[Community mental health services in various cities in Hokkaido, Japan]

Mental health services in Japan have been changing from hospital-based ones to community based ones. Now we have to try to reduce the number of psychiatric beds by returning the inpatients who continue hospitalization for social reasons to the community. To achieve this goal successfully, we should enrich community mental healthcare and maintain accessibility to the hospital for all patients in the community. My experiences in the Soya area gave me some clues to overcoming these hardships. The number of the psychiatric beds in Soya is very small, but the ratio of psychinatric beds and group homes in Soya area is very high like Western countries. The extensive number of community-based residences compensates for psychiatric beds in Soya area. Plenty of resources and close cooperation are the key to the community mental health of the Soya area. About the accessibility to the hospital, psychiatric telemedicine is clue to overcome the disadvantage. The images and voice of the patients are good enough for the doctor to examine and all patients who use this system want to continue this. I got several clues from my own experiences in the Soya area to achieve deinstitutionalization successfully. I hope the experiences of many young psychiatrists contribute to improving community mental healthcare in Japan.