Why making mental health care more accessible is particularly challenging in Japan

The spread of COVID-19 deprived everyone of their regular routines and left many scars. In particular, the protracted pandemic had a major impact on the mental health of women and young people in Japan and it altered suicide trends in the country.

The Organization for Economic Cooperation and Development reported that the prevalence of depression in Japan doubled to 17.3% in 2020, up from 7.9% in 2013, while the number of suicides in Japan in 2020 increased for the first time in 11 years. The number of female suicides increased for the second year in a row and the number of suicides among elementary, junior high and high-school students has remained high since reaching a record high of 499 in 2020. In response to this, the Japanese government has adopted new suicide prevention guidelines with enhanced support for women and young people.

The Ministry of Health, Labour and Welfare's expert panel noted in its report that women are trapped physically and mentally, as spousal violence during the pandemic, child and nursing care fatigue and the economic impact of many part-time jobs have become more serious. It was also clear that children and youth who felt that they could not be themselves at home found life even more difficult because they spent longer at home due to school closures. The fragmentation of their connections at school and in their community deprived them of their purpose in life and left them with no place to escape.

While the prevalence of depression in Europe and the US is 20 to 30%, Japan has an extremely low prevalence rate of about 10%, yet it stands out among developed countries in terms of its suicide rate. Japan has a high suicide rate due to mental illness and a low depression prevalence rate. This is because the hurdle that needs to be jumped to seek medical care when feeling mentally challenged in Japan is extremely high for all mental illnesses, from mild anxiety and adjustment disorders to severe depression.

In Japan, only 6% of people have used psychological counselling for mental health problems, compared to 52% in Europe and the US Many people in Japan are under the impression that counselling is not readily available. Why is it that people go to the doctor if they have a fever, but tend to underestimate the state of their mental health even on days when they cannot get out of bed because they feel so down?

One of the reasons for the low penetration of counselling in Japan is the ingrained belief that enduring what is unacceptable is a virtue. Japanese people are reluctant to confide their mental difficulties to those closest to them and try to survive and overcome their mental illnesses.

In a country where peer pressure is strong and societal cooperation tends to take precedence over the individual, people are compelled to suppress their thoughts and feelings.

This happens when "living your own way" with different ideas and arguments from those around you goes against being the same as everyone else. While this Japanese-specific pressure has the benefit of increasing group cohesion, it can cause stress to the point where diversity is not respected and mental health is compromised.

Mental health literacy education has not been part of the school curriculum in Japan for a long time and most people have not had the opportunity to learn how to deal specifically with mental health issues. This year, for the first time in about 40 years, a course on prevention and recovery from mental illness has been added to high school health and physical education classes.

The goal is to help young people learn about mental illness, become aware of mental illness in themselves and those around them and develop the ability to take action to seek help at an early stage when they sense something is wrong. But, to protect children's minds, which fluctuate greatly as they grow up, it is crucial to provide them with opportunities to learn at an earlier age, from elementary and junior high school. And, we must remember that it is also essential to improve teachers’ knowledge and understanding of mental health issues. Education reform in schools, where children and youth spend the majority of their lives, is key.

A Japanese startup is confronting these challenges too. The emol app helps users face their emotions by recording their feelings and having a conversation with an AI robot. It provides emotional support to users who are in a state of fear or find it difficult to open up about their feelings to others. The results of these AI robot chat conversations are recorded and users can check their daily state of mind on a graph designed to help them calm down by looking at themselves objectively. The fact that this service can be easily used by people who are hesitant to visit a medical institution or use counselling services is expected to contribute greatly to the early detection and treatment of mental illness.

The spread of COVID-19 brought to prominence a complex and intertwined issue in Japanese society that has been overlooked until now. It is imperative to unravel one by one the factors that make life difficult for women and prevent young people from finding hope and taking countermeasures.

The World Economic Forum's Global Future Council on Mental Health, a multi-stakeholder network, aims to promote innovation in the area of mental health and help solve the global mental health crisis brought on by the pandemic.