Current and Future Consultation Support for People with Disabilities: Practical Values and Policy Challenges
My research focuses on policies and systems relating to people with psychosocial disabilities based on my practical experiences in the field of mental health welfare. After graduating from a university of social welfare, I obtained employment at a psychiatric hospital. Initially, most of my duties were to respond to financial consultations from patients including the applications procedure for public assistance or disability pension. Gradually, however, I was asked to provide support for their daily living including shopping, cooking, cleaning, or safety confirmation, which are usually provided by home care workers or visiting nurses. Then I realized that my role was to respond to various consultations from troubles of their daily lives to chats every day including consultations about dispelling their anxiety, their own physical conditions, their troubles with others, problems related to love, payment of their debts, how to take out the garbage, helping someone’s moving, renewal of driver’s licenses, or arrangement for their funeral. Many of the consultations were conducted not as a formal consultation but as a daily chatting. Consultations regarding their daily life tend to spread without end as they keep their living. However, people with psychosocial disabilities tend to become confused by little things and they may disrupt their own lives easily. Through these consultations I realized that difficulties over psychosocial disabilities affect their entire life.
Even when I started working in 1990s, a public services people with psychosocial disabilities were able to use in their daily lives were limited—psychiatric hospitals, public health centers, and welfare workshops. In the later 1990s, the national government established a consultation support system for people with disabilities in order to improve the situation. After several revisions, the consultations which are subject to consultation support were divided into “paid consultations” and “unpaid consultations.” As it is difficult to make consultation support visible or quantify it, no compensation is provided for various forms of consultations regarding the daily lives of people with disabilities. On the other hand, as it is easy to quantify the works relating to care service coordination, a small amount of compensation is paid for such works. In my opinion, the primary ideal of consultation support is to respond to all kinds of consultations. However, with the standardization of work, the consultation support system currently has pressing issues such as the improvement of staff’s skills and enhancement of the training system for consultation support.
As stated above, consultation support have been provided in the history of the challenges the system has and the revision of the system. Then, for what purposes have consultation services been established in the policy of people with disabilities and how have consultation support been institutionalized and transformed as it is today? Questions regarding the policy and system relating to consultation support arose as I work in the field of mental health welfare.
With such problem awareness, I published a book titled Detailed Discussions on the Basic Structure and Development Process of Consultation Support for People with Disabilities: Focusing on Mental health services based on my doctoral dissertation I submitted to the Graduate School of Core Ethics and Frontier Sciences at Ritsumeikan University in fiscal year 2018. In this book I analyzed consultation support, which has caught attention in the field of disability welfare, in relation to social security system reform, and examined the process of how consultation support have been developed systematically and historically. In particular, I focus on mental health services because it has a unique historical process compared with physical disability and intellectual disability and requires various forms of supports in many cases.
How should the individualized support be provided for people with psychosocial disabilities etc.? The issue remains unsolved. In addition, issues regarding expansion of subjects, regions, and scope of work, staff recruitment, and the gap in the content of services between municipal governments remain unsolved, too. I am interested in the policy rather than the development of human service skills because a good policy is required in order to provide good support. Human services tends to rely on enthusiasm and a sense of responsibility of staff. However, in order to provide good support stably, it is also necessary to consider profitability. Then, what policies and resources are necessary to provide good support? Moreover, it is necessary to present rationality of the value and significance various forms of support have. I would like to work on these issues as my future research challenges while engaging in the field of mental health welfare.