Chapter 2: Major agenda items

1. Recognition of problems

In recent years, we have seen an increase in the number of cases of abortion and sexually transmitted infection due to increased sexual activity at lower ages among the adolescent. This has also been a rise in the number of cases of drug abuse, smoking, drinking, and excess dieting. It has been pointed out that such problematic activities affect the health of boys and girls during adolescence. In line with such trends, psychological problems specific to adolescence such as psychosomatic disorders, school avoidance, secluding themselves at home, anorexia nervosa peculiar to adolescents, have become more serious, developing into a social problem. Furthermore, cases of child suicide, murder and violence have also become more marked, which is a problem for adults who cannot fully communicate the value of life to their children.

The prevalence of such causes mirrors the changing social environment of our county, vividly reflecting the problems of the times. Although the problems may be extremely difficult to solve, we need to strengthen our efforts toward improvement. We must also concentrate our efforts in solving this situation by making it the key issue to be solved in the 21st century.

We also need to recognize the fact that the development process in infancy is closely related to health issues affecting adolescents. We have extremely limited resources in terms of child psychiatrists and child psychiatry service providers in Japan compared with other countries. This situation calls for immediate improvement.

2. Direction of initiatives

(1) Health and sex issues during puberty

Adolescence is a period in which both the adult and the child co-exist. Therefore, in dealing with children during puberty, the adults surrounding them, including their parents, need to understand their childhood anxieties or misgivings, respect their dignity as people who have partially acquired competencies equivalent to those of an adult, and listen to what they have to say.

Problematic behavior during adolescent is not just a problem for this stage of their child's life. Such problems may develop into health disorders in the future or even have an adverse effect on the next generation. Therefore, we must make the child in question understand such risks and encourage him/her to correct his/her behavior.

To do this, we aim to obtain an understanding of the problems and to provide information through education, awareness raising activities and consultations in cooperation with families, schools and communities. However, learning from the insufficient results obtained from similar attempts in the past, we must attempt to expand our initiatives quantitatively and make a qualitative changeover.

Regarding quantitative expansion, we must strengthen the initiatives in respective fields including medical services, community health care, child welfare and school health care, and step up awareness raising campaigns to prevent juvenile misconduct and drug abuse, etc. In addition, the cooperation of commercial organizations and volunteer groups as well as that of the media will be vital.

As for qualitative changes, we must encourage the development of teaching materials, tools, and methods, which can convey clear messages to the greatest possible effect in our education and awareness raising activities, and make children understand that sexual perversion and drug abuse during adolescence is undesirable, thereby urging them to change their behavior. Regarding sex, in particular, we should explain male-female relationships and the necessity for mutual understanding. At the same time, we should not avoid explaining methods of contraception. It is also necessary to urge adolescents to recognize the value of life and to be aware that they will be responsible for rearing their own children in the future.

With regard to sex and reproductive issues, it is particularly important that each individual judges, makes their own decisions and respects others. Therefore, it is necessary for us to try to improve sex and health education in schools and communities so that children can obtain accurate information on their own bodies and bodies, generally, and control their own health based on personal judgments. In improving sex education, we need to have a full grasp of the highly stressful and complex environment in which children during puberty are placed. This must take of sexual activity at younger ages and increased chances of exposure to information on sex into account.

At a community level, various measures, including maternal and child health, countermeasures for sexually transmitted diseases and drug abuse will need to be promoted with the close cooperation of all parties involved. It is particularly important that the Ministry of Welfare and Labour and the Ministry of Education and Science cooperate in sending out a clear message about the direction of the initiatives, and strengthen ties between health care, medical services, welfare and education at the community level.

(2) Psychological problems during adolescence

Children often show some kind of physical sign when they start to develop a psychological problem. We need to provide parents with learning opportunities in order to make them aware of these signs at an early stage. It is also necessary to have a family doctor from infancy so that parents can acquire learning opportunities to detect signs at an early stage, and can receive appropriate advice from the doctor.

Anorexia nervosa is a problem peculiar to adolescents. The number of adolescent girls is with this problems has grown recently, making early detection and prevention an urgent requirement. Onset of the disease in the teens, in particular, weight loss and multi-organ dysfunction in the period of most rapid growth can lead to serious developmental disorders, both psychological and physical. It is also known to have adverse effects on the psychological development of the next generation as ex-anorexia nervosa patients tend to have problems during pregnancy, childbirth and child rearing. They may suffer from a child-rearing disorder, and find it difficult to take good care of their child or are unable to feed their child with baby food. In this particular area, the establishment of a system for early detection is needed.

With regard to measures for school avoidance, development of measures with latitude --- regarding school avoidance as an approach route to mental growth, and providing supplementary guidance and outdoor activities with the help of specialists both inside and outside the school --- is desirable.

Improvements in the care for those who have psychological problems, including education and support of parents, are an effective means of attaining specific results. Toward this end, strengthening the ties between parties and organizations involved is crucial. It is particularly important to develop a system of cooperation between health care in schools, medical services, community health care and child welfare, and to position it as a routine interactive activity. Such a task will generate an enormous workload, and organizational actions, so the understanding of managers and the parties concerned will be needed.

In order to support initiatives for mental problems, we need to secure human resources. In addition to family doctors who will be responsible for the primary care for the psychological and health care problems of the adolescent, it will be important to involve specialists, including child psychiatrists, who specialize in the secondary and tertiary care of illnesses such as developmental disorders, emotional disorders, and behavioral disorders, as well as providing counselors. Furthermore, improvements in the system of providing psychiatric treatment for children are a major challenge. With regard to other professions concerned with health care during adolescence, the acquisition of appropriate knowledge and counseling techniques is needed according to their respective roles.

3. Specific initiatives

(1) Health and sex issues during adolescence

A. Quantitative expansion

We should work on the following initiatives: strengthen school counseling for children during adolescence, hold seminars aimed at making improvement in the counseling abilities and quality of teachers including school health/nurse teachers, improve school doctor activities, promote the appointment of school counselors, improve the counseling function of dispensaries (including the appointment of more than one school health/nurse teacher at every school), and set up specialized counseling rooms.

We should further strengthen community counseling systems. In particular, this should include counseling systems for troubled children and their families at community health care and welfare organizations (public health centers, municipal health centers, mental health care and welfare centers child guidance centers, and welfare offices.) and the counseling function of commercial organizations for adolescents.

With regard to health issues during adolescence, we should strengthen public relations ("PR") and awareness-raising activities through TV, radio, magazines and the Internet, which can are most likely to be used by young people. This should be in addition to awareness raising and dissemination activities using pamphlets and posters distributed by the organizations concerned. Particular emphasis should be placed on contraception and the prevention of sexually transmitted diseases as well as the prevention of drug abuse when conducting such activities.

While providing accurate information concerning adolescence through books and magazines targeted at children of all ages, we should provide learning opportunities through campaigns on health issues for adolescents through information magazines and educational TV programs targeted at parents who have adolescent children.

B. Qualitative changeover

(a) Initiatives in schools

Health education initiatives in schools should include the following issues, aimed at the acquisition of basic knowledge and putting abilities/techniques into practice.

In schools, it is important for teachers to work together to promote health care across the range of educational activities. In related classes and special activities, guidance on adolescent health care should be further promoted with the participation and cooperation not only of teachers, but also of other members of staff such as school health/nurse teachers, school doctors, school dentists and school pharmacists.

In particular, health education in "gymnastics and health/physical education" classes should be encouraged by inviting the participation and cooperation of school health/nurse teachers. As for sex and drug abuse prevention education, the cooperation of external specialists (doctors, pharmacists, midwives, public health nurses, police personnel, ex-drug regulatory officials, etc.) should be sought.

(b) Initiatives in communities

Peer education initiatives designed to obtain knowledge from people of the same generation, are effective in providing sex education and preventing drug abuse. In the future, initiatives in which adolescent children will play the leading role should be promoted in communities through activities such as meetings to discuss young people's opinions on health care matters, training of peer counselors and peer counseling.

Opportunities for learning about contraception, including a program offering free contraceptives should also be provided, depending on the situation of the individual community.

By a way of addressing the behavioral problems of adolescent children who are not attending school for various reasons, counseling and advice should be given to the parents, supportive measures to help children return to school should be taken and initiatives should be implemented to ensure that learning opportunities are not hindered by pregnancy or childbirth.

Harmful information that affects children's mental states is also an issue that we cannot afford to overlook. We should urge the media to take measures against harmful information, which is published in an irresponsible manner. We should also actively support improvement in the ability of young people to be selective in their choices to interpret the topic subjectively and to come to their own conclusions. In addition, we should promote the supply of information for adolescents through other media forms such as the Internet, which is spreading out very quickly.

C. Ties between the parties and organizations concerned

We should provide opportunities for schools and related organizations in the community to learn from each other and exchange information and opinions on a regular basis.

We should also provide opportunities for the parties and organizations concerned to study and provide optimal services in cases where specific problems arise.

We should improve the function of school health care committee meetings and encourage the establishment of school health care committee meetings for the community. These will be established jointly by the school health care committee meetings of kindergartens, grade schools, junior high schools and high schools to discuss health issues for the children in the community.

In order to strengthen ties between public health centers and school health care, we should promote the dispatching of specialized personnel in the field of sex,sexually-transmitted infection and drugs, etc., and encourage their participation in the school health care committee meetings and the health care committee meetings of the community. We should also hold educational classes on the issues facing parents in cooperation with PTAs.

(2) Psychological problems during adolescence

We should attach importance to seminars for school health/nurse teachers and teachers to help increase the level of their consulting activities for psychological problems in schools. We should also encourage the proactive activities of school doctors in health care consultations and in appointments of school counselors. In addition, we should also improve the consultation functions of dispensaries. (including the appointment of more than one school health/nurse teachers).

We should improve the services provided by consultation organizations in communities (public health centers, municipal health centers, mental health care and welfare centers, child guidance centers, etc.) and medical service systems (outpatient department for adolescents and hospital building dedicated to adolescents).

As a preventive measure for suicide, we should improve the anonymous telephone-counseling project for adolescents. In addition, we should give lectures for concerned parties regarding early-stage prevention measures for students who have a desire to commit suicide.

As a measure to address the mental health of adolescents, mental health care, welfare centers and child guidance centers should take the initiative in creating a community network, and promote a model business on the basis of which the organizations concerned including medical institutions, public health centers, and board of education can carry out cases and studies support activities.

In order to improve the system of psychiatric medical services for children, we should consider the following issues: the improvement of medical treatment fees; open lectures at medical and affiliated universities; tasks as required by the Medical Treatment Law; the training of doctors, child psychiatrists and other medical professionals who can cope with the psychological problems of the adolescent; the appointment of child psychiatrists at child guidance centers and residential treatment center for emotionally disturbed children; and application of these issues to school education.