Health Labor & Welfare Ministry proposed mental health test draws criticism from experts

Labor ministry's proposed mental health test draws criticism from experts

A law amendment being promoted by the health ministry that would require workers to undergo a standardized mental health test with very little scientific backing is attracting criticism from mental health experts.

The Ministry of Health, Labor and Welfare submitted the draft revision to the Industrial Health and Safety Law to the Diet late last year. While the Diet has yet to engage in full-fledged debate on the issue, if the proposal is passed, employers would be legally bound to provide a specified mental health test to its employees in addition to regular health examinations.

In the test, the health ministry has identified nine symptoms such as "I'm extremely tired" and "I feel melancholy," on which workers would be asked to rate themselves on a four-level scale. The results of the test would not be revealed to employers without the employees' consent, and if necessary, test takers would be interviewed by a doctor.

The ministry maintains that the purpose of the standardized test is the early detection of people with high levels of stress, as part of its efforts to reduce suicides and depression.

However, Norito Kawakami, a professor of mental health at the University of Tokyo's Graduate School of Medicine, says, "People with high levels of stress are not necessarily at the highest risk for depression. Of those who are determined to be 'depressed' according to mental health tests that are currently used in the private sector, 5 to 20 percent of people are actually diagnosed with depression." Moreover, there have been no studies to show that looking into the nine items proposed for the test leads to the prevention of depression or suicide.

According to the health ministry's calculations, the cost of testing, which includes an interview with a doctor, comes out to 350 yen per person. Approximately 30 million workers would be subject to the test, and if implemented, the tests would cost business operators a total of 10.5 billion yen.

"It's wasteful to put money into a system whose efficacy has yet to be proven," Kawakami says.

Meanwhile, Jun Nakamura, a psychiatry professor at the University of Occupational and Environmental Health, warns of the confusion that such tests could cause for the medical industry. "If people are mechanically advised to consult psychiatrists based on their test results, it could throw medical facilities into confusion," he says. He adds that workers could be rejected by others in the workplace if tests are implemented before there is more widespread understanding for psychiatric illness, and advocates caution. "It would not be too late to make (a mental health test) mandatory after we obtain evidence from model projects."

Cases of suicide and depression in Japan saw a steep rise beginning in the late 1990s, when it became clear that the Japanese economy was suffering from stagnation. The labor ministry's current anti-depression policy planning began at the behest of former Labor Minister Akira Nagatsuma, who aimed to turn that situation around.

Then Labor Minister Nagatsuma demanded that mental health screening be included in companies' regular health examinations for their employees, which was reflected in a report produced in May 2010 by a ministry project team. An expert panel that was then established met six times in just a month and a half, coming up with a framework for the mental health test.

The then Cabinet of Prime Minister Naoto Kan approved a "new growth strategy" for the country that included raising the number of workplaces implementing mental health measures to 100 percent by the year 2020. The initiative in its beginnings appeared to be a largely politician-led one, and one member of the expert panel recalls having the impression that it was a "rash process" in which the conclusion was already decided before the deliberations began.

Asked about the criticisms directed against the proposed mental health test, an official at the labor ministry's Industrial Health Division said, "We obtained the deliberation committee's understanding on the validity (of the test)."