1. Takahiko Inagaki M.D. Department of Psychiatry, Shiga Prefectural Mental Medical Center Department of Psychiatry, Shiga University of Medical Science 6.3.2016 The 112 th Annual Meeting of the Japanese Society of Psychiatry and Neurology At Makuhari Messe, Chiba, Japan

2. Conflicts of Interest I was employed by an endowed chair sponsored by the Government of Shiga Prefecture, Japan Disclosure of research funding: National Mutual Insurance Federation of Agricultural Cooperatives Shionogi & Co., Ltd Otsuka Pharmaceutical Co., Ltd Shiga University of Medical Science The Shiga Medical Science Association for International Cooperation

3. Something Wrong in Japan 1)Report on School Basic Survey. Ministry of Education, Culture, Sports, Science and Technology, JAPAN. 2017 2)Report on School Withdrawals. Ministry of Education, Culture, Sports, Science and Technology, JAPAN. 2016 The number of junior high school students who withdrew from school was about 100,000 (2.8%). 1) Our government says that the 68.4% of the school withdrawals stay out of school for over one year. 2) Our government’s definition of school withdrawal excludes those who cannot go to school because of their illness. School withdrawal cases never receive the mental health services (MHS).

4. Something Wrong in Japan In Japan, the “school counselor” deployed in over 75% of all junior high schools. 1) They are defined to play a role in child welfare with regard to the connection between schools and MHS. In view of this fact, the rate of school withdrawals who do not receive MHS is extremely high! Perhaps, those in charge of child welfare do not trust MHS? 1) Conference material of Ministry of Education, Culture, Sports, Science and Technology, 2008

5. Failure of Cooperation between Welfare and MHS in Shiga Inagaki. T, Current trial of Child and Adolescent Mental Health in Shiga Prefecture, Japan, Psychiatry, 2016 (Japanese) Who have been referred to MHS before consulting to Welfare: 7 ％ Have never been referred to MHS: 93 ％ Percentage of welfare institutions that encourage referrals: 2 ％

6. Failure of Cooperation between Welfare and MHS in Shiga Educational Institutions Mental Health Service (MHS) Governmental Agency Job Assistance Agency Welfare Agency Principles & Family ×

7. Failure of Cooperation between Welfare and MHS in Shiga Inagaki. T, Current trial of Child and Adolescent Mental Health in Shiga Prefecture, Japan, Psychiatry, 2016 (Japanese)

9. Lack of Skilled Services in MHS for Management of Child and Adolescent Mental Health (CAMH) The Japanese education system is responsible for CAMH We have no official license for child and adolescent psychiatrists. We have only private licenses certified by: The Japanese Society for Child and Adolescent Psychiatry (JSCAP) Japanese Society of Pediatric Psychiatry and Neurology (JSPPN) Unfortunately, these certification systems do not reflect the public needs. We can update our certification only by attending congress a few times.

10. Problem with Relaying Information about MHS to the Public In Japan, it is not common for MHS to disclose the treatment outcomes to the public and the government. For example, on Google Japan TM, if we search for “school withdrawal” and “treatment outcomes”, we obtain the information of only 2 institutes. Because of this, many Japanese, including the teachers and parents of children who withdraw from school, do not believe that MHS can treat the school withdrawal cases.

12. To Improve the Quality of Resources for CAMH New semi-official license system for doctors will start in 2017. In 2011, Investigative Commission for Medical Specialist was established in Ministry of Health, Labor and Welfare In 2014, Japanese Medical Specialty Board was established and now they are programming of new training system for every medical field including CAMH. The program includes not only the certification but lifelong education. We can raise the baseline for clinical techniques

14. Lack of Skill Lack of Information What Interferes with the Cooperation between Welfare and MHS? MHSWelfare ×

15. My Proposal We should create a system to declare our treatment results to the public and government. The public are unaware of the treatment efficacy. We should provide them with the appropriate information. For technical improvement, the appropriate comparison is necessary between the therapists or the clinics. Inagaki. T, Significance to disclose the outcome to the public: Introduction. Japanese Bulletin of Social Psychiatry. Vol.25(1):33-35, 2016. (Japanese)

16. Lack of Skill Lack of Information How to Improve the Cooperation between Welfare and MHS? MHSWelfare ×

17. Summary In Japan, many children and adolescents who needs for help do not receive MHS. But many children and adolescents receive the welfare services. The welfare agencies do not encourage the referrals to MHS because of their dissatisfaction. I consider two causes of this situation as shown below; Lack of skill of MHS Misunderstanding regarding MHS’ role from lack of information. We have already started establishing new certification system. I propose to create the disclosure system of information for our treatment results to the public and government in MHS. To provide the appropriate information to the government and public. To provide the appropriate comparison to improve our clinical technique.

18. kerosuke3@gmail.com