July 10, 2020

#WhatWENeed Japan

Excerpts from TCI Asia Pacific Action in Japan


Osaka  – 22-23 November 2017

#WhatWENeed is peer support as community development, not “mental health care”

Excerpts from “TCI Asia Action in Japan”[1] [2]


One of the objectives of TCI AP’s Japan exchange were:

  • To bring a small group of peer support practitioners from TCI Asia membership and to have focused discussions on the importance of peer support in Asia.
  • It was also hoped that there will be a lively exchange with the Japanese government, and other key policy stakeholders, on the importance of peer support in Japan.  Being a high income economy, TCI Asia Pacific also learnt a lot about the highly institutionalized setting of mental health care.

Peer support movement in the way practised in the West has been there for at least 2 decades, as far as we know, in Asia (e.g. Hong Kong, Japan). Some leading user/survivor figures at the time, for e.g. Mary O’Hagan, supported the trainings and mentorship of DPOs in the countries[3]

Open Dialogue was also popular. Such community development methods were growing at a fast pace, with lead taken by organizations and by persons with psychosocial disabilities, particularly the Japan Group of Mentally Disabled People (JGMDP, Osaka).

In Osaka[4], we learnt that peer support for ‘Recovery’ (within the mental health system) and peer support for ‘Inclusion’ (as a part of community development) were two different pathways of actions.  The former is done within the medical paradigm;  the latter is within the disability / social inclusion paradigm.   

The Japan Health Department presented their study on the experiences of peer workers within their highly institutionalized mental health system. A high percentage of mental institutions in Japan are private and they have the typical warehousing design of colonial hospitals with a very high conduct of involuntary admissions. Hospital stay is very high in Japan, 275 days per person on an average. The Government is concerned, but hasn’t known how to work in communities. So they provided for special cadres of “peer supporters” who work in such highly institutionalized medical settings. Around 2000 peer supporters exist within the system.

While the stated objective of Peer Support in this framework was “living independently in communities” the program did not have the desired effect. Community care is not making good progress from the view of the health department – readmission, revolving door phenomena, all continue to exist in Japan. The Ministry of Health did a survey on peer support utilization from 64 local municipalities. Participants had high experience as peer supporters with a 10.6 years average.

The definition of ‘peer supporter’ is not very uniform or even clear. Peer supporter activities – awareness and psycho-education, escort services for activities outside of hospital, running support groups, home visits assistance very much underpaid, with between 2.5 – 30 hours a week. Peer staff support medical consultations especially on medicine compliance. They provide decision making support within the medical system. They expected that their co workers will understand their disability, respect them as human beings, be recognized for their special skills, appreciate their professionalism and enjoy equal treatment. They also expected that their peer support work will be recognized. However, peer support work was not recognized and was undervalued within the system. 

The way peer support is being used in countries like Japan, Hong Kong raises the question of whether the expected outcome strengthening mental health treatment, or is it to strengthen the supports in the community. Peer supporters- are they to work more like personal assistants to the person with the disability, or more like a psychiatric nurse?

Within high income Asian countries, the role of the peer supporters are largely within the medical, often institution based, system. In Thailand, peer supporters can be exhorted to share confidential information by psychiatrists.  There was sharing of experiences about widespread ‘co-optation’ when peer supporters work within the system. There was a strong opinion that a peer supporter should give news about side effects of medication to the person with disability, whether they want to hear it or not.

Low and middle income country experience of peer support is more from the location of Disability Inclusive Development (Indonesia, Pakistan, India, Sri Lanka), within communities, informal support and going beyond medical role, towards access to a variety of support systems for enabling living in communities. There is more DPO led actions in these countries. In India, however, the situation is fast changing, with psychiatrists leading peer support efforts. It raises the question whether it is peer support at all.
In nearly all countries, using arts and performances, turning to nature / agriculture and running, football and sporting were included as part of self care and recovery; and as community development activities. Some countries enjoyed funding support from social welfare for some of these activities. In Japan, the use of rhythm and drumming to explore possibilities of dialogic communication was useful, and it was considered as the ‘Asian’ way by JNGMDP.

The question of ‘who pays’ for peer support services has a variety of responses in Asia.  Peer supporters staff are paid in places, but not peer supporters.  Its a part time or full job for some people. Others are working closer with community families, etc. where it may also be voluntary, stipend based, informal work, etc.

Peer support is a felt training need for all over the region. Different small and big groups of persons with psychosocial disabilities are practising it. However, locally adapted, culturally appropriate peer support models, in compliance with the CRPD need to be developed, for sustaining the movement and expanding it through the region.  There is a crying need for a regional training program, and having peer partnerships throughout Asia.
Japan National Group of Mentally Disabled Group (JNGMDG) is a Japan based organisation led by users survivors of psychiatry fighting against Japanese Ministry of Health and Welfare, mental hospitals, psychiatrists and discrimination against persons with psychosocial disabilities.  To contact them reach out to: scp_kirihara@yahoo.co.jp 


References

[1]  JNGMDP & TCI Asia (2017).  “TCI Asia Action in Japan: Peer Support”. Report of a Country Mission Visit to Japan, Ibaraki, Osaka, November  22-23,  2017.  Japan National Group of Mentally Disabled People (JNGMDP) in collaboration with TCI Asia,  Research Center of Ars Vivendi of Ritsumeikan University, and NPO Corporation Aru.  Report by TCI Asia, 2017.

[2]  Thanks to, the team of JNGMDP, for visioning, planning, mobilizing resources, leadership, cordial and generous hospitality; Core team of JNGMDP for the gracious partnership; Ito, Kasumi, JNGMDP for tireless admin, translation, organizing and local support work;  Shivani Gupta, for overall co-ordination and backend support.

[3] Anthony C. Stratford, Matt Halpin, Keely Phillips, Frances Skerritt, Anne Beales, Vincent Cheng, Magdel Hammond, Mary O’Hagan, Catherine Loreto, Kim Tiengtom, Benon Kobe, Steve Harrington, Dan Fisher & Larry Davidson (2017): “The growth of peer support: an international charter”. Journal of Mental Health.  To link to this article: http://dx.doi.org/10.1080/09638237.2017.1340593

[4]  TCI members and international participants who travelled to the meeting were, Indonesia (3); SriLanka (1);  Pakistan (1);  South Korea (1);  Thailand (2); Taiwan (3);  HongKong (2); China (2); India (1);  Japan (9 key members from different provinces).   In all, 66 people participated in the peer exchange. Importantly, there was provincial representation from Japan in the meetings. JNGMDP organized simultaneous translation services for the 23rd meeting. For the meeting on the 23rd, around 89 persons participated from all allied sectors. The Workshop attracted around 50 participants.


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