In Japan, It Has Become Extremely Difficult for Only the Mentally Disabled to Receive Disability Pension Benefits Since September 2016

One day in November 2016, my depression flared up. This forced me to retire from work. I was suffering from a serious sleep disorder. For example, I went to bed at 23: 00 and woke up at 24: 00. The very short sleep led to a serious sleep deprivation. Of course, I came in late and was absent too often. Finally I couldn't go to work anymore.

Awareness of Disability

Originally, I developed depression in April 2010. But soon, in early May, I rushed to a psychotherapist. As a result, this quick action prevented me from becoming seriously ill.

I was diagnosed with masked depression that didn't come with psychological symptoms such as depressive mood, decreased motivation, and diminished ability to think. Therefore, until November 2016, I was working at a company with no problems as a healthy person. I'm sure that no one knew I was a depressed patient.

However, 6 years later (a very long time), I suffered from severe symptoms again. This made me aware of the persistence and the difficulty in preventing recurrence of depression.

• Though my depression had been steadily going into remission, suddenly it got worse.
• I couldn't find an obvious reason for this relapse.

I was thrown into the depths of disappointment all at once. That has made me consider myself as a person with a disability for the very first time.

Source: Week 3 of CBT in 7 Weeks: What Are You Thinking? - Seth J. Gillihan, PhD

No One Knows Much About Disability Pensions

Even though I was suffering from a serious mental illness, I had no choice but to continue working. Because I was living alone, no one could help me sustain my livelihood.

On November 1, 2016, to learn more about the employment of people with disabilities, I met Seishinshogaisha-koyo-totaru-sapota (Total supporter of employment of the mentally disabled). By the way, why is there a specialized consultation service only for people with mental disorders? This graph tells the answer. The answer is only the employment rate of people with mental disabilities is extraordinarily low. There must be various reasons for companies. But it's clearly discrimination.

Source: Summary of Employment Status for People with Disabilities in 2016 ｜Press Release｜Ministry of Health, Labour and Welfare

Let's get back on the track. Here's a summary of what he told me.

I was shocked and speechless. Fixed-term employment and minimum wage. Obviously, I would lose my home and die on the side of the street.

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Vain Effort Brought on by a Lie

So I asked him, “How on earth do the mentally disabled survive?”

Mostly they seem to be living with disability pensions. As for Grade 3, it is relatively easy to be approved.

I was a bit relieved. But later I found that the latter half of his remark was entirely false.

Believing his words, I ran here, there and everywhere in order to apply for a disability pension that could never be approved. It was really hard to gather dozens of evidential documents and fill out many applications.

One day when I was preparing to apply for it, I asked my doctor for an opinion on whether I might be eligible for the disability pension. He said that recently the disability pension review process has become much stricter, and in fact, cases that would have been OK in the past were no longer being approved. And he said that in my case, there was very little chance of passing the review.

Involuntarily, I said to myself, “That's different from what I was told.” I became extremely anxious. But of course, unless I applied for a disability pension, it would not be granted. And the doctor concluded by saying, “It's up to you whether you apply for it or not.” After much consideration, I decided to apply for it and asked my doctor to write a medical certificate.

Only the Second Page Matters

Three weeks later, I went to the hospital to receive my medical certificate. After reviewing it, I realized that it would be quite difficult for my application to be approved.

As a side note, in Japan, before applying for a disability pension, applicants must go to their local pension office for consultation. There, they need to receive an explanation about application requirements, general certification criteria, procedural flow, and necessary documents.

Therefore, on November 4, 2016, I met with the person in charge. She explained about the general criteria for certification by showing the table below.

According to that chart, it appeared that my condition was serious enough to qualify for Grade 3. She agreed with me on this point. But at the same time, she told me that this chart was just a guide, and that in reality the second page of the medical certificate would matter most.

Same as the Certification of Long-Term Care Need?

The second page of the medical certificate is as follows.

Source: Applications and Procedures for Receiving Disability Pension｜Japan Pension Service

It consists of two assessment sections: “Score of Daily Living Skills” (left half) and “Level of Daily Living Skills” (right half). It merely evaluates how well the applicant can live without the support and assistance of others. Actually, it was not designed to evaluate the severity of mental illness and difficulties in social life, such as working.

Source: Long-Term elderly care - Cubaheal | World-renomned healthcare at affordable prices

By the way, "Daily Living Skills" are the skills to perform basic daily activities by him/herself, such as eating, washing his/her face, taking a shower, and shopping.

When I got home, I checked the medical certificate again. The questions “Can you eat properly”, “Can you keep yourself clean”, and “Do you shop properly” without help or assistance from others are almost the same as those asked when applying for certification for long-term care need. Since I was neither elderly nor physically disabled, I thought it was extremely unreasonable.

Useless Certification Criteria Chart

For a while, I lost myself in strong anger. Then I looked at the brochure of disability pension again and double-checked the certification criteria chart.

The sentence in the chart, “Labor is severely restricted” corresponded to my life situation at the time. In fact, I was unable to work due to the severe sleep disorder. I could only go to work 5 days a month. Before the relapse of my depression, I was working full time 5 days a week.

As a result, by reviewing the certification criteria table, I mistakenly believed that there was still a possibility. And two days after receiving the medical certificate, on November 28, 2016, I applied for the disability pension.

Four months later, on March 10, 2017, one thick envelope was dropped in my mailbox. The timing of its arrival and the weight of the envelope made me realize that it was a notice of the results of my application. A mixture of anxiety and anticipation caused me to panic and my heart to beat faster. With trembling hands, I put the scissors in the envelope of my life.

Notice of Non-payment Decision

The Survival Instinct Revived Me

Source: Frustration and hopelessness can cause heart attacks cause of death, Research | News Time

I was slammed to the depths of hell. The force of the impact shattered my mind and body into pieces. But even after such a huge blow, I was barely alive.

Before long, my survival instincts issued a fierce warning and commanded me to resolve the greatest crisis I faced, death by hunger, as quickly as possible. Driven by these instincts, I put together the fragments of my mind and body and began to take one action after another to keep alive.

From Pillar to Post

First, I visited Seikatsu-jiritsu-shigoto-sodan-senta (Life Independence and Job Counseling Center). But they knew nothing about livelihood support for the mentally disabled, nor about disability pensions. No advice was given there. Instead, however, they told me about a more specialized organization, Shogaisha-seikatsu-shien-senta (Livelihood Support Center for Disabled Persons).

Immediately, I went there and asked for advice. They certainly gave me more professional and extensive advice. And it became clear that the only livelihood support I could receive was a disability pension. But I knew that I could request for re-examination of my application. So I asked the person in charge whether the decision could be overturned if I requested for re-examination. She said, “I don't know, because I'm not a caseworker.” And she gave me information about caseworkers in my city. Surprisingly, one of them belonged to the clinic I usually visited.

Being passed from pillar to post, finally I was sent back to the starting point. Played in someone's dice game, I felt immensely helpless.

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Later, I had a meeting at that clinic. The person who came into the room was the man who always worked at the reception desk. I couldn't help giving a bitter laugh and said in my mind, "Why am I always out of luck?" Anyway, finally, after the consultation with him, I was able to understand the reason why my application was rejected and its background.

New Guidelines Became Effective

The very reason my application was not approved was that the evaluation based on the new guidelines has started since September 1, 2016. These new guideline are called Seishin-no shogai-ni-kakaru-tokyu-hantei-gaidorain (The New Grade Determination Guidelines for Mental Disorders). And now, the grade of disability pension is determined based solely on the second page of the medical certificate.

Source: Applications and Procedures for Receiving Disability Pension｜Japan Pension Service

Point Rating System: Brutal Elimination

Under the new grading system, the patient's “ability to perform activities of daily living” is first evaluated on a 1 to 4 point scale. And based on that Score as well as Level (severity), the grade of disability pension is determined. It's like a mark sheet scoring system. The following chart will make it easier to understand.

Score of “Ability to Perform Activities of Daily Living”

In practice, the Score is the average of the ratings of Daily Living Skills (on a 4-point scale) in seven categories. For example, 1 point is given if the patient can perform basic daily activities by him/herself. The details of the points are as follows:

And the seven categories are as follows:

In my case, the average score was 1.28 (below 1.5) and the level (severity) was evaluated as (2). As a result, my application was   Rejected   in such a simple manner.

Reduce the Disability Pension Payments

As mentioned earlier, since September 1, 2016, Seishin-no shogai-ni-kakaru-tokyu-hantei-gaidorain (the new grade determination guidelines for mental disorders) has come into force. Its good cause, simply put, was to eliminate and equalize regional disparities in disability pension denial rates. But this is a blatant untruth.

Source: Urgent Correction of Regional Disparities in Disability Pensions and Public-Private Disparities:Yoshihiro Ide, Member of Ibaraki Prefectural Council, Official Homepage

Indeed, there used to be significant disparities in the denial rates. But the truth was that by drawing people's attention to this issue alone, they have sneakily changed the grading criteria to curb the disability pension payments. Perhaps, they were concerned about the ever-increasing number of mentally disabled people. In short, it was nothing but a measure to control social security spending.

The Number Keeps Growing

There is a distinctive difference between mental disabilities and the other disabilities. That is, mental disorders have psychogenic etiologies. For example, depression can be classified into three types depending on its cause.

Endogenous Depression :

Inborn factors such as genetics and constitution

Exogenous Depression :

Due to brain damage caused by a physical blow, other illnesses, or drug abuse

Psychogenic Depression :

Due to mental stress

Therefore, as society's stresses increase, the number of people with mental disabilities, especially psychogenic depression, will grow accordingly.

This chart was made with reference to the 2013, 2014, and 2016 editions of the White Paper on Disability

In fact, the number of people with mental disorders is soaring. At present, I think it has already exceeded the number of people with physical disabilities. But recently, no convincing information has been disclosed on the number of the mentally disabled. Will unfavorable information continue to be withheld?

The Majority of Applicants Will Be the Mentally Disabled

This chart was made with reference to the 2013, 2014, and 2016 editions of the White Paper on Disability

As this graph clearly shows, the number of people with mental disabilities is already the highest. Furthermore, in this stressful society, the number of the mentally disabled, especially due to psychogenic depression, will surely keep increasing. It won't be long before the number of the mentally disabled doubles that of the physically disabled, or about 7 million.

Meanwhile, the number of people with physical and intellectual disabilities will continue to level off. At present, there are no external factors that would increase that number. So, from now on, the majority of applicants will be the mentally disabled. And due to the growing number of people with mental disabilities, the number of applications for disability pensions will also increase rapidly. If the officials respond diligently to the ever-increasing number of applications and continue to provide disability pensions, Japan will be in dire fiscal straits.

GPIF's revenues and rates of return (2009-2016). GPIF: Government Pension Investment Fund. The Fund fell into the red in 2015.
Source: GPIF the gimmick of “5 trillion yen of pension investment deficit” | PRESIDENT Online

This nation has already great difficulty financing even old-age pensions. So I guess the officials built a Trump Wall against the most vulnerable people, the mentally disabled, who are unlikely to raise their voice due to privacy concerns and fear of prejudice and lack of understanding. And they are now becoming the majority of ever-increasing number of disability pension applicants.

Source: Another judge rules against Trump on border wall - POLITICO

No Chance, as Long as They Live Alone

As mentioned earlier, since September 1, 2016, Seishin-no shogai-ni-kakaru-tokyu-hantei-gaidorain (The New Grade Determination Guidelines for Mental Disorders) has come into operation. The adoption of this new grading system has created a pitiable group of people who will never receive disability pension benefits throughout their lives. They are the mentally disabled living alone.

Simply put, the new grading system evaluates only how well the patient can live without the support or assistance from others. However, if they are living alone, there is basically no one to support or assist them in their daily life. Therefore, they are unable to earn points in the Score of “ability to perform activities of daily living.”

In almost all of the seven situations, they can do them by themselves (i.e. 1 point).

This means their Score of “ability to perform activities of daily living” will certainly become below 1.5. At this point, their applications will definitely be rejected.

Patients Living Alone Are Urgently in Need of Help

So, if you compare the two:

1. The mentally disabled living with their family who are able to receive disability pension benefits.
2. The mentally disabled living alone who can no longer receive them eternally.

Who is in more financial need?

Those who live alone have to pay for the rent, utilities, food and other living expenses on their own. Cash spreads its wings and flies away without mercy. Even if they starve, they must force themselves to work again in order to secure a place to live. However, the overwork doesn't last long, and the disease re-worsens. The tragedy repeats over and over again.

The mentally disabled living alone can hardly reintegrate into society without public financial support.

Also, they have to ease their sufferings all by themselves. They don't have any family or roommates to talk to about their hardships and pains. Which of the two are suffering more and facing more obstacles in their lives? Who should be aided first?

Healthy people may think that their symptoms are so mild that they can live without the support or assistance from others. But it's totally wrong.

Procedural Memory and Survival Instinct

Some adults may have this kind of experience: drinking to the point of oblivion, but somehow came home safely and slept in their pajamas. The reason we can do such magical thing is that the actions of coming home and going to bed are remembered as a single procedure, procedural memory. Unlike semantic and episodic memory, procedural memory is said to be formed through the cycle of physical activities. There are many other familiar examples, such as learning to ride a bicycle, play the piano, and master touch typing.

Little boy falling off bicycle Source: When You Fall, Get Back Up - p.s. That's Life!

In all cases, it is very important to keep practicing with physical activity. The more experience you gain, the more your procedural memory develops. Experience is a key factor for procedural memory.

Less Experienced, More Advantaged

People living with their family, with or without disabilities, have far less experience in cooking, cleaning, and managing their money by themselves. Less experience means that people living with their family have poor procedural memories for performing activities of daily living by themselves. On the other hand, the mentally disabled already living alone have much more experience in performing basic daily activities by themselves.

Ironically, under the current grading system, the higher their abilities are, the lower they are graded. In this way, their applications are   Rejected   one after another.

Persistence of Procedural Memory

Procedural memory has an unique feature, long-term persistence. Once acquired, it lasts for a lifetime. In fact, it is said that even patients with advanced dementia hardly lose procedural memories. Meanwhile, the other memories are easily forgotten. Thanks to the persistence of procedural memory, the mentally disabled already living alone can “perform activities of daily livings” without much difficulty.

Of course, mental illness such as depression decreases motivation and interferes with daily activities. Nevertheless, when the risk of death from hunger increases, the survival instinct urges them to get something to eat. Such instinctive behavior corresponds to an Appropriate diet?

Application After Recovery

As mentioned before, the number of the mentally disabled is on the rise. I believe this is mainly due to the increasing number of patients with psychogenic depression. Psychogenic depression has a very different characteristic from other mental illnesses: very fast recovery.

Source: Phases of treatment for MDD. MDD = major depressive disorder. Adapted,... | Download Scientific Diagram

As the above chart shows, with proper rest and medication, patients can recover from it in about 6-12 weeks. This is like a V-shaped recovery. However, when their symptoms are so severe and painful, they can not even think about disability pensions. Despite this, because of the short recovery period, by the time they consider applying for a disability pension, their condition has already become much less severe. Obviously, their applications will not be approved. The most effective way is to have a family member apply on their behalf when symptoms are most severe. But the mentally disabled living alone have no family living together or roommate to whom they can delegate the application process.

These conditions are too inhumane for the mentally disabled living alone. Their illness cannot be cured under these circumstances. Naturally, their reintegration into society is almost impossible.

Source: Being Ridiculously Good at Life: How to Deal With Hopelessness

Privacy Concerns & Fear of Prejudice

Finally, I would like to add that in Japan, people with mental disabilities very often do not obtain disability certificates due to privacy concerns and fear of prejudice. As a depressed patient myself, I thought the same way. This means that the actual number of the mentally disabled is higher than that shown in the chart below. In other words, so many mentally disabled people work for companies in Japan, disguised as healthy people while suffering from mental illness.

This chart was made with reference to the 2013, 2014, and 2016 editions of the White Paper on Disability

It is very hard and stressful to fight against disease while pretending to be healthy. Such difficulties peculiar to the mentally disabled are due to the prejudice and lack of understanding of mental disorders among the Japanese people. And because mental disabilities are the most prejudiced and least understood of all disabilities, they continue to be discriminated against in the employment of people with disabilities.

Source: Summary of Employment Status for People with Disabilities in 2016 ｜Press Release｜Ministry of Health, Labour and Welfare

There are two types of minorities: those easily exposed to public attention and those invisible (dark minorities). The mentally disabled are the dark minority who are always left out in the cold.

Without any support from my family and the government, still I'm living alone. To be honest, I am so starved that I could die alone.

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I've wanted to change this unfair society.
No energy to let out a howl anymore.