distress. However, since other factors and elements can influence changes in behavior, it will also be necessary to simultaneously improve mental health literacy among surrounding adults such as teachers, parents, community members, and family doctors.

A current initiative called the “Weakness is Strength Project” is a mental health project “from athletes, by athletes, and for everyone” operating under the leadership of the Japan Rugby Players Association. In that project, professional athletes are utilizing their influence to communicate about mental wellbeing, including accepting one’s mental condition including during times of distress, engaging in mutual support with the people you trust instead of enduring it alone, and solving issues together to move forward.

 

A Preventive Approach to Mental Health to Implement in School Education
Shinichi Ishikawa (Professor, Faculty of Psychology, Doshisha University)

• Certain school mental health prevention programs have, in recent years, made concentrated efforts to introduce child-friendly education methods like comics and group activities

Looking at past trends in research regarding mental health prevention programs in schools, we see it has been on a per school basis. Group social skill training programs have been conducted since 2000, depression prevention programs have been conducted since 2008, and mental health prevention programs have been conducted starting in 2014. In these programs, school teachers use Evidence-Based Practice (EBP) methods to provide psychosocial support to promote protective factors for all students in a classroom format.

In 2020, an initiative called “Creating programs and a human resources development system for improving resilience from early childhood to adolescence” (Lead researcher: Shinichi Ishikawa) was selected by the Japan Science and Technology Agency’s Research Institute Science & Technology for Society (RISTEX) for the Solution-Driven Co-creative R&D Program for SDGs (SOLVE for SDGs). Efforts are being made through that program to help children learn how to cope with mental health issues without straining themselves. These efforts include creating lesson plans and worksheets, finding new ways to use comics to present issues and examples using characters, sharing positive-minded explanations using metaphors, and emphasizing group activities.
 

• There has been accumulating evidence in recent years that educational interventions for children are effective at improving self-efficacy and at reducing general difficulties

One trial that involved 396 children in grades four through six at eight elementary schools (Oka et al., 2021) showed educational interventions had significant overall effects at improving self-efficacy and social skills while decreasing general difficulties. It also demonstrated significant effects in the group with high autistic traits, such as increased self-efficacy and decreased general difficulties.

Furthermore, for groups with high autistic traits, it has been shown that even relatively light interventions were effective to a certain degree (Kishida et al., under review), and in a trial conducted during temporary school closures due to COVID-19, overall anxiety was significantly reduced with particularly strong effects in the high anxiety group.

• When popularizing mental health prevention, it is important to clearly communicate the objectives, the organization conducting the program, and the timing and duration of the program; and to adopt initiatives that are based on evidence

Such forms of universal protection can be provided in various settings, including education, welfare, and healthcare. As for issues facing the popularization of mental health prevention, first, it is important to clarify the objective, be it cross-diagnosis, initial prevention, or risk prevention. Then, it is important to consider who will be conducting the programs, like teachers, school counselors, or school social workers; and what field they will be conducted in, such as education, psychology, welfare, or healthcare. Other items to consider include when to introduce the programs (during which grade) and how long to conduct follow-ups. It is particularly important to rely on evidence when considering which initiatives to adopt.

 

Getting Closer to the Individual Through Digital Health
 Ayako Kanie (Visiting Researcher, National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry; Senior Medical Advisor, JOLLY GOOD, Inc.)

• Digital healthcare has great potential to enable a seamless approach that reaches all age groups

When taking a seamless approach to all age groups, one encounters the challenge that it is impossible to be close to everyone. I believe digital health can resolve this issue. I would like to introduce my own experiences regarding the answer to the question, “How can human warmth be created through digital technology?”

The first example is an intervention provided during pregnancy and after childbirth to fathers and other partners of new mothers using the LINE social messaging system. About 10% of fathers experience depression, which is not much lower than the rate mothers experience depression during and after pregnancy, which is 10% to 20%. Mental disorders during the perinatal period can reduce child care quality and increase the risk of abuse, which can then cause delayed neurodevelopment and increased risk of mental disorders in children.

We know that fathers are less likely to seek help for mental health-related issues, and a study from Australia reported that interventions over text message can be effective for reaching them. In the Kizuna Mail Project, medically accurate and kindhearted text messages were sent on LINE and other services. These messages were tailored to the week of pregnancy and after childbirth. We thought using LINE would be effective because messages would be sent automatically, without the fathers having to request support every time they needed it.

The Kizuna Mail Project then conducted a joint study with the National Center of Neurology and Psychiatry (NCNP) called “A randomized controlled trial using text messaging to improve mental health among fathers during the perinatal period.” That system makes it possible to deliver human warmth digitally to parents through kindhearted messages sent at the most appropriate times, tailored to user attributes, and under the supervision of specialists.

The second example is an intervention for middle and high school students using a smartphone application. According to a survey conducted among 20,000 adolescents who were middle and high school students, common issues that were reported included troubles related to grades, future paths in life, the body, and relationships with friends. It also found that many students – up to 5% – have attempted suicide.

The lesson section of the app features a cat character who shares content that aims to help address issues faced by children during adolescence. It was designed to be easy to read like the LINE app. Using information based on evidence from cognitive behavioral therapy (CBT), app users can make daily records. As for how it delivers human warmth digitally, it helps users develop skills at an early age needed to identify sources of stress or their own emotions and respond to them or seek help. The children are also provided with twenty-four hour suicide prevention support.

The third example is a system for providing social skill training (SST) to children with autism spectrum disorders using support provided through virtual reality (VR). Using real-world spaces recreated in VR as the educational material, the children are able to repeatedly practice talking with friends, interacting with superiors, and responding to things that trouble them while maintaining peace of mind in a virtual space where they are allowed to make mistakes. This helps them deepen self-understanding and learn coping methods. Additionally, by automating the progression, the people in supporting roles are able to focus on what the children really need despite differences in supporter experience level and ability.

• Promoting the effective use of digital health, which can deliver human warmth, will enable the creation of systems that allow people to focus on the tasks that can only be performed by people

To stay closer to more people while maintaining human warmth, the key question in future mental health care will be how to make people feel human warmth that is delivered digitally. Experiments in which tasks that cannot be performed by people are performed using digital technology are also important. These might include providing daily messages in a timely manner or creating safe, calm spaces by watching over people around the clock. Forms of digital healthcare like these will make it possible to deliver human warmth.

However, there are still things that can never be replaced by digital tools. These are empathy, care, and hugs. To provide seamless support, digital health tools should be used to replace what they can and enable people to focus on the people in front of them regardless of their abilities and experience levels to help create a kinder future.

 

An Overview of Child and Adolescent Mental Disorders
Masaki Kojima (Psychiatry Officer, Mental Health and Disability Health Division, Department of Health and Welfare for Persons with Disabilities, Social Welfare and Victim’s Bureau, Ministry of Health, Labor and Welfare) 

• The number of children and adolescents with mental disorders has been increasing in recent years, and the types of disorders they experience are more diverse than adults and include developmental disorders, schizophrenia, and neurotic disorders

Child and adolescent mental health care mainly handles mental health issues for people under age twenty. In addition to mental disorders like developmental disorders or depression, there are also people who seek consultations for reasons like absenteeism or delayed speech in children at age three. There are many instances when this care requires coordination from and is performed across different institutions, such as schools and child consultation centers.

Looking at the total number of patients under age twenty with mental disorders by disease, we find that 276,000 people under age twenty with mental disorders were receiving continuous treatment at healthcare institutions in 2017. Their numbers have gradually increased since 1999, when the total was 117,000 people. There has been particularly large growth in the “Other mental and behavioral disorders” category, which includes developmental disorders.

Looking at the total number of people by hospitalization type and by disease, the number of people under age twenty hospitalized with mental disorders is trending slightly upwards. One factor behind this is the increase in child and adolescent psychiatric care beds. Among people under age twenty with mental disorders hospitalized in psychiatric care beds at the time of the survey, there was a greater variety of disorders compared to adults. These included psychological development disorders (developmental disorders, etc.), schizophrenia, and neurotic disorders.

• Among national policies, proactive initiatives are underway that include providing adolescent mental health training programs and adding the “inpatient child and adolescent psychiatric care management fee” to the medical service fee schedule

Looking at policy trends, starting in FY2001, the MHLW has been conducting a training program to develop specialists who can respond to issues in child and adolescent mental health. In that program, training on child and adolescent mental health is being provided to specialists like physicians, nurses, public health nurses, mental health social workers, and clinical psychiatric technicians. In FY2012, the “inpatient child and adolescent psychiatric care management fee” was newly added to the medical service fee schedule, which was paid to healthcare institutions in 19 prefectures as of 2016.

Regarding issues related to the healthcare provision system currently under consideration, the seventh revision of the Medical Care Plan System stated there is a need to clarify which healthcare institutions have the capacity to respond to child and adolescent mental disorders. It also stated that to promote the development of specialists who can treat child and adolescent mental disorders and to encourage coordination across multiple disciplines and institutions, it will be necessary to reinforce the functions of regional and prefectural collaboration centers and that the aforementioned training program on adolescent mental health is to be utilized when doing so.

Training being provided in the adolescent mental health training program, which is being operated as an initiative for encouraging mental well-being, includes comprehensive, systematic lectures on child and adolescent mental health, group discussions and other practical training activities, and comprehensive training on the “Guidelines for Assessing and Supporting People with Acute Social Withdrawal.”

 

Panel Discussion Topic (1)
The Importance and Challenges of Adopting a Life Course Approach to Children’s Mental Health

• It is important to provide age-appropriate social skills education from childhood for children’s mental health prevention

There are preschools and nursery schools that provide social skills education. In these programs, children learn things like how to get along with friends from an early age. Based on that, the children can then use these skills at times they want to emphasize something or make themselves heard at elementary school. They can learn while being connected to others and become able to apply what they learned when facing difficult situations. It is important for lessons to be age-appropriate and to take the child’s abilities into account when starting out.

We should also view the many attachments formed with people like friends, siblings, and teachers in terms of the life course. Attitudes that are limited to childhood and parent-child relationships should be dispelled based on scientific evidence when establishing the Children and Families Agency.

• To respond to disparities in healthcare access that occur due to differences in household economic circumstances and health literacy, it will be necessary to utilize digital technology and have strong communication of information from specialists

Differences in economic and literacy capacities are creating disparity among families. For example, families with high health literacy and good economic circumstances are receiving Parent-Child Interaction Therapy (PCIT) for developmental disabilities from around age one. It is important for specialists to disseminate accurate information. One method of doing so might be to adopt digital technologies that can be utilized without disrupting anyone’s everyday life.

It is also necessary to assess and demonstrate the effectiveness of children’s mental health education already being provided. I look forward to society becoming a place where influential people from various fields speak up about mental health.

• It is important to build mental health literacy among all people in support roles that involve children

There are many cases in which family pediatricians or public health nurses at public health centers who are in contact with small children are worried they will cause harm by referring the child to a specialist. Time passes and diagnosis is delayed as a result. It is important for everyone in a support role that involves children to possess mental health literacy. Responding to issues before a child engages in self-injury or is still only “difficult to handle” opens up the possibility of using evidence-based, highly versatile therapies that can be effective without having to rely on medical specialists. Instead of highly specialized care, what is needed is generous Government support that enables communities to focus on children’s mental health.

 

Panel discussion Topic(2)
The Importance of Eliminating Siloed Measures to Enable Collaboration Among Education, Healthcare, and Government and Challenges for Doing So

• Issues in mental health span multiple fields, so cooperation from each related institution is needed for the smooth operation of programs

Mental health is not something that can be handled by any single institution operating alone. Cooperation is key. Use of online and video services has increased during the COVID-19 pandemic. This is also advancing progress on new forms of mental health care. I feel programs are operating smoothly where the relevant organizations are working together. It is also important to have horizontal connections like those between school teachers and school counselors when actually implementing mental health programs in real-world settings.

• When thinking about mental health issues using a life course approach, vertical divisions must be eliminated and data sharing must be made possible

In addition, in the life course approach, I think cooperation among each department, including linking of data, is important. For example, a program in which midwives can provide CBT has been created through cross-disciplinary collaboration between obstetrics and gynecology and psychiatry. I think developing an app for CBT with assistance from pediatricians who are performing medical examinations can facilitate collaboration. This is another major role of digital technology.

Also, instead of only presenting data, I also think it would be more relatable if young people who have experienced a mental disorder share messages, like in the Sanita initiative. Everyone should recognize that they are affected by mental health, not just people who have been diagnosed with a mental disorder.

 

[1] After this meeting, the Cabinet approved the basic policy for the Children and Families Agency on December 21, 2021. The agency will be established in 2023. At the time of this report, the official agency name has yet to be decided, so here it is referred to as the “Children and Families Agency.”