シンポジウム：Current Status of Psychiatry in Asian Countries

第135回日本精神神経学会総会

シ ⃞ン ⃞ポ ⃞ジ ⃞ウ ⃞ム⃞Current Status of Child and Adolescent Psychiatry in Japan
Mariko Setsuie , Naoki Hashimoto , Ryuji Sasaki , Masaru Tateno
1）Obihiro National Hospital, Department of Psychiatry and Neurology, 2）Japan Young Psychiatrist
Organization, 3）Hokkaido University Graduate School of Medicine, Department of Psychiatry,4）Division of Neuropsychiatry, Department of Clinical M edicine, Sunagawa City M edical Center,5）Sapporo M edical University, Department of Neuropsychiatry

Japan is behind in the area of child ander（This situation has not changed after theadolescent psychiatry training compared to

new clinical training was introduced in 2006 ）.

other developed countries like the USA . It is

One is to become a pediatrician and then spe-even very diﬃcult to deﬁne child and adolescentcialize in mental health, and the other is to

psychiatry in Japan,because both psychiatrists

become a psychiatrist, and then specialize forand pediatricians take part in the treatment ofchildren and adolescents.

children and adolescents with mental health

Although there were 14,700 pediatricians

problems. So, instead of the word “
child andand 12,474 psychiatrists in Japan in December

adolescent psychiatry”or “
child and adolescent2006 ,the number of CAMPs were only 70. On

psychiatrist”, I will use the term “child andthe other hand, the number of children andadolescent mental health”or “
child and adoles-adolescents who were under 20 years old werecent mental health practitioner”.

about 23,539,000 in Japan . So, the number ofCAMPs per 100 thousand children would beCurrent status of child and adolescentmental health in Japan0.30. This number is quite low compared to 12.
5 in Sweden, and 12.0 in Switzerland .

According to a report done bythe Japanese

In order to solve this problem, the Japanese

Ministry of Health, Labour and Welfare in

Ministry of Health Labour and Welfare has

2007, there are only about 70 child and adoles-

proposed a model training program for CAMPs

cent mental health practitioners（CAMPs）inin 2007 . The ﬁrst aim of the program was toJapan . Because there is no national board forenhance the skill of the general pediatricians

CAM Ps in Japan, this number was estimatedand psychiatrists who are taking care of chil-from the number of doctors who work for thedren with mental health problems. And thehospitals that have a special section or ward forsecond aim was to increase the number of child

child and adolescent mental health. In Japanand adolescent mental health specialists inthere are two totally diﬀerent ways to become

order to organize advanced and technical edu-a child and adolescent mental health practition-

cation and training（Fig. 1）.

精神経誌（2010）112 巻 2 号

136

Fig. 1 A model course of training for CAM P proposed by the Ministry of
Health, Labour and Welfare

Two years have passed since this proposal,trists） and child and adolescent mental

without seeing a noticeable change. There washealth pediatricians（CAM pediatricians）

a one‑day training course launched which was

are satisﬁed with their training respective-

supported by both the psychiatry associationly.

and pediatrics association but this was all and it

・To know how current clinical practices andwas held only once a year,in 2007 and 2008. So

knowledge between CAM psychiatrists andmy question would be,“What is the best way to

CAM pediatricians diﬀer.

become a CAMP ?”and “How can we make a・To know what CAM psychiatrists andbetter training system in Japan ?”. To answer

CAM pediatricians in Japan think is impor-this question, I thought it important to knowtant or necessary for developing a betterthe current status of CAMPs and diﬀerence

training system.

between the pediatricians and psychiatrists who

Subjects were the psychiatrists and pedia-

are specialized for the child and adolescenttricians whose subspecialty is or is going to bemental health problem. To achieve this pur-child and adolescent mental health.

pose,my colleagues and I conducted a questionnaire survey.

This was an internet questionnaire survey.
The study was performed from the 1st of April
2009 through the 30th of April 2009. Site inves-

The materials and methods oftigators were recruited through the Japanthe questionnaire survey

Young Psychiatrists Organization membersʼ

The aim of the study was as follows.

web sight, Japan Pediatrics Mailing List Con-・To know what kind of training Japanese

ference membersʼweb sight, and Japanese

CAMPs have taken.

Society of Pediatric Psychiatry membersʼweb・To know whether the child and adolescentsight. The purpose of this study was clearlymental health psychiatrists（CAM psychia-stated on the cover sheet of the questionnaireシンポジウム：Current Status of Psychiatry in Asian Countries

137

Table 1 Background
CAM Psychiatrist

CAM Pediatricianp value

52
31 2144
26 18

0.96

9.8（8.8)

11.2（10.0)

0.08

5232
00.33
＜0.0001

N
Male Femal
Experience(year, mean(S.D.))New clinical training program
Change the specialty＊ 1; chi square test, ＊ 2; studentʼ
s t test

Fig. 2 Do you think it is necessary for psychiatrist totrain pediatrics and vice versa ?

Fig. 3 For those who answered it is necessaryto train
vice versa, do you think it is easy to do so ?

and answering the questionnaire was consid-

in the experience between CAM psychiatrists

ered to be consent to use and publish that infor-and CAM pediatricians. There were 52 an-mation.

swers from CAM psychiatrists and 44 answers

The questionnaire contents included theitems as follows; 1）Background which include

from CAM pediatricians respectively（Table1）.

sex,experience,and change of the specialty. 2）

There was no statistical diﬀerence in theTraining system which includes satisfaction,frequency of seeing children and adolescents

distress and necessity of new training system.

with mental health problems.

3） The diﬀerence of clinical practices andIn the original questionnaire sheet, the fol-knowledge upon normal development of several

lowing items had 5 alternative answers which

age categories and schizophrenia.

were“very”“some”“neither”“not so”and “
notat all”. To make it easy to compare, we com-The results of a questionnaire survey

bined “very”and “some”in one category andIn total, there were 176 answers. Because“not so”and “not at all”in another category.

we aimed to put a weight on comparison be-More than half of both CAM pediatricians andtween the CAM psychiatrists and CAM pedia-

CAM psychiatrists thought that it is necessary

tricians in this report, we chose the answers

to obtain training in the specialty which wasmade by doctors who have less than 17 years

not of their own,though the CAM pediatricians

experience. This made no statistical diﬀerence

felt it to be more important（Fig. 2）. At the精神経誌（2010）112 巻 2 号

138

Fig. 4 Are you conﬁdent to see this year aged child ?

Fig. 5 Are you conﬁdent in these area ?

same time, they thought it is diﬃcult to do soConclusion and my suggestion（Fig. 3）. The satisfaction for their training

From this survey, we noticed that 1）Both

program was not so high. About the clinical

CAM psychiatrists and CAM pediatricians see

practice skills and knowledge,the pediatricianschildren with mental health problems in thefelt more conﬁdent than psychiatrists when thesame frequency. 2） Both CAM psychiatrists

patients were under 6 years old. There are noand CAM pediatricians feel they need to obtainstatistical diﬀerences in children between thetraining in the specialty which was not of theirages of 12‑15, but in the ages above 18, theown, but feel it is diﬃcult to do so. 3）CAM

CAM psychiatrists felt more conﬁdent than thepsychiatrists are more conﬁdent seeing adoles-CAM pediatricians（Fig.4）. For the knowledge

cent patients and patients with psychotic dis-of schizophrenia, the CAM psychiatrists wereeases whereas CAM pediatricians are more

more conﬁdent.

conﬁdent seeing young children and patients

But for the knowledge ofnormal development, the CAM pediatricians
were more conﬁdent（Fig. 5）.

with developmental problems.
As for myself, I graduated medical schoolPowered by TCPDF (www.tcpdf.org)

シンポジウム：Current Status of Psychiatry in Asian Countries

139

in 2001,before the new training course had been

and it is unrealistic to merge psychiatrists andintroduced.

Though I wanted to become apediatricians into becoming child and adoles-

CAM P,there was no speciﬁc training course tocent psychiatrists. But if we think of this as an

become a CAMP. I had to ﬁgure out by myself

advantage and make a training system from

how to get the training, and which specialty towhich young doctors can learn both psychiatrychoose, pediatrics or psychiatry. I decided toand pediatrics systematically,it would not only

start training as a pediatrician. But after 5

be unique but also widen clinical practice skills

years as pediatrician, I felt the same as thoseand knowledge. The establishment of the new

who took the questionnaire survey. I felt that I

training system should be eﬀective not only toneeded to study psychiatry. So I quit working

increase the number of the CAMPs but also to

as a pediatrician and started working as aachieve uniform skill of the CAMPs regardless

psychiatrist in a hospital which only had aof their carreer.

psychiatry ward for children and adolescentswith mental health problems. Soon, I realizedReferencesthat I needed the knowledge of general psychia-1）General window of government statistics―

try. After a year of working in child andprogress of the number of doctors and dentists（http:adolescent psychiatry,I enrolled in the residency program of general psychiatry to learn thebasics. Although it is still an unsolved question
to me whether this was the best way to becomewww.mhlw.go.jp toukei saikin hw ishi 06 tou9.html）
2）General window of government statistics―
progress of population （http: www.e‑stat.go.jp SG1
estat OtherList.do?bid =000001007603&cycode =1）3）Japanese M inistry of Health : Labour anda CAMP,I am sure that learning both pediatri-Welfare report 2007（http: www.mhlw.go.jp houdouciansʼand psychiatristsʼpoints of view was

2007 03 h0330‑13.html）

very valuable, and through this training, I am
now conﬁdent in dealing with all age groups.
In Japan, the number of CAM Ps is notenough and it is urgent to increase the numberof them. At the same time, making a speciﬁctraining system is also very important. Current
status shows that both psychiatrists and pediatricians are taking care of children and adolescents with mental health problems in Japan,4）Jorma, P.: The status of child and adolescent
psychiatry in EU‑and EFTA‑countries.European Child& Adolscent Psychiatry, 6; 116‑118, 19975）Tamiya, T.: The training program of childand adolescent psychiatry in the USA. Psychiatria etNeurologia Japonica, 111; 198‑203, 2009
6）Yamauchi, T.: The current status and theproblem of child and adolescent mental health.
Psychiatria et Neurologia Japonica, 111; 174‑187, 2009