The Yokohama Declaration: an update.
Authors: Mitsumoto Sato
Journal: World Psychiatry (2005)

According to the Atlas on Mental Health Resources in the World published by the World Health Organization in 2001, 52.2% of the countries in Africa, 51.9% of those in the Western Pacific Region, and 30% of those in South-East Asia do not have a mental health policy. Furthermore, 78.9% of the countries in Africa and 62.5% of those in South-East Asia spend less than 1% of their budget on mental health care. This evidence clearly indicates that immediate action is needed in the world, but especially in African and Asian regions, to improve mental health care and to provide the mentally ill with advanced psychiatric treatment. In every country, comprehensive and adequate treatment plans, including a balance of medications and advanced psychosocial intervention, should be implemented, with the agreement of the major partners in mental health programs, the patients themselves, and their families.

To this purpose, the Japanese Society of Psychiatry and Neurology (JSPN) proposed the Yokohama Declaration, which was approved by the WPA General Assembly on August 25, 2002, and which is reproduced below.

The Japanese Society of Psychiatry and Neurology: 

- aware that the majority of people with mental illness in Asia and elsewhere in the world do not receive appropriate care;

- noting that the United Nations' resolution 119 recognizes the human rights of people with mental illness and that an appropriate treatment is a human right;

- noting with regret that less than half of the countries in the Asia-Pacific region and in the African region have set up mental health policies, as recorded in the 2001 WHO World Health Report on Mental Health;

- recognizing that the education and training in mental health matters is insufficient and not in keeping with current scientific knowledge;

- considering that the 12th World Congress of Psychiatry takes place in Yokohama, Japan, for the first time in the Asian continent; 

recommends to all Member Societies of the WPA, particularly in Asia:

-To do everything in their power to introduce adequate and comprehensive treatment of mental patients in their countries. This means that mental patients receive a balanced treatment combining pharmacotherapy with advanced psychosocial interventions for an optimal outcome. This also means that humane conditions of treatment, both from the institutional point of view and in the relationship between mental health workers and patients, have to be promoted.

- To fight for rehabilitation of mental patients and their right to live in their community so that they obtain the best quality of life despite their illness.

- To contribute and help in the development of mental health policy, mental health legislation, and national mental health programmes, these being the necessary instruments for such positive change in all countries, especially in developing ones.

- To take an active role in the improvement of training and education in mental health matters, paying particular attention to the education of young psychiatrists.

- To ensure that all members of the community are involved in efforts to relieve the burden of the illness from patients and their families. Patients, their families, community agents, decision makers, health industry, media and other social forces should be seen and sought as important partners in this continuous endeavor.

The implementation of the Yokohama Declaration is currently ongoing in Japan. The JSPN changed the old Japanese term for schizophrenia (seishin bunretsu byo, that is, mindsplit disease), corresponding to the concept of dementia praecox, into the new term of togo shitcho sho (integration disorder syndrome), corresponding to the modern concept of the disorder. This change is making psychoeducation much easier and is being useful to reduce misunderstandings about the illness and to decrease the stigma related to schizophrenia. The new term has been officially accepted by the Japanese medicine and media and is being adopted in the legislation in 2005. This exactly responds to some of the recommendations of the Declaration.

In response to the first recommendation of the Declaration, practice guidelines for the treatment of schizophrenia and mood disorders have been published in Japan. The mental health legislation will be revised in 2005. The Minister of Health, Welfare and Labor decided to discharge in the next few years 7,200 inpatients who are staying in the hospital because they are not accepted by their families.

In order to monitor the implementation of the Yokohama Declaration in the other Asian countries, we carried out a survey. We found that discussion about the contents of the Declaration is ongoing in all Asian countries and WPA Zones except the South Asian Zone, and that projects to implement the recommendations of the Declaration have been developed in all Asian countries except those of the South Asian Zone. These projects aim to improve the quality of mental health care and welfare by completing mental health policies, increasing financial resources, developing networks, and improving training of mental health professionals.

Several Asian countries and WPA Zones provided proposals for the promotion of the Declaration. These include nationwide collaboration; partnership with governments, nongovernmental organizations, and the various disciplines involved in mental health care; remote awareness and public education campaigns; the establishment of an Asian Federation of Psychiatric Associations; the inclusion of mental health care and welfare in post-graduate curriculum and general physicians' training; the development of a network to circulate information among Asian countries; the development of practice guidelines for the treatment of major mental disorders; the improvement of mental health legislations and policies; and the promotion of anti-stigma programmes. A meeting aiming to monitor and promote the implementation of the Declaration was held in Kobe, Japan in October 2004. A Symposium focusing on the implementation of the Declaration will take place during the World Congress of Psychiatry in September 2005.

In conclusion, the implementation of the Yokohama Declaration is ongoing in many Asian countries, but continuing efforts are needed to take further concrete steps in the future. Moreover, the Declaration should be promoted in other parts of the world, especially in African countries.