 Hello everyone. Good morning, good evening wherever you may be. Welcome to looking to the east. My name is Steve Zercher. I'm a professor at Kansai Gaida University professor of management and a Dean there. This is a show that I host twice a month, where we look at issues trends. Interesting phenomenon in the east, primarily Japan, which is where I'm located you can see here I am in Kobe, Japan. Oh, you're welcome to send us questions during the show if you like about the topic the topic today is mental health in Japan. And I decided to put together this show for a couple of reasons. I think that the coverage of mental health issues in Japan. It's not not well, well analyzed or well distributed and also I think that those of you in the United States and Hawaii in particular may not understand some of the challenges that Japan has in the mental health area. So that's the purpose of the show and I have a very, very special guest with me on this show she graciously has agreed to wake up early on our Tuesday morning here and discuss with us this particular topic. My name is Vicky Scorgi Vicky. Thank you so much for participating and being with us this morning on this very important topic. Thank you Steve for the invite. Yeah, absolutely and Vicky is associated with an organization that will discuss for the course of the show as well called tell Japan. And that that is a call in service, specifically focused on mental health issues and suicide prevention, for example. I think Vicky, what we should do is not assume that our viewers or listeners understand about some of the challenges that Japan faces from a mental health issue. I think the general perception of Japan is a very positive industrious type of organization country, great accomplishments and so forth. I don't think the discussion of some of the challenges that this country faces in the mental health area. So, from your perspective, from your organization which is directly in touch with all of these issues, could you give us an overview of mental health conditions in Japan some of the challenges and so forth that you guys have observed over the years. So mental health exists everywhere. Right. So we all have physical health and we all have mental health and the Japanese have mental health issues just like everybody else has. However, how we talk about mental health can be different from country to country and how we treat mental health can be different from country to country. If you like stigma or acceptance of the topic also varies. So in more developed countries or Western countries or European countries where they've had a long history of study around the topic of psychology and mental health issues. It's more acceptable and the treatment options are more well accepted if you like or developed than maybe many of the Asian countries. So when you're looking at the issue in Japan, I think it's quite not uncommon across many Asian countries or developed countries or developing countries sorry that that understanding or that social acceptance of mental health issues is a little bit different. And in Japan. Often, it'll get a lot of attention about the high suicide rates. Right. So it looks like on when you look at the number of people who have or are registered as having mental health issues is low per capita. But the suicide rate is really high. And that is that gap between the people feeling like well I can get some treatment or support for my mental health condition or even understanding that I have a mental health condition. And ending up at that end point where you think I can't cope anymore and this is my only option out. So that high suicide rate is an indicator that things aren't so great here in Japan. The other thing I was going to say the other thing that happens in Japan is they have very high hospitalization rates for mental health conditions and long hospital stays. So the treatment options here are more likely to be if you do get treatment that you're going to be hospitalized and you're going to be hospitalized for a greater length of time. Or on your health national health insurance, you can't see a counselor. It's not covered, but you can see a psychiatrist. So people will end up seeing a psychiatrist who hasn't they are so overwhelmed with and don't have enough time to do the if you like the psychological treatment options with them. So they're more likely to be medicated. So here in Japan, if you do have a mental health condition, you're more likely to be medicated heavily or hospitalized if it's really serious. And that doesn't give those who are dealing with mental health problems or or caring for someone with a mental health problem. A lot of confidence that I can continue doing my work or, you know, I can still function. So it's sort of like catching it at the end stage rather than doing some of that preventative work. Yeah, a couple, couple comments based on your description. I, I'm going to give away my age here but I came to Japan as an exchange student actually to the university where I'm a dean and instructor now. And I lived in a homestay and close to where this this home was was a session beyond mental health. So I guess you could call it a hospital but it actually looked more like a prison frankly, and it was built so that you could not really see into it. And the only reason I knew it was a mental health institution was that my parents told my Japanese parents told me about it. But there was a very strong sense that the people that were in there needed to be excluded or hidden. Things have changed dramatically since I was a student I think but that's just an example of how aberrations in people's behavior or both a mental aspect or physical aspect have historically been hidden. Like for example, disabled people now you see them, and there's elevators for them and pathways for them and Japan's kind of responded to the fact that there are disabled people in this country but many years ago it was it was this pretending that they, they didn't exist so that's that's one thing so that's my observation of Japan over the years is an alignment with what you're talking about. Similarly, when it comes to counselors, our exchange program at Kansai guide I brings in 300 to 400 foreign students. And many of them actually a remarkably high number, especially Americans are on some kind of mental health medication or on some kind of program. And that prompted me to set up counseling at Kansai guide I specifically for the foreign students. The school also has that for Japanese students. It was really difficult finding someone to, to help in this area so you're right this kind of mid area where, as an American, my family and others and my friends have access to just general counseling which is a great service in Japan that's just underdeveloped. Can you explain why that is, is it, is it reflective of the general perception of mental health in Japan that people tend not to be interested in becoming counselors or some kinds of, you know, psychotrists are an option for people in the mid range rather than, you know, just a psychiatrist as a final choice. So you have a lot in Japan. There's more recognition of that psychiatrist or going down that medical model. There are psychologists here at the, if you are looking at their ranking or even their licensing bodies. It's really not as sophisticated or developed as it is in, say, the United States or where I'm from from Australia. Right. It's, it's in the infancy and it's just beginning to think about licensing. So there's no real body that's really saying well this is what you need to do to offer to be a clinical psychologist right so my background is in psychology and neuropsychology. Right. So, and our bodies are very clear about what I can and can't do with a particular qualification and I must keep my license up to date. All of those sorts of things. It's not so regulated here. So it's really difficult to sort of find someone even if you did find someone and say, are they actually qualified to do to treat me do they know best practice are they keeping up to date with these things. And that's part of the reason that telexists, because when our crisis line was dealing with people who are suicidal or they were dealing with a whole lot of mental health issues, we needed people to refer them to, and we couldn't find any real qualified even though this is your, your primary right. Wow. Correct. So in the 90s we set up a clinic where everybody that we have that's working for us is fully licensed and qualified and we can trust those qualifications and marriage. We make sure that they're keeping them up to date so we know okay well this is somewhere we can refer those people that are struggling, but you're right it's, it's a, it's a gap, but they're trying to address. So, I do want to talk about tell in more detail and the services, I did find your referral service when I was looking myself. And that was the really the only resource that I found to help me set up a counselor at the consign guide I, but before we start talking about telling more detail. I, there's many articles that I read in preparing for the show and also statistics now that indicate that COVID has had an effect on the mental health condition in Japan, which again as you point out is probably a worldwide phenomenon. But the suicide rate in Japan which had peaked at over 30,000 a number of years ago, had been going down year by year and this is in part because of a government effort to try and create suicide prevention policies procedures. But unfortunately in 2020 reversed, and the number actually increased for the first time in many years as I think you mentioned it was around 21,000. What is your observation through tell about what's happened in the last couple of years in terms of mental health issues in Japan. So maybe I'll start with that broader picture right so one of the things that tell knows about disasters is that in when the earthquake happened in 2011. We became involved with an organization Mary care that helped us set up psychological first aid for Japan so it helped us train first responders and those that are dealing with people in disasters. How to support them so they're going to have less damage right and be more resilient recover quicker. And with that there's a whole body of research that tells us how people are going to respond in disasters, and they also tell us about the percentage of individuals that might develop if you like, ongoing mental health issues following a disaster, and how to support those during a disaster. Right from the beginning of covert we were out there at the front sort of telling organizations whether it was schools businesses community anybody that will listen to us. This is what's coming and this is what you need to do to look after your mental health. And we're still in it where we're not at that post phase yet, but also it tells us to look at vulnerable populations. And when you look at the suicide rates here in Japan, Japan actually puts out suicide rates every year. So yes, Japan suicide rates have gone up and I'll talk a little bit about those particular populations that have been where did go up, and the impact that covert's had on them. But it's probably gone up in many other countries as well. You just not haven't seen that you just haven't seen the data yet. So we know that mental health went up everywhere. We know that everybody was experiencing a lot of stress and a lot of anxiety. And also on our line, which coincided when the suicide rates went up in Japan around September, October, the mood changed from anxiety initially and stresses to more of a heavy tone and more depression. And we started getting a whole lot of calls about suicide and it wasn't that time September, October, this year, just recently, last year, last year, last year, sorry, last year. So around that time, last year, the mood really changed. And since then, it's been heavy. And at that time, that's when the suicide rates actually peaked around that September, October, November of last year. And it was women in particular, because they were impacted globally and here in Japan, more so by the pandemic. And here in Japan, I think women have less choices and options to support them. So they're more likely to be in jobs where they were part-time, caring positions, hospitality, you know, tourism. Those positions that were really impacted either lost their income or incredible stresses placed upon them. Also when the schools closed initially and people were working from home and the schools were at home, it was the women that had to pick up that load even if they were working. So that shared responsibility of tasks is less developed, if you like. Here in Japan, the roles are stricter. So on many levels, the women were experiencing the stresses and they felt that they had nowhere to go. And I'll also talk to you about a survey by a group called She-Stan. And they did a survey of 4,000 people and the women in that group that they were talking to, this is in 2020, said that they felt 90% of them said that they felt envious of men. They felt that men in Japan had a lot more options for work, for life, for choices than they did. So that's quite telling of what was going on. The other group that were under enormous pressures were university students. A lot of them were depending on income. Again, they were in those groups that lost their income or they were thinking that they were going to go to university and have this wonderful experience and it didn't happen. So you had a lot of youth that were struggling and if you don't get that support and you're not seeking treatment, the depression takes over and you start to feel like, well, I have no options, I am a failure. People would be better off without me. That's what happened. Wow. Interesting analysis. Regarding the students, that's my world since I'm a Kansai Gaidae and that's the last two years basically we've either been in full online mode or in hybrid mode. And anecdotally from the professors, we see the stress that the students are under. And also interesting, something we've observed just recently, Vicki, which maybe fits in with the analysis that you just discussed. When the pandemic started early spring last year and we switched over to online education, there were many, many complaints from the students that they hated it. They were just like taking their courses through a screen, they missed their friends and so forth. We're in hybrid mode now, a year and a half later, a year and a half plus later. So the students have the option of coming to campus or taking the courses at home. And what professors are telling me now is that the students are electing to stay at home. We'll be back on campus again, which we have felt initially when we switched over to online in spring 2020. Now is coming to the point where the students really don't want to come to school, it seems like. So if you go to a classroom there might be five students there and then 25 or so that the proportions, you know, 10% or 50% are in class, and many are choosing not to come to class so they're, you know, maybe the students have accommodated this kind of isolation or screen based education and maybe the desire to be with their friends and to be in a social environment. I'm just speculating this is just very narrow data, maybe that's changed over the last year and a half or two years now that we've endured this pandemic. We've got a lot of things going on there. So initially you're right, we all sort of, when we were all told to work from home or do our classes from home, there was a lot of stress and anxiety about that change, right. And there was no choice, right, and it impacted all aspects of our lives. So that was really stressful. Over time, just like you were saying, people have adapted. It's the same in the workplace. Initially people were complaining, we don't want to be at home. We really miss the workplace. But now they're sort of saying, well, now I've adjusted to it and there are some good things about it. And there are some things that I don't like about it. Right. So now they're wanting to have some choice and some options. But when you look at your students, I think you might also have different populations. You may also have those that have mental health conditions and don't want to come back and be seen on campus. You may have those who, you know, it's been a big increase in obsessive compulsive disorders or those who've got anxieties about worrying that they're going to be impacted by others, right, or get germs or, you know, a lot of social anxiety. So there are, you know, there's a combination of why you might be seeing that in your students. The other thing I'll say to you is that even before the pandemic, there was a lot of research in Japan saying that university students were already experiencing an increase in anxiety and depression, not just even in Japan, but around the world. And that's kind of one of those really high periods of stress in a young person's life. And maybe the other thing I'll throw in here that 75% of all mental health conditions have their onset before the age of 24. Okay. So here you are, and you're making that transition, and it's a very challenging period, never mind COVID. Right. So I think you've got, this is already a stressful period. You've got the challenges of COVID. And now you've got this, what's the state that we're in now, right? So I would be, I would think you've got some that are making a healthy choice, some that are hiding mental health issues, if you've got a combination of things happening. I agree with you. The mental stresses and challenges and students certainly predates COVID. So the incidents of mental health withdrawals from classes going up prior to COVID with Japanese students. Again, the perception, the general perception is, at least I think it is, is that the student life is an enjoyable period, you don't have to work, you know, and so forth, but I agree with you, students are working. They're in a position and so forth. So they were showing signs of that. And as I mentioned, the foreign students and Americans in particular seem to be the highest. Many of them are on medication of some sort. So it's a high percentage. We see it on the applications that are coming in. So just to sum up what you were saying before, so through COVID, the stresses on mental health seem to be growing faster within women, as opposed to men. I think traditionally, when I think of suicide in Japan, it's usually middle-aged men or older men, you know, for example, people who lose their jobs because of retirement seem to be particularly high. And then also university students, as we discussed, those two demographics seem to be the ones that are the most affected by the pandemic over the last two years. So men have been impacted by the pandemic. That's something that was happening around the 2000s. But the highest suicide group is typically elderly. What's my point here? You've got a lot of elderly in Japan that are all around the country and feeling like they're a burden. So that was the highest suicide group for a long time. But the pandemic, you're seeing particular groups at the moment, and it may change in the post-COVID phase or the endemic COVID phase. Whatever this next phase looks like, it may be different populations that are impacted. But through this current phase, it's been the women primarily in those occupations. They're more likely to be in those caring roles, caring for someone in the hospital, caring for someone in an aged care facility, caring for an elderly parent at home, caring for young children. They've been under an awful lot of stress and the young students going into university because that was already a key period. And you mentioned that the American students were already on their applications. Here in Japan, because of that stigma, it's unlikely to have been recognized. So they're probably dealing with it just the same. It's just not noted or getting support. Okay, this has been so interesting. We're coming to the close of the show and I wanted you to talk about your organization. So can you give briefly, we have about five minutes or so, the history of Tell Japan and some of the services you offer, and also how the viewers of this show can get involved and volunteer potentially. Yeah, sure. Thank you. We've been around since 1973. We are one of the founding members of Inochino-Denwa, which is the Japanese lifeline. They have a call centre in every prefecture around the country. And we look after the English language population. We were started by a group of churches and missionaries to provide that support and we've grown a lot over the years. As I was saying to you, initially, we didn't know where to refer. We were catching all of these people that were struggling, but we didn't know where to refer them. And in 1990, we established a clinic so that we could refer people to get that counselling support right after we caught them. They were no longer feeling suicidal, but they still needed treatment and support. So that's our clinic and our clinic has grown. Then we have a clinic in Kansai. We have them in Okinawa and we have them in various places around the country. And then more recently, we have established an outreach facility where we go out and we give talks to the community. We try to raise awareness about the signs of mental health issues, the signs of supporting someone who may be feeling suicidal, talking about at-risk populations, educating schools or anybody that will listen to us about mental health and trying to raise awareness about this topic and get people the support that they need. Because the thing is, with treatment, people do get better. We don't have to have suicides. We spend a lot of this time talking about suicide, but suicide is an outcome of a mental health issue that's not treated. So let's talk about it. So how can our view is that they are interested in assisting? I guess I can just Google, tell Japan, you have websites and so forth. And I know that you have programs too for those people who are viewing this in Japan to become volunteers for the teleline of what you manage. Correct. I've often thought about doing it myself. It's just a matter of time for me. But can you please describe that? We have just a minute or so left, unfortunately. We've been inundated with the amount of calls that we couldn't get to, and we would love to have our Lifeline Go 24-7. To do that, we need more volunteers. So if people are willing to help us, if they can go to our website, we're going to do three training sessions next year. So we're going to increase it. We have phone and we have chat support that we assist people with. So visit our website, telljp.com. If you are able to help, we'd love to hear from you. Thank you so much for two things. One for being on my humble show here and talking about this very, very important issue. I'm sure viewers have learned a great deal about what's really going on here in Japan, some of the trends and the explanation as to why Japan's suicide rate per capita tends to be on the high side. And also to promote your organization and for the wonderful service that you guys provide to the foreign community here in Japan. And also, I think you provide services in Japanese as well. Yeah, in our clinic and in the workshops we deliver, we offer the counselling support in a variety of languages, about seven, I think. Right, so those of you that are in Hawaii that are viewing this and your niece or son say, and you have cousins and family tell us helping your people your family as well through this outreach. Vicki, thank you so much. This went by so quickly. Really appreciate you spending time and explaining your program to our viewers. I really appreciate your being with me today. And for those of you viewers will be on in a couple of weeks or so I'm planning to do a show on nutrition in Japan, which is also kind of an emerging area, even though the perception that Japan diet is good. There are trends in the Japan diet that are not so positive that we'll take a look at as well. So Vicki again thank you so much really appreciate you being a part of my show today. Thank you for having me here. Thank you and if anybody needs support please reach out and get that support.