Sosei Yamaguchi

Psychosocial rehabilitation strategies should be expanded to address difficulties as a component of the recovery process for people with mental illness. However, empirical evidence remains limited because few longitudinal studies have examined occupational dysfunction, defined as negative experiences in daily activities, as a factor associated with recovery. This study aimed to examine the influence of difficulty in daily life and occupational dysfunction on changes in the recovery process in individuals with severe and persistent mental illness. Participants were community-dwelling individuals with severe and persistent mental illness (schizophrenia, bipolar disorder, and major depression) voluntarily responding to recruitment in 16 community facilities. Data from a longitudinal observational study with repeated assessments of the recovery process were analyzed using latent growth modeling with a Bayesian estimation approach. The hypothesized model examined the direct and indirect relationships among difficulty in daily life, occupational dysfunction, and changes in the recovery process. This multicenter study consisted of data collected from 63 participants. The results from the Bayesian latent growth modeling demonstrated good model fit (convergence statistics for Bayesian estimation: 1.001; posterior predictive p-value: 0.35) and statistical significance of the influence of difficulty in daily life and occupational dysfunction on changes in the recovery process. The findings suggested the importance of addressing occupational dysfunction as well as difficulty in daily life. Comprehensive assessment of negative experiences in daily activities may contribute to person-centered practices for the recovery process of individuals with severe and persistent mental illness.

Background: This study aimed to contextualize structural barriers to the implementation of Individual Placement and Support (IPS) in Japan. Analysis: We examined the position of Japan’s employment service policies for individuals with mental illness within the OECD framework for IPS implementation and identified key challenges. A mixed-methods approach was employed, combining a narrative search of Japanese policy documents with systematic searches of Japanese IPS research. According to the OECD framework, Japan’s IPS implementation was positioned between the stages of “Building the foundations for integrated mental health, skills, and work policy” and “Shifting from trials to a scaled-up integrated approach.” A major barrier was the absence of a comprehensive vocational service system for individuals with a diagnosis of severe mental illness. Policy Options: Advancing IPS dissemination in Japan requires multifaceted strategies, including grassroots efforts by service providers, strengthened advocacy, incorporation of employer and client perspectives, and consideration of resource allocation across populations with varying levels of needs. Conclusion: While macro-level research on IPS implementation remains scarce in Japan, the practical and feasible policy considerations identified in this study could be beneficial in Japan as well as other non-Western contexts encountering similar implementation challenges.

Background: Individuals with severe mental illnesses (SMIs) experience anxiety that impairs functioning and quality of life. This cluster randomized trial evaluated exposure-based cognitive behavioral therapy (ebCBT) integrated into assertive community treatment (ACT) teams to reduce anxiety. Methods: Fifteen ACT teams were allocated to ebCBT + ACT (k = 8, n = 50) or ACT-only (k = 7, n = 43). The intervention followed four steps: situation identification, four-component analysis (behavior, cognition, emotion, physical symptoms), psychoeducation, and graded exposure. Staff received 50 h training and bimonthly supervision over 12 months. Co-primary outcomes were trait and social anxiety; secondary outcomes were psychiatric symptoms, functioning, quality of life, and recovery. Results: The ebCBT + ACT group showed significant improvements in State–Trait Anxiety Inventory–Trait scores at 12 months (AMD = −5.30, 95% CI = −8.71 to −1.90, p = 0.002, d = −0.64) and 18 months (AMD = −7.22, 95% CI = −12.1 to −2.34, p = 0.004, d = −0.60). Brief Fear of Negative Evaluation scores showed near-significant improvement at 18 months (AMD = −3.70, 95% CI = −7.44 to 0.04, p = 0.052, d = −0.40). Secondary outcomes, including global functioning, recovery, and quality of life, also improved. Cost-effectiveness analyses indicated favorable cost-effectiveness for anxiety outcomes. Conclusions: Embedding ebCBT within ACT services may reduce anxiety-related fear and avoidance and enhance recovery-related outcomes in individuals with SMI. These findings support the feasibility and clinical value of integrating structured psychological interventions into intensive community-based outreach services.

Outcome evaluations using patient-reported outcome measures (PROMs) are becoming increasingly important in healthcare, including long-term care and disabil

Aim: Adverse childhood experiences (ACEs) have been reported to have a detrimental impact on future mental health. However, limited research exists on how mental health staff perceive service users' ACEs. This study examined the prevalence, types, and related factor of staff‐perceived ACEs among community outreach service users using 4‐year retrospective data.Methods: In this retrospective study conducted using service records from the mental health outreach service in Japan, we collected demographic and clinical characteristics, as well as the number and types of ACEs perceived by staff at six assessment points, from registration to 4 years post‐service initiation. We compared each clinical characteristic between groups with and without staff‐perceived ACEs using independent t‐tests and χ² tests. To analyze changes in staff‐perceived ACEs at six time periods, repeated measures mixed models were used, adjusting for sex, age, and diagnosis.Results: Of the 143 participants whose data were analyzed, the prevalence of ACEs was 54.5%. ACEs were associated with younger age and receipt of public welfare owing to economic deprivation. The number of ACEs notably increased from registration to 6 months post‐service initiation and continued to increase 2 years after service initiation and stabilized.Conclusion: More than half of the participants had ACEs. Outreach service users with ACEs were generally younger and faced economic challenges. While most service users' ACEs are recognized within the first 6 months, it is important to note that they may gradually become apparent over a long period, such as 2 years.

Aims: Community mental health outreach teams offer a range of individualized services tailored to meet the diverse needs of clients. This study aimed to identify service use patterns within community mental health outreach programs using 12-month longitudinal data. Methods: Data from users of the Tokorozawa City mental health outreach service in Japan were analyzed. Service trajectories over a 365-d period were mapped and categorized by primary service type each month. These trajectories were then analyzed using state sequence and clustering methods. The services included 10 categories (i.e., family support and psychiatric symptom management) and cases of no support. We compared the demographic characteristics (e.g., sex, age, living situation, and diagnosis) and reasons for service initiation (e.g., symptom-related life problems, treatment interruption, or untreated conditions) between clusters. Results: The service use trajectories of 70 participants were divided into four clusters. Cluster 1 had a high proportion of psychiatric symptom management services (n = 25). Cluster 2 focused primarily on family support (n = 11). Cluster 3 offered a mix of diverse services (n = 21). Cluster 4 involved inter-agency collaboration and early termination of services (n = 13). Significant differences were found between clusters in terms of sex and some reasons for service initiation. Conclusions: While community mental health outreach programs deliver a broad range of personalized services, we identified four distinct service use patterns over the first 12 months. Given that demographic and clinical characteristics may vary across these patterns, further research with a larger dataset is needed.

Background: Adolescents’ mental health‐related public stigma, encompassing personal and perceived stigma, may vary according to family dynamics and personal or familial experiences. This study aimed to investigate the association between adolescents’ and their family members’ stigma, specifically whether adolescents’ personal and perceived stigma are associated with other members’ experiences, particularly contact experiences.Methods: From a population‐based cohort of adolescents aged 17 years in Tokyo, 1,198 responses from 378 families (349 target adolescents, 364 mothers, 291 fathers, 194 siblings) were used in this study. Adolescents, their parents, and elder siblings responded to the self‐report questionnaires. Personal and perceived stigma were assessed using the behavioral intention subscale of the Reported and Intended Behavior Scale and Perceived Stigmatizing Attitude Scale, respectively. The relationship between stigma and contact experiences with people with mental health problems was examined simultaneously among adolescents and their family members.Results: The stigma of adolescents and their siblings was lower than that of their parents. Personal stigma of adolescents is associated with that of their siblings. Overall, contact experiences with people with mental health problems were associated with reduced personal and increased perceived stigma. Mothers’ contact experiences were associated with adolescents’ personal stigma.Conclusion: The stigma toward people with mental health problems may be shared between adolescents and siblings. Mothers’ contact experiences with people with mental health problems may be related to adolescents’ stigma. Family members’ stigma toward people with mental health problems and their contact experiences may play an important role in stigma formation among adolescents.