How to take Mental Health Leave in Japan

Introduction

With articles like “Japan report to show mental health concerns tripled since 2004”, it is increasingly evident that mental health is a critical matter in Japan.

World Mental Health Day, a global event led by the WHO, was only officially recognized in Japan in 2002. While mental health is universally a foundational aspect of well-being, the approach to maintaining it can vary significantly depending on where you live.

In Japan, the most common mental health-related reason people take time off work is due to workplace relationships. This includes cases of harassment, bullying, and other stress-inducing situations that lead to burnout.

Thanks to growing awareness and recognition of its importance, there are now more resources available to support mental health. However, uncertainty still surrounds many questions about mental health and work: What steps do you follow if you need time off? Should you talk to your boss or HR? Uncertainty in such situations can add stress, especially when your mental health is at risk.

This article provides practical steps to take if you decide to take time off work. While specific rules may depend on your workplace and contract type, the information here is relevant to anyone currently employed.

1. Recognizing When It’s Time to Take Leave

Identifying the signs that your mental health may be at risk early on can help you decide how to proceed. The American Psychiatric Association lists common signs and symptoms to look out for here are a few:

• “Sleep or appetite changes — Dramatic sleep and appetite changes or decline in personal care.

• Mood changes — Rapid or dramatic shifts in emotions or depressed feelings, greater irritability.

• Withdrawal — Recent social withdrawal and loss of interest in activities previously enjoyed.

• Drop in functioning — An unusual drop in functioning, at school, work or social activities, such as quitting sports, failing in school or difficulty performing familiar tasks.

• Changes in school or work — Increased absenteeism, worsening performance, difficulties in relationships with peers and co-workers.”

There are online self assessments you can take if consulting a professional or talking about it to someone seems too soon. 

If you are at a point where you feel your mental health is at risk and you need to take time off, consulting a professional may be the next common step. At the same time, there is a crucial step to take. 

2. Understanding Your Rights as an Employee

Before taking leave, it’s important to understand the legal and company-specific rules that apply to you. You can do this by reviewing the company work rules or 就業規則 shūgyō kisoku which outlines various policies for taking leave. Focus on the section which mentions Paid Leaves 有給休暇 yūkyū Kyūka or any other special leaves. Below are some common types of leaves:

• 慶弔休暇 (Keichō Kyūka) – Leave for celebratory or condolence purposes like weddings and funerals.

• 病気休暇 (Byōki Kyūka) – Sick leave.

• 生理休暇 (Seiri Kyūka) – Menstrual leave.

• リフレッシュ休暇 (Rifuresshu Kyūka) – Some companies provide this leave for employees who’ve been with the company for some time. As the name suggests, it’s meant to be used to ‘get refreshed’.

• 教育訓練休暇 (Kyōiku Kunren Kyūka) – Educational or training leave.

Apart from the rules stipulated by the company, employees can apply for “Injury and Sickness Allowance” 傷病手当金 shōbyō teatekin. This applies if a person takes more than four consecutive days off from work for approved health reasons. To learn more about possible allowances including this one, check the website of your health insurance association. 

If you’re unsure if something applies to you,  the best is to contact your HR. 

3. The Role of Occupational Health Physicians (産業医)

As you’re considering who to consult, one option is Occupational Health Physicians or 産業医 sangyoi. They are licensed doctors appointed by the company. They provide medical advice for employees experiencing health issues including mental health. Japan Organization of Occupational Health and Safety (JOHAS) describes their role as the following:

"Occupational Health Physicians are tasked with managing the health of workers.[...] The duties of an Occupational Health Physician are legally classified into nine categories:

1. Conducting health checkups and implementing measures based on the results.  

2. Providing consultations for employees who work long hours and implementing measures based on those consultations.  

3. Conducting stress checks, providing consultations for employees identified with high stress, and implementing measures based on the results.  

4. Managing the work environment.  

5. Managing work tasks.  

6. Overseeing the overall health management of employees beyond the above categories.  

7. Providing health education, health consultations, and implementing measures to promote employees’ health.  

8. Offering hygiene education.  

9. Investigating the causes of health issues among employees and implementing measures to prevent recurrence."  

(As defined in Article 14, Paragraph 1 of the Industrial Safety and Health Regulations.)

Their role is to inspect workplace conditions, including monitoring employees who do long overtime. Essentially their role is to understand, advise, and help improve the working conditions. JOHAS also highlights in one of their publications in 2023, “In managing the safety of foreign workers, focusing on mental health care has become an indispensable element”. 

So how do you access them? First you’ll need to check if there is an appointed Occupational Health Physician at your workplace. There may be some information about this on the company work rules but the fastest way is most likely to ask the HR. Though the HR may ask why you’d like to speak to them, you’re not required to disclose the details. From there, you may either be asked to fill out a consultation request form or be asked to contact the clinic or the physician. A hurdle you may experience is the language barrier. Unfortunately, most of these physicians provide their service in Japanese. If you have a trusted friend or person who is fluent in Japanese, asking them to help you out with booking the appointment is a good idea. If they are open to, and you feel comfortable with the idea, you may want to consider asking them to come with you to the appointment to help with the language. 

If you find out your workplace does not have an Occupational Health Physician, there are some other options. First, there are Regional Occupational Health Support Centers managed by JOHAS that provide free consultations. You can find a center near you from the link. Another option is to consult your family doctor. If they can write a medical certificate that demonstrates you need to take time off, you can take the certificate yourself to your workplace to submit it. A resource that can come in handy for anyone looking for clinics providing services in different languages is Ministry of Health, Labour and Welfare" (MHLW)’s NAVII, a nationwide information system to search for medical institutions which comes with a language filter (you can choose to view this website in English by toggling the language options). 

4.  Financial and Insurance Considerations 

If it’s likely you’ll be taking time off for more than a couple of days, you may be wondering how this will impact your income. It’s good to understand how taking time off can impact you, especially at a financial level. 

Paid vs. unpaid leave. If the time you’re taking off can be covered by your paid leaves this will not have any immediate impact on your income. However, in some cases, you may not have enough paid leaves to cover the time off. In this case, make sure you understand this beforehand. 

Social Insurance payments. If you’re not familiar with Japan’s Healthcare system, you can learn more about it in this article. If you are currently paying for pension and health insurance, it’s also important to keep in mind that even when you’ll be taking a break from work, you are required to continue paying these. This still applies even if you take any unpaid leaves. Have a clear agreement on how this payment will be handled. In some cases, you may need to pay yourself, in which case you are responsible for remembering the payment dates and the due amount. The company may suggest you apply for the Injury and Sickness Allowance (傷病手当金) . By doing so, the company can receive the allowance on your behalf and deduct social insurance from it. What’s most important is that you and your company have a clear agreement on how this will be covered. 

5. Step-by-Step Guide to Taking Leave

If you’re planning to take mental health leave, the following steps provide a general guide. Keep in mind that specific procedures may vary depending on your workplace’s policies.

Review the Company Work Rules and know what options you have. Start by reading your company’s work rules. Pay special attention to information about any leaves, like sick leaves. Assess how taking leave may impact your finances. 

Consult a Professional and Obtain a Medical Certificate. Schedule a consultation with a doctor or an Occupational Health Physician who can provide you with a medical certificate. If you’re unsure whether your doctor can issue such a certificate, make sure to confirm this in advance because it’s essential for formalizing your leave application and accessing certain benefits.

Notify Your Manager and/or HR. Once you have your medical certificate, approach your manager or HR department to inform them of your request for leave. You’re not obligated to share personal details, but be prepared to discuss the duration of your leave and submit any required documents.

Follow Company Policies and Finalize Details. After your request for leave is accepted and approved, work with HR and your manager to finalize logistics. This may include determining how your responsibilities will be handled during your absence. They may also ask for any preferences for communication while you are away.

6. Handling Burnout: An Example Scenario

Self-Awareness and Informing about conditions

Burnout is one of the most common situations that arise from working. Mental Health UK defines burnout as the following:

“‘Burnout’ is recognised by the World Health Organization (WHO) as an ‘occupational phenomenon’. While it is not a medical or mental health condition, it has been classified as a syndrome, meaning a collection of symptoms or signs associated with a specific health-related cause. Burnout is a state of physical, mental and emotional exhaustion. It can occur when you experience long-term stress and feel under constant pressure.” 

In Japanese burnout is called 燃え尽き症候群 moezuki shōkōgun. As defined on こころの耳 kokoro no mimi, a mental health website provided by the Ministry of Health, Labour and Welfare (MHLW):

“It refers to the physical and mental fatigue symptoms exhibited when a person who had previously been exceptionally active in their work suddenly loses energy and vitality due to some trigger, as if they have "burned out." Key symptoms include a sense of physical and mental exhaustion, a tendency to distance oneself from others and avoid emotional contact, and a diminished sense of achievement. In psychiatric terms, it may also be diagnosed as depression.”

Another similar term is 過労 karō, meaning overwork. This term is often associated with 過労死 karoshi or death caused by overwork which is a serious issue in Japan. 過労死等防止調査研究センター（RECORDs）managed by JOHAS, gives a definition of 過労:

“The physiological perspective defines overwork as a state where the body’s balance is disrupted, making recovery impossible even with rest.

The social perspective ties overwork to societal value judgments, identifying it as excessive fatigue that disrupts work-life balance and requires immediate intervention.

 Examples of symptoms of overwork: 

• There is a pronounced sense of fatigue, accompanied by discomfort when continuing work.

• Task performance becomes inconsistent, accuracy drops, and tangible difficulties in completing tasks arise.

• The impact extends beyond work itself, leading to noticeable changes in behavior.

• A gradual decline in motivation to work is evident.

• The likelihood of accidents and errors increases as critical thresholds are reached.

• The time needed for rest increases dramatically.

• After work, daily activities are limited and tend to become more passive.”

Solutions

Based on the steps mentioned above, here are some possible solutions:

Consult an Occupational Health Physician or your doctor. Receive a diagnosis to gain understanding of conditions and a possible treatment plan. They may suggest options such as taking time off work. 

Receive a Medical Certificate. If taking leave is a recommended plan, a doctor’s note is necessary for any further steps. 

Seek Adjusted Working Arrangements. Apart from taking time off, discuss options like minimized work hours, adjusting responsibilities to support your recovery. 

7. Resources for Mental Health Support in Japan 

Japan offers a range of resources for individuals seeking mental health support, from public institutions to private organizations. Below is an overview of available options.

1. Ministry of Health, Labour and Welfare (MHLW) ResourcesThe MHLW’s mental health website provides tools in Japanese, like self-assessments, informative reading materials, and a directory of hotlines. These resources are designed to help individuals better understand their mental health and seek appropriate support.

2. Therapists, Clinics, and Institutions

GroupWith, a nonprofit organization, offers a comprehensive list of mental health institutions in Japan, including details about a wide range of language support.

The U.S. Embassy in Japan also provides a curated list of mental health services tailored for foreigners living in Japan.

1. Hotlines MHLW lists multilingual mental health hotlines specifically for foreigners. These services cater to a variety of needs, from immediate emotional support to advice on navigating mental health care in Japan.

2. Public Centers and Institutions For workers without access to an Occupational Health Physician, there are public centers dedicated to mental health support:

Industry Health Comprehensive Support Center and Regional Occupational Health Support Center (産業保健総合支援センター (sangyō hoken sōgō shien sentā and 地域産業保健センター chiiki sangyō hoken sentā,), both managed by JOHAS, provide free consultations.

These centers offer services in person, over the phone, or via email, making them accessible for a wide range of workers.

1. English-Speaking Hospitals Many hospitals in Japan cater to foreigners and offer services in English. If you’re seeking a mental health specialist, check with hospitals in your area to confirm language support and availability of relevant expertise.

English speaking hospitals in Japan can be a great source to access especially for foreigners. If you’re looking for a mental health specialist, check with the hospital to confirm their language support.

These resources, both public and private, provide vital support for maintaining mental well-being in Japan. Whether through local centers, online tools, or professional consultations, you can find the help you need to navigate mental health challenges effectively.

8. Cultural Considerations and Tips on How to Spend your Time Off

One of the biggest hurdles to accessing mental health support is overcoming the stigma associated with it. While issues such as long overtime and depression are widely recognized, discussing mental health treatment remains an uncommon practice in Japan. However, isolating yourself or avoiding seeking help, especially when you need it most, can worsen the situation. A helpful way to navigate this stigma is to view mental healthcare as an essential component of overall health, much like caring for any physical ailment.

As a cultural consideration, when communicating with your workplace about your situation and your intention to take time off, you may be asked several questions. Common inquiries include:

• What is the illness or condition?

• Do you have a medical certificate?

• What symptoms are you experiencing?

• How long do you plan to take off from work?

• What treatment is planned during your leave?

• How much information would you like shared with your colleagues?

If you’re notifying your workplace via email, it’s a good idea to address these points in advance to provide clarity. Additionally, you may need to meet with your boss or HR to finalize details such as social insurance payments and preferred methods of communication while you are on leave. While this process can feel overwhelming, having a clear agreement beforehand will ease the transition and allow you to focus on recovery.

During your time off, it’s natural to feel tempted to think about work or worry about your job. However, the most effective way to spend your leave is to prioritize rest and healing. Establishing a stable daily routine, engaging in relaxing activities, and incorporating light exercise such as walking can help you recover both mentally and physically.

Conclusion 

Mental health is a cornerstone of well-being for everyone. For foreigners living in Japan, taking proactive action to maintain one’s mental health has never been more important. With steady recognition from the public, and a growing demand from the foreign community, there are more resources and services available for non-natives. Utilizing these services go hand in hand with taking leave from work for many people as they navigate maintaining their mental wellbeing.

Being self-aware of changes in your health is an excellent start point which can help prevent issues from becoming more serious. In addition, understanding your rights and responsibilities as an employee allows you to plan ahead. Reading the company’s work rules can offer clarity on resources available to you, and Occupational Health Physicians play a significant role in providing support to employees. 

When initiating the process of taking leave, it’s important to understand the steps to follow. In the process of planning, considering financial and insurance implications can help prepare for any possible changes in income. Finally, the article addressed some of the cultural aspects of communicating, taking leave for mental health reasons and advice for how to spend your time off. 

If you are evaluating options as you focus on your mental well being, gaining information, consulting with professionals, and learning from personal stories can support you to find the best step forward.