Comparison of the effectiveness of psychiatric day care treatment between Japan and western countries: a review

Over the last two decades, day care (DC) treatment for mentally ill patients has come into wide use in Japan, following the precedents get in Western countries providing evidence of effectiveness. Several studies to examine the efficacy of DC treatment have already been performed in Japan. However, they were limited to chronic schizophrenic patients as subjects, and therefore the findings showed only improvement of the negative symptoms of schizophrenia. In contrast, Western studies have included heterogeneous mental disorders, and some showed DC was effective not only for treatment of global mental dysfunction but also for that of antisocial or violent behavior, drug dependence, emotional distress, and other characteristic disorders. Several Japanese and Western studies have shown DC treatment to be superior to outpatient treatment for relieving psychiatric symptoms. Regarding reduction of readmission rate, the Western studies were not supportive, but some Japanese studies showed that DC treatment was preventive against readmission as long as the follow up period was brief (within two or two and a half years). These findings suggested that the effectiveness of DC treatment may be limited. However, recently, medication against negative symptoms of schizophrenia has been revolutionary changing, offering the possibility that the combination of DC treatment and appropriate drug therapy may overcome the great obstacle of rehabilitating mentally ill patients in society. It is also very important that an evidence-based, standardized methodology of DC treatment should be immediately established in Japan.