Presentation Information
[SY-1-01]Implementation and Current Challenges of ACT in Japan
*Koji Yoshida (Toyo University, JPN(Japan))
Keywords:
Outreach,Assertive community treatment,dissemination
Assertive Community Treatment (ACT) was first introduced in Japan in 2002 through a government-funded clinical research project (ACT-J). The initial study demonstrated reductions in hospitalization and high client satisfaction. Since then, ACT has expanded gradually, mainly through private-sector initiatives. By 2020, around 20 ACT teams were active nationwide, organized under the ACT Japan Network, now known as the Community Mental Health Outreach Network Association.
Japanese ACT teams have maintained service quality using fidelity scales adapted from international models (DACTS, TMACT) to fit local conditions. Core principles and technical standards have largely been preserved. However, the sustainability of these teams is threatened by systemic challenges, particularly in financing. Japan lacks a dedicated reimbursement structure for ACT. While medical visits (by doctors and nurses) are adequately reimbursed, services by other professionals (e.g., social workers, psychologists) are undercompensated. Welfare-based payments are significantly lower, and most systems require formal user contracts—often unworkable with hard-to-reach populations. As a result, ACT teams often provide unpaid services, threatening long-term viability.
Another major challenge lies in the educational infrastructure. Japan's mental health system still emphasizes pharmacological and hospital-based care. Training opportunities for field-based community mental health practices are limited, especially for psychiatrists, nurses, and social workers. This lack of structured education and training is a key barrier to ACT’s expansion—especially critical given Japan’s aging population and mental health workforce shortages.
Despite ACT’s proven effectiveness, its dissemination remains limited. Structural constraints in finance and training must be addressed to scale the model.
During the upcoming symposium, the presenter will share data on Japan’s ACT situation and hopes to engage in dialogue with Canadian professionals to explore strategies for strengthening community mental health systems.
Japanese ACT teams have maintained service quality using fidelity scales adapted from international models (DACTS, TMACT) to fit local conditions. Core principles and technical standards have largely been preserved. However, the sustainability of these teams is threatened by systemic challenges, particularly in financing. Japan lacks a dedicated reimbursement structure for ACT. While medical visits (by doctors and nurses) are adequately reimbursed, services by other professionals (e.g., social workers, psychologists) are undercompensated. Welfare-based payments are significantly lower, and most systems require formal user contracts—often unworkable with hard-to-reach populations. As a result, ACT teams often provide unpaid services, threatening long-term viability.
Another major challenge lies in the educational infrastructure. Japan's mental health system still emphasizes pharmacological and hospital-based care. Training opportunities for field-based community mental health practices are limited, especially for psychiatrists, nurses, and social workers. This lack of structured education and training is a key barrier to ACT’s expansion—especially critical given Japan’s aging population and mental health workforce shortages.
Despite ACT’s proven effectiveness, its dissemination remains limited. Structural constraints in finance and training must be addressed to scale the model.
During the upcoming symposium, the presenter will share data on Japan’s ACT situation and hopes to engage in dialogue with Canadian professionals to explore strategies for strengthening community mental health systems.