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It has often been been said that Japanese people have an attitude to work that resembles a worker bee. This working style may, however, be a cause of mental and physical health problems, such as depression, burn out syndrome, and chronic fatigue. Among these, karoshi, which is sudden death from overwork, has been reported as the most serious consequence.1-3 Overwork can kill employees especially if combined with high demand, low control, and poor social support.4 At the present time, we should consider another serious consequence, which is “karo jisatsu (suicide from overwork)”. Currently in Japan, which is undergoing a long recession and restructuring of work practices,5 the incidence of karo jisatsu is rapidly increasing.6 There is, therefore, an urgent need to develop countermeasures to cope with the situation.
The Work Accident Insurance Act of Japan has prescribed that insurance can not be provided in the case of suicide. Karo jisatsu has been recognised as a work related accident by the law only when the work is the cause of mental disorder and the worker loses the rational ability to evaluate suicide.7 However, there has been no standard for its recognition, and in some cases it has taken around 5 years from submission of an application about a work related accident until a conclusion is reached, as the applications are assessed at an expert meeting of the Ministry of Labour on a one by one basis.8Also, the difficulty of gaining recognition of karo jisatsu is indicated by the fact that only four cases out of the last 108 applications have been assessed as work related accidents. Recently, a special review meeting in the Ministry of Labour issued a report recommending easing the requirements which recognise mental disorder and karo jisatsu as work related accidents.9 Based on the international classification of diseases, the report extended the range of mental disorders that can be evaluated as work related accidents. Also, a list of 31 items including “error in work” and “non-achievement of the norm” was produced to evaluate stress at work.
Recognition of karo jisatsu as a work related accident is, however, the final remedy. The first measure should be to improve the working environment that causes the mental disorder and eventual suicide of industrial workers. There is still room for improvement when the work environment in Japan is evaluated from this viewpoint. The system for counselling employees and referral to psychiatric specialists in Japan has lagged considerably behind other developed countries. Also, the social prejudice associated with having a psychiatric medical examination remains ingrained. Therefore, people are being driven to attempt suicide because of physical and mental failure even when they are aware that they could be counselled or referred to a psychiatric specialist. There were over 40 applications for recognition of karo jisatsu as an industrial accident in 1997 and 1998.8 It is expected that these applications represent only “the tip of an iceberg”,7 and reports of mental disorders and karo jisatsu will continue to increase once the condition becomes socially accepted. The prejudice against psychiatric disorders should be eliminated from society, and overworked people should be able to consult psychiatric specialists more light-heartedly. Therefore, the basis for preventing karo jisatsu is to change the attitude of the workplace and society toward occupational mental illnesses.