Familism and Secular Special Interests in Italy and Japan: The Case of Mental Health Care

This paper interrogates the assumption that “familistic” welfare systems rely on informal care giving to supplant state-sponsored services. While the Italian government has closed mental hospitals and transitioned patients into community-based and/or informal care settings (i.e., “de-institutionalized”), Japanese mental health policy remains heavily hospital-centric.  Government efforts to reform the system in 2004 and 2009 have failed, thereby allowing institutionalization to persist in Japan. In contrast, Italy began its de-institutionalization process decades earlier (in 1978), when psychiatrist Franco Basaglia led a national movement to reduce the number of mental hospitals. Thus, while Italian state authorities managed to implement Basaglia’s plans, this was not the case in Japan. Comparing the two cases highlights the fact that countries with insulated bureaucracies are less likely to give way to special interests than countries without insulated bureaucracies. Both the Basaglia movement and pharmaceutical interests influenced the Italian state bureaucracy. In many countries, the pharmaceutical industry pressured governments to adopt community-based approaches to mental health care in order to promote sales of anti-psychotic medications. But insulated bureaucracies, as in Japan, were less influenced by these interests.  By tracing the process of mental health policy development and assessing its implications for path-dependent policy-making, this paper lays out the role of special interests  -- particularly secular special interests -- in promoting familistic welfare arrangements.