Psychiatry in Japan vs. the U.S.: What Expats Should Know About Mental Health & Medical Leave

I’ve seen firsthand how different mental healthcare is between the two countries. In short? It’s night and day.

For Expats: What to Expect from Psychiatry in Japan

In Japan, psychiatry often functions more like internal medicine: short, focused visits—typically 7 to 8 minutes—followed by prescriptions. First-time consultations may take longer (sometimes up to an hour), but don’t expect deep, extended dialogue. Psychiatrists typically see 5–6 patients per hour and treat a range of conditions including depression, anxiety, adjustment disorders, insomnia, addiction, bipolar disorder, schizophrenia, developmental disorders (発達障害), autism, and more.

While Japan’s system is structured and efficient, expats expecting in-depth talk therapy in a comfortable, living-room-like setting may need to adjust their expectations.

Forget the U.S.-style “hour on the couch” approach. When my former expat boss in Tokyo went looking for a “shrink,” he was confused and disappointed by how different the system was. Japan’s mental healthcare is fast, structured, and practical—not centered around talk therapy.

By the way, I later learned that “shrink” is a very common, casual term in the U.S. for a psychiatrist or therapist—which surprised me at first!

This difference in care style is partly due to how Japan's medical system works. All services are governed by a national points system set by the Ministry of Health (厚生労働省). Doctors are reimbursed based on this system, which makes U.S.-style long-form therapy sessions difficult to provide—even if they want to.

If you're used to “talking it out,” you’ll need to adjust expectations. Bring any past diagnoses and treatment records, and try to find a psychiatrist who speaks English.

Online Consultations

Online consultations with psychiatrists have recently become more available and convenient. According to Japanese medical regulations, first-time online appointments are allowed if no prescriptions—especially for psychoactive medication (向精神薬)—are needed. If a prescription is required, an initial in-person visit is mandatory to verify identity and ensure safe treatment. Be sure to confirm the detail with your psychiatrist’s office.

Team-Based Support

In Japan, it’s also common for psychiatrists to provide team-based care when needed—working alongside nurses, psychologists, social workers, and other professionals. Many clinics and hospitals offer group programs such as art therapy, drawing sessions, or “re-work” (reintegration) programs to support patients returning to work.

Mental Health in the Workplace: A Real Challenge

Mental health issues are rising globally—and Japan is no exception. According to the WHO, depression and anxiety cost the global economy over $1 trillion annually in lost productivity.

In Japan, stress-related diagnoses like adjustment disorder are common among employees. Doctors often recommend 1–3 months of leave, supported by a medical certificate.

Legally, you can’t be fired in Japan for medical reasons. However, in reality, returning to the same job after mental health leave can be complicated. You're guaranteed a job, but not necessarily the same role. Paid and unpaid sick leave depend on your company’s policy. Once paid leave is exhausted, many people turn to health insurance for partial salary support—but here’s where it gets tricky.

About Sickness and Injury Allowance傷病手当金 (Shōbyō Teatekin)

If you're enrolled in employer-based health insurance and are unable to work due to mental illness (or other health conditions), you may be eligible for 傷病手当金 (Sickness and Injury Allowance).

Key points:

• Covers ~66% of your average salary

• Begins after 3 consecutive days of absence

• Can be received for up to 18 months

• ❗️Only applies to employees with company-sponsored health insurance
  (National Health Insurance (NHI) does not include this benefit)

If you're still unwell after using up paid/unpaid leave, many companies have rules allowing for automatic termination, even for medical reasons. This isn’t personal—it’s typically outlined in the company’s employment regulations.

That’s why open communication between HR, managers, and the employee is critical. I’ve seen both successful reintegration and unfortunate breakdowns—it really depends on transparency and timing.

Wrap-Up

Stigma around psychiatry is still strong in Japan. A psychiatrist once told me, “Many mental health issues can be treated like a textbook, if caught early.” That really stuck with me—though of course, more serious conditions require long-term support and patience.

Wherever you are in your journey, please don’t wait too long. Seek help early, and find the care you deserve.

The good news is many companies are starting to offer more wellness programs, stress checks, and preventive support. It's a slow shift—but a hopeful one.

Visit NavigatorJapan.com and check the Freebie Shelf tab for a list of English-speaking clinics/hospitals.