Number of long-term inpatients in Japanese psychiatric care beds: trend analysis from the patient survey and the 630 survey

Abstract

Background: The number of psychiatric care beds and the mean length of stay in psychiatric care beds in Japan have decreased over the past 10 years. However, as has long been indicated here and elsewhere, Japan lags behind other countries in terms of deinstitutionalization. Furthermore, the population of inpatients in psychiatric care beds is aging dramatically. In addition to the diversification of mental illness, the question of what measures to implement going forward regarding current psychiatric bed resources has emerged as a new challenge.

Methods: Using data from the Patient Survey and the 630 Survey, we examined trends in the number of long-term inpatients in psychiatric care beds in Japan through 2040. Population estimation was used for estimating long-term hospital bed demand because of small fluctuations in the admission and discharge of long-term inpatients.

Results: In 2017, nearly one-third of all long-term hospitalized patients were aged ≥75 years, and an estimated 47% of the total are expected to die by 2040. Thus, the overall demand for long-term hospitalization is forecast to decrease sharply due to aging of currently hospitalized long-term inpatients. The number of long-term inpatients in 2017 was 167,579, and this is projected to decrease to 103,141 in 2040.

Conclusions: We believe it is necessary to adopt a multifaceted approach to promote hospital discharge and transition to the community, and to address the diversification of mental illness and the issue of psychiatric care bed supply/availability, which are forecast to decrease due to the natural decrease in long-term inpatients.

Keywords: Community-based integrated care; Fatalities; Future estimates; Long-term inpatients; Psychiatric care beds.

Fig. 1

Psychiatric beds per 100,000 population. The number of psychiatric beds in Japan in comparison with those of other OECD countries

Fig. 2

Projection method. We used the following formula: Projected number of long-term inpatients by illness = Total number of long-term inpatients in 2017 − Deaths among long-term inpatients in 2017^*1 − Number of long-term discharges to determine discharge-admission differences.^*2. ^*1 Deaths among long-term inpatients in 2017 = Number of long-term inpatients by age group × General mortality rates by age group. ^*2 Number of long-term discharges to determine discharge-admission differences = Number of discharges (excluding deaths) of long-term inpatients by illness − (Number of new long-term admissions by illness × 2017 overall survival rates by age group)

Fig. 3

Projected number of fatalities. In 2017, there were a total of 167,579 long-term inpatients, nearly half of which (79,016) were projected to die by 2040

Fig. 4

Projected number of discharge–admission differences. The number of admissions for all illnesses other than schizophrenia is projected to increase from 2017 onwards. The number of admissions is projected to exceed the number of discharges in terms of total number of illnesses from 2017 onwards