[Psychiatric Emergency/Acute Care Wards in Japan Present and Future Perspectives]

The prospective payment system in the psychiatric acute care ward began in 1996 in Japan. This was up-graded to the psychiatric emergency ward in 2002. Chiba Psychiatric Med- ical Center, the model institute of these wards, has been leading the transformation from asylums to therapeutic apparatus. Although emergency/acute care wards occupy only 8% of the total psychiatric beds in Japan, they cover 41% of annual admissions onto psychiatric wards because of their high bed turnover rate. Therefore, they contributed to reduce the aver- age length of stay to two-thirds, and for the numbers of inpatients to decrease by 11% up until 2012. The Ministry of Health, Labor and Welfare presented an image of future types of psychi- atric bed-emergency, acute, recovery, and severe chronic beds, and a plan to reduce long- stay patients. Outcomes and improvements of patients with severe mental illness in the emer- gency/acute care wards may be a determinant of the future design. We propose three plans to turn it into reality: increasing the number of psychiatric emergency wards/units in general hospitals, requiring some residency program in emergency wards to become a certified psychi- atric specialist, and limiting new admissions onto psychiatric emergency wards to involuntarily hospitalized patients. These plans could facilitate deinstitutionalization in Japan, sustaining the provision of continuous and responsible care.