Title: Working Conditions and Mental Health Among Staff in

Japanese Welfare Facilities for People with Disabilities.

Authors: Yuuka OOKA 1),2)

Affiliation:
1) Department of Psychology and Social Welfare, Mukogawa Women’s University, Japan.
2) Research department(research associate), Hyogo Institute for Traumatic Stress,Japan.

Correspondence and reprint requests to:

Yuuka OOKA, Ph.D.
Department of Psychology and Social Welfare, Mukogawa Women’s University, Japan.
6-46,Ikebiraki, Nishinomiya,Hyougo,663-8558,JAPAN
Tel: +81-798-45-9821
Fax: +81-798-45-9821
Email: ooka@mukogawa-u.ac.jp

ABSTRACT:

Background:
While the importance of work for mental health has been widely acknowledged, the specific
influence and action in workplace, especially welfare facilities, are less clear when considering the
public policy.
Aims:
We investigated the relative weight of job-related characteristics on the perceived organizational
working factors in the facilities and predicting high-risk mental conditions of staff.
Method:
A sample of 1,173 facility staff members in Kansai, Japan participated in our survey. Perceived
organizational working factors and mental health were assessed by using the GHQ-28 assessment
tools.
Results:
62 percent of workers were in the condition of high-risk mental health. Those experiencing high-
risk mental health were female workers, workers in their late 20s, middle management executive
workers and those who worked 60-80 hours per week. These workers found it difficult to take
holidays and were statistically dissatisfied with their job.
Moreover, a multiple regression equation was estimated to determine the independent contribution
of various demographics to high-risk mental health. Gender and job satisfaction proved to be
strongly and positively associated with mental-health (p<0.001).Working hours also proved to be
positively associated with high-risk mental health(p<0.01). Differences in mental health were tested
with a t test and revealed significant differences between high-risk and low-risk mental health.
Significantly more than low-risk workers, Persons experiencing high-risk feel a “consulting system”
and individual support from their facility for their needs are important in maintaining their health.
Conclusion:
Improving the workplace system by consulting persons when they have risk of mental stress, or
are involved with difficult affairs, should be one of the most important targets in staff mental health
keeping strategies. The potential benefits of such a way may in return have a favorable impact on the
outcome of persons with disabilities. Thus, government should support facilities in creating mental
health support systems for their workers with an emphasis on work-life balance so that the welfare
system can be more effective in the process of normalization.

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INTRODUCTION

While the importance of work for mental health has been widely acknowledged, the specific
influence and action in workplace, especially welfare facilities, are less clear when considering the
public policy. Especially in Japan, due to policy reforms that took effect in 2000, many Japanese
workers in non-profit welfare field have experienced heightened rates of job-related stress during the
past 10 years. In this article, first of all, we recall back in past dozen years when the issue first came
out in workplace of facilities.

Transition of social welfare facilities:

The background of this issue dates back to reforms which the Japanese government enacted in 2000
with the Social Welfare Basic Structural Reform. Currently, the Japanese government has proceeded
in reforms of persons with disabilities following the trend of normalization or deinstitutionalization.
As part of the reform, the Services and Supports for Persons with Disabilities Act came into effect
in 2006. It is aimed at helping those with disabilities live independently in society according to their
respective abilities and aptitudes. The system switched from a traditional model where care and
services were available but choice was limited to an institution to a contract-centered model with the
use of facilities in communities. Shifting to a new model was a way for the government to reduce the
cost of care following the rapid aging of the population resulting from the decline in the birthrate. So
in other words, the Japanese welfare system for disabled people changed from a system where
service fees were paid by the public to a system where disabled individuals had to pay for their own
service fees. As a result, persons with disabilities had to pay more for their care.
At their facilities, disabled persons received training on how to live independently and how to work
with having disabilities. However, the quality of services for those with disabilities seems to have
declined at that time because disabled individuals refrained from using these care services to avoid
out-of-pocket service expenses, thereby decreasing the revenue for the facility.
But disabled persons and their families raised their voice, and forced the Liberal Democratic
Party(LDP) government to concede defeat after 3 years in power. The Democratic party of
Japan(DPJ) who got a victory over the LDP had decided to abolish the Services and Supports for
Persons with Disabilities Act which the LDP enacted and then decided to make new law within four
years. The government announced that it intended to form an advisory panel including scholars,
lawyers, politicians and disabled persons and their families to investigate the issue. As one of their
efforts, the DPJ government began to subsidize the self-pay of care for persons with disabilities
according to their income. As various reforms continue now, the quality of welfare services looks
hopeful to some degree and services could be improving.

Staffs and facilities :

Facilities for disabled persons have existed in Japan for many years but since the governmental
reforms, these facilities have seen an increase in workload and overhead. Most social welfare
facilities belong not to a governmental organization but to a private agency in Japan. After World
War II, the financial state of Japan was deteriorating, so it promoted the management of private
welfare institutions through subsidies rather than establishing completely government-run
institutions. Over the years, facilities have developed various approaches in caring for those with
disabilities with the luxury of having volunteers and sufficient funding from government subsidies.
However, as was explained earlier, the Japanese government decided to reform the system of
welfare back in 2000. Various law revisions happened one after the other, and eventually made the
facilities more difficult to manage because of the reduction in funds which had the effect of making
working conditions harder for workers in welfare facilities. For example, facilities that provided
care for disabled persons could no longer make enough profits to sustain themselves despite the
demand in society and the staff’s hard working ethics.
In their struggles these facilities have been adjusting to this change by switching full-time workers
to part-time in order to balance their budget. In recent years, problems in mental health among
welfare staff have been increasing in every facility, resulting in their leaving or early retirement. It is
clear that the reform efforts made makes the staff exhausted and sometimes sick. This trend in Japan

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has been a serious issue among facilities for people with disabilities.
***
The background of this issue was explained above. In this study, the data following this survey
show the results from a quantitative investigation of staff in various facilities to clarify how
strenuous working conditions for Japanese facility workers are, and show how mental health and
working conditions are correlated. Finally I propose what actions and policy changes the Japanese
government should make with regard to this issue.

METHODS

Subject:
The study included more than a hundred private facilities with five to about three-hundred staff
members. All staff members were asked to fill in a self-report questionnaire and return it in February
of 2010.This study was conducted in the Kansai region of Japan including Osaka and Kyoto.
Interviews of staff members were made at the site, and the contents of the survey slip were
examined repeatedly. The survey slip was distributed from each director of a facility and the
manager provided the slips to staff members. We requested staff members who answered the survey
slip to tightly seal it after being filled in, and to send it back to the study committee by individual
mailing.

Measures:
We asked them to specify their sex, age, qualification and occupation etc. Subjects also were asked
to fill in their workplace conditions such as working arrangement, class of position, working hours,
salary, paid-holidays and job satisfaction.
Subjects were evaluated using the 28-item General Health Questionnaire. GHQ-28, as developed
by Goldberg, D.P.(1978)1, was used in this study to measure the dependent variable mental health.
This is the most widely used screening measure of a wide range of psychological symptoms with
numerous studies supporting its validity and reliability in a range of settings including stroke. The
GHQ-28 consists of four sub-scales: somatic concern, anxiety, social dysfunction and depression.
The score from the GHQ-28 were then divided into two groups: high-risk of mental health and low-
risk mental health. The cut-off score of Japanese version is 6/7.

Statistical analysis:
Statistical analysis employed SPSS, version 18.0 for windows. In the first bivariate analysis, work
environment and demographic characteristics of facility staff are described. Differences were tested
between gender, age-group, qualification and occupation. Moreover, working arrangement, class of
position, working hours, salaries, paid-holidays, job satisfaction were tested with a Chi-square test
which are used for comparing the differences between high-risk group of a GHQ-28 score and a
low-risk score. The predictors of mental health were tested with a multiple regression equation and t
test. The significance level was less than 5%.

Ethical issues:
The study committee verified that the cooperation of staff members was done by on their own free
will. Moreover, it was guaranteed to those participating in the study that the collection of the survey
slip could be discontinued in the investigation at any time. Staff members were also insured that they
would not receive a disadvantage in the workplace even if their participation was discontinued.
Respondents’ anonymity is preserved, and a written informed consent was obtained from all the
respondents and confidentiality of ratings was assured. Neither the individual nor the organizations
were specified. The investigation obtained the approval of the university ethics committee.

3
RESULT
Respondents:
1,173 staff members, or fifty-three percent of those who picked up a questionnaire completed it.
Workers who help those with disabilities in facilities----broken down by the mental health high-risk
or mental health low risk character of the PSU in which they work are provided in TABLE. 1.
Almost half (59 percent) of workers were female and 43 percent of staff had a social/care workers
certification. The largest group, 29 percent, of workers was in their thirties.

TABLE. 1
Demografic breakdown of partcipants ; Mental Health (high-risk/Low-risk)
low-risk high-risk Total
Demografic variable % % %
PSU setting 38 62 100
Sex **
Female 54 63 59
Male 46 37 41
Age ***
20s 19 27 23
30s 27 30 29
40s 21 25 24
50s and over 32 18 24
Qualification
Social/Care workers certification 43 42 43
Care workers without certification 16 18 17
No licence 40 37 37
the other 1 3 3
Occupation
Direct user care 69 75 72
management work 11 7 9
clerk/hasher/driver 15 11 13
the other 5 6 6

*p<0.5 ** p<0.01 *** p<0.001

The average age was 40.5 years, with an age range of 21 to 71 years. Most workers (72 percent)
were direct user care, while 9 percent were a supervisory employee. 62 percent of workers were in
the condition of high-risk of mental health.
Results of the chi-square test indicate that workers who are at high-risk of mental health were
significantly different. More female workers reported mental health as high-risk than did male
workers. Whereas workers in their late 20s reported that their mental health was more high-risk than
older generations, especially 50s tend to have their mental health of low-risk.
In addition, working conditions of staff members broken down by the mental health high-risk or
mental health low risk character of the PSU are provided in TABLE. 2. Workers in middle-
management executive positions were more high-risk of mental health compared with managerial
level and non-executive employees. And workers who work for 60-80 hours per week were
considered a high-risk group in mental health. With regard to paid holidays, workers who thought it
was easy to take a holiday, were less high-risk of mental health than the others, whether part-time

4
workers tend to think that it is easy to take Paid holiday. Finally, job satisfaction differed by mental
health conditions, with forty percent high-risk workers on mental health having job dissatisfaction.
No other statistically significant differences were identified.

TABLE. 2
Working condition of partcipants ; Mental Health (high-risk/Low-risk)
low-risk high-risk Total
Demografic variable % % %
PSU setting 38 62 100
Working Arrangement
full-time 69 73 72
part-time 31 27 28
Class of position *
managerial level 11 9 10
middle-management executive 14 19 17
non-executive employee 75 72 73
Working hours (per week) **
<40 hours 32 24 27
40-60 hours 58 60 59
60-80 hours 9 15 13
> 80 hours 1 1 1
Salary (per month)
< 150,000 yen (\) 23 22 22
150,000-200,000 yen (\) 29 35 33
250,000-250,000 yen (\) 21 21 21
250,000-300,000 yen (\) 11 12 12
300,000-400,000 yen (\) 11 9 10
400,000-500,000 yen (\) 4 1 2
> 500,000 yen (\) 1 0 1
Paid holidays ***
easy to take 48 35 40
difficult to take 43 69 53
willing not to take 9 6 7
Job satisfaction ***
yes 85 60 69
no 15 40 31
*p<0.5 ** p<0.01 *** p<0.001

A multiple regression equation was estimated to determine the independent contribution of each of
the demographic variables on the mental health of respondents (see TABLE. 3).Qualification,
occupation, working arrangement, class of position, salaries, and paid-holidays did not distinguish
the level of mental-health between high-risk and low-risk. While, sex and job satisfaction proved to
be strongly and positively associated with mental-health (p<0.001) , it means that when a worker has
high job satisfaction, he/she is well and able to keep low-risk of mental health, especially male tend
to keep low-risk of mental health. Moreover, working hours also proved to be positively associated
with high-risk of mental health(p<0.01). That is to say, the more the working time increases, the
more mental health deteriorates. In addition, age proved to be negatively associated with high-risk of

5
mental health. Thus, according to the age, the tendency of mental health is different.
When describing in detail, late 20s(25-29yrs), 40s(40-49yrs),and late 30s(35-39) were sequentially
increasing the ratio of high-risk of mental health. The person of 75% was a high risk as for their late
twenties.

TABLE.3
Weighted Multivariate Analysis of Worker ; Mental Health (high-risk/Low-risk)
Model Variable Beta Coefficient (SE) p
(Intercept) 3.13 (2.26) .167
Sex 1.46 (0.41) .000 ***
Age -0.06 (0.02) .003 **
Qualification 0.15 (0.42) .714
Occupation -0.26 (0.22) .243
Working Arrangement -0.28 (0.55) .614
Class of position -0.43 (0.38) .257
Working hours 0.93 (0.34) .006 **
Salary -0.17 (0.21) .401
Paid holidays 0.02 (0.33) .941
Job satisfaction 2.99 (0.27) .000 ***
Note:Overall model multiple adjusted R2=.156
*p<0.5 ** p<0.01 *** p<0.001

TABLE. 4
Important things in the workplace ; Mental Health (high-risk/Low-risk)

mental health low-risk mental health high-risk

Guarantee on holidays

Salary that is commensurate to workload

Work discussions

Securing a breaktime

Consulting system ＊＊
Effective care for user center

Work related social events

Supervision

Training oppotunities

Havng child care and care leave

More invollvement of Labor Unions

Establishing a promotion system

Other ＊＊＊

0 20 40 60 80 %
*p<0.5 ** p<0.01 *** p<0.001

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 When you see the results of the survey titled "Important things in the workplace" by three answers
(see TABLE. 4), as total of respondents, most staff members think Guarantee of holidays is the most
important. Second to holidays is Salary that is commensurate to workload then, discussions, securing
a break time, a counseling system, effective care for user center, work related social events,
supervision, training opportunities, Having child care and care leave, More involvement of Labor
Unions, Establishing a promotion system, and other. Within “other”, there are a lot of opinions, for
example, no overtime work, no power harassment, good interpersonal relationships, appropriate
welfare system, decrease of paperwork, full-time job opportunities and the availability of paid-
holidays.
While significant differences across mental health (high-risk, low-risk) were tested with a t test,
there are differences in the “counseling system” and “other.” Persons who are on high-risk of mental
health think a consulting system and taking other individual needs were important.

DISCUSSION

In Japan, the burst of the economic bubble of the 1990s caused a prolonged recession and a
historically high unemployment rate of over 5% which started to increase in 2000. Around the same
time, the Japanese government enacted the Social Welfare Basic Structural Reform and the Services
and Supports for Persons with Disabilities Act as the part of the reform. In this tumultuous decade,
as the result of this investigation shows, staff workers who exhibit high -risk mental health start to
stand out.
However, there are very few studies which investigate the mental health of workers in welfare
facilities, and most cannot explain statistically and practically how governmental policies and the
working environment affects them (though there are many studies within psychiatry and psychology
that investigate workers’ mental health worldwide generally).
In this part, we consider how to think about these situations in today’s socio-political climate by
considering the results of our survey.

Long working hours and job satisfaction:

That the Japanese tend to work longer hours comparatively to the rest of the world is well-known.
The OECD shows yearly the average annual working hours worked per person, in which the
Japanese worked 1,772 hours in 2008, compared to 1,653 hours in Britain, 1,792 hours in the United
States, 1,542 hours in France, and 1,625 hours in Sweden 2 . The ILO 3 statistics show the
proportion of workers working more than 50 hours per week by each country. The ratio of Japanese
workers is 29.3 percent in 2005, compared to 25.7 percent in Britain, 18.1 percent in the United
States and 9.7 percent in Finland. Our study also indicated that on average staff workers working 40
-59 hours represented 59.3% of workers, 60-79 hours (12.6%) and 80 or more hours (1.4%).
The analysis of our study demonstrates that long working hours were the predictor of high-risk
mental health.
In addition, high levels of job satisfaction were important to maintaining good mental health. In
terms of job satisfaction, as TABLE.4 shows, the most important things in the workplace were the
guarantee of holidays, following a salary that is commensurate to workload. On the other hand the
high-risk group for mental health indicated that the high proportion of those who seek to establish a
consultation system is needed. Thus job satisfaction for high-risk staff workers on mental health may
not be connected to having holidays or higher salary, but to systems where they can resolve both
their work-related and private problems. In other words, such a system may not exist in facilities
now due to the high levels of job-related stress and dissatisfaction of working conditions. Although
in Japan, some commercial corporations have already established a support system for mental health
like the EAP (Employee Assistant Program); however, a majority of non-profit welfare sites have not
created such systems yet. This is because the number of staff workers is comparatively small to

7
profit organizations, so such a system would not be a necessity. That is to say, very few people
thought that a non-profit welfare site could have mental health problems, which typically tend to
occur in profit-driven businesses.
It is arguable that facilities also need such a system of mental health in place. Facility management
has shifted from community service based on volunteerism to a more capitalist-driven enterprise due
to laws passed by the Japanese government including the Social Welfare Basic Structural Reform.
Significantly, the Services and Supports for Persons with Disabilities Act made managing by
facilities more difficult by increasing the amount of clerical work and the number of part-time
workers following the lack of money for managing.
As a result, many staff workers who have problems of mental health tend to appear in facilities who
have been affected by changes in the Japanese law. It is necessary to think critically about the
reforms of Japanese Government as contributing to this problem .

Working condition of young staff:

Moreover, it is necessary to pay attention to the particular attributes of a person whose mental
health has worsened. In this survey, staff workers of high-risk mental health were comparatively
young, female and worked as middle-management executives.
It is said that Japanese young adults tend to become depressed and take a leave of absence from
their job. Even the government-owned program NHK of Japan has grandly taken up this mental
health issue in a program titled “Striking It in One's Thirties” which was presented on both television
and print.
Workers in their thirties or late twenties usually have a myriad of very taxing problems. For
instance, they have an opportunity to be promoted to middle-management executive, though this
position requires more responsibility and working time without an equal increase on remuneration.
Furthermore because the part-time employment increases and an increasing number of middle
executive managers getting ill due to job-related stress, and governmental reforms requiring the
hiring of more managers, workers in their early to late 20s were promoted to a middle executive
position and in effect increasing this demographics' level of high-risk mental health.
They have to give instructions for other staff workers who may be older than them, and part-time
workers of the same generation. They cannot help solitarily determining the direction without person
with whom it consults, because there is no room about which it consults the executive in the site one
by one.
It is difficult for young middle-ranking managerial post staff members to work harmoniously with
other similar workers . It may be difficult for them to ask for their co-worker’s opinions who may
have been hired with different conditions such as lower salary, or hired as a result in the reduction of
personnel. In the past, there were typically equitable and consistent working conditions that were
conducive to worker harmony. But because working conditions may more greatly vary between
similarly situated workers, such an equitable atmosphere may not exist resulting in less
communication between workers.

Life stress and Job stress:

Moreover, such an age group also experiences changes in their private life such as getting married,
having babies, raising children or establishing a house with a loan. Historically, worker promotions
to middle-ranking managerial positions typically occurred after major life changes happened;
however, due to the growing popularity of late-marriages, being promoted often occurs concurrently
with these life changing events today.
Additionally, female workers who have serious mental health conditions may tend to do more
domestic work than their male counterparts regardless if they have a job, which adds to the severity
of their mental health. Time spent working on domestic chores per day shows that regular female
workers in Japan spent 166 minutes per day on average doing cooking, washing, shopping etc.
compared with males who spend 59 minutes4.
There is no way for women to do both job-related and domestic work other than to cut down sleep,
which is very much a key role in the maintenance of mental health. Even though the effect of more
women in the work place has reduced the disparity in the allotment of household chores between

8
men and women, it still has created the negative effect in reducing women’s average sleeping time.
Japanese women's average sleeping time is 7.28 hours which is shorter than the Japanese men's
average time of 7.44 hours. Japanese woman have the shortest sleeping time in any overseas
country5 (England; female 8.25h / male 8.11h, Finland; female 8.22h / male 8.12h). This fact is also
confirmed by our survey, which shows that females have less sleep than males with higher ratios for
women sleeping 5-6 hours compared to a higher ratio of men sleeping 6-7 hours.
As a result, it is natural that both men and especially women should become tired and sick when
thinking about their workplace environment and their private life. In our data, 3/4 of staff workers
aged 25-29 years old belonged to the high risk group of mental health in our survey. It is assumed
that holding various stresses in their private life in addition to work related stress have deteriorated
their mental health. The condition of either male or female stress may be related to cultural
differences that the man or the woman bears in housework.

Directionality that should be pursued:

With regard to their problems, recently, Japanese researchers have started to point out that a
company policy on environmental improvement is effective in helping to achieve a work-life
balance in Japan. It is suggested that facilities should also improve the working environment for
enhancing their work-life balance.
Above all, facilities exist in society to help persons with disabilities by inspiring happiness and
motivating them to pursue life goals and achievements. In other words, if the facility thinks about a
user's happiness, it should also consider the staff’s happiness and well-being as an overall pursuit in
the process of normalization.
One should not forget that the principal of nonprofit-organizations is different a profit
organization’s. It is not a purpose for the profession of facilities to try and make profits. Then there is
a dilemma between helping users and having a work-life balance for staff. The more the facility
regards helping the user as a profession, the more focus can be made on the difficulty of facility
workers in their life. In other words, only thinking of facility users may make staff workers sacrifice
their holidays, break-time, and family in favor of the variety of user demands. As for the young
working generation, there is more of a possibility that they cannot handle the balance between the
demands of the user and their own life, and could make their mental health unstable. This dilemma
has grown while the funds of management have decreased from the reduction in national
government subsidies. Facilities find themselves in a difficult position not only economically but
also managerially.
It is typically the responsibility of government to enhance the allowances of welfare staff, being
that government is one of the biggest contributors to a national welfare system. Therefore, it is
recommend that the Japanese Government understand the complexity of welfare management where
difficulties exist for non-profit-organizations in balancing user-demand and staff's wellbeing, in
addition to advancing a policy that protects work-life balance. Without the government’s support for
young, mid-level staff workers who bear the future of the welfare society, the consequences of the
recent trends in normalization and deinstitutionalization for persons with disabilities could worsen.
In summary, it is necessary to improve the workplace environment as the most important target in
staff mental health keeping strategies. Governments should support facilities in creating mental
health support systems with the purpose of maintaining a work-life balance and establishing an
effective welfare society where each user and staff worker lives and works healthy in their facility.
Lastly, this study couldn’t examine other welfare facilities that care for elderly and children. In
addition, we couldn’t focus on the working situation of part-time staff because of their low-risk
mental health in our study. Further studies that analyze the situation of staff workers in other welfare
facilities such as children and elderly facilities are required.

Acknowledgements:
I would like to express my sincere appreciation to Dr.K. Yamamoto, and Dr. A.Mineshima at
Ritumeikan University for guiding me in my studies. I also would like to thank the facility staff for

9
their valuable discussions and the graduate course students at Ristumeikan University for their
support. I also wish to express my gratitude for the opportunity to present at this conference. Thank
you to the committee of SPA and the recommendation by my colleague, Dr. K.Kashino at
Tezukayama University.
Lastly this work was supported by the Ministry of Education, Culture, Sports Science and
Technology, Grant-in-Aid for Young Scientists (B), KAKENHI(20790429) in Japan.

Reference:

1
Goldberg D. Manual of the General Health Questionnaire.: NFER-Nelson, London, 1978.
2
OECD: Employment Outlook 2009,OECD Database ”Average annual hours actually worked per
worker” 2009.
3
ILO: Working time around the world: Trends in working hours, lows. and policies in a global
comparative perspective,2007.
4
Union synthesis life development laboratory : Union synthesis life development laboratory, 2009.
5
Ministry of Public Management, Home Affairs, Posts and Telecommunications Statistics Bureau:
Life basis investigation in 2006 fiscal year, Main structure of daily average time use of the employed
by activity group and sex, 2007.

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