Two things make mental health care here harder to navigate than it needs to be. The first is that Japan splits it into two systems that sound like one. The second is that the scheme which makes long-term treatment affordable is not advertised, and most foreign residents never hear about it.
Psychiatry and counselling are different systems
A psychiatric clinic (心療内科 or 精神科) is staffed by medical doctors. They diagnose, manage treatment and prescribe. Consultations and prescriptions are covered by public insurance like any other medical care, so you pay the standard 30 per cent. Expect roughly ¥2,500–¥4,000 for a first visit and ¥1,000–¥2,000 for follow-ups, plus the pharmacy.
Counselling (カウンセリング) is talk therapy, delivered by clinical psychologists rather than doctors. It is generally not covered, and you pay the whole amount. English-language sessions commonly run ¥10,000–¥20,000 for fifty minutes. The exception is therapy delivered inside a hospital treatment programme under a psychiatrist, which can fall under medical billing.
This catches people out badly. Someone who wants to talk to somebody weekly, and assumes insurance applies because it is health care, discovers the cost only after they have started.
The discount nobody mentions
If you need ongoing outpatient psychiatric treatment, 自立支援医療（精神通院医療） — Services and Supports for Persons with Disabilities, outpatient psychiatric care — reduces your share of both consultations and prescriptions from 30 per cent to 10 per cent. There is also a monthly ceiling based on household income.
It applies to foreign residents enrolled in public insurance. It is not a disability declaration in the sense people fear, it does not appear on your residence status, and it has no bearing on a visa renewal or a permanent residency application.
The saving is substantial for anyone in continuing treatment: a year of monthly visits plus medication typically moves from a five-figure annual cost to something closer to a third of it.
ADHD medication: read this before you fly
Japan regulates stimulants far more tightly than most countries, and the rules are enforced at the border rather than explained at it.
- Amphetamine salts — Adderall, Dexedrine — are prohibited outright. They cannot be brought in under any circumstances, with any paperwork. People are detained at customs for this every year.
- Methylphenidate (Concerta) is permitted in limited quantity; above the threshold you need an import certificate arranged in advance.
- Lisdexamfetamine (Vyvanse) requires advance permission from the Narcotics Control Department.
- Atomoxetine (Strattera) and guanfacine (Intuniv) are the least restricted.
Only four ADHD medications are approved in Japan at all: methylphenidate, atomoxetine, guanfacine and lisdexamfetamine — and lisdexamfetamine is approved for children. An adult arriving on a medication that works for them may find there is no legal Japanese equivalent.
Getting a domestic prescription is also harder than elsewhere. Psychiatrists who prescribe methylphenidate must be registered with both the government and the manufacturer, which limits who can help you, and new adult patients face real barriers. Since late 2025 there has additionally been a nationwide supply shortage of Concerta affecting even established patients.
Finding someone who speaks your language
English-speaking psychiatrists cluster in central Tokyo, Yokohama, Osaka and Kobe, and are scarce elsewhere. Outside those areas, options are an international clinic, an online consultation, or bringing an interpreter.
Ask when booking whether the doctor speaks English or whether interpretation is arranged, because clinics that advertise English sometimes mean the reception form. Describing a mental health problem accurately is hard enough in a first language.
If you need help now
- TELL Lifeline — free, confidential English-language support by phone and online chat. 03-5774-0992.
- #7119 — medical consultation line in many areas, to find what is open now.
- 119 — ambulance and emergency medical care.
The phrases
- 心療内科を受診したいです。 — Shinryō naika o jushin shitai desu. — I would like to see a mental health doctor.
- 英語で話せる先生はいますか。 — Eigo de hanaseru sensei wa imasu ka? — Is there a doctor who speaks English?
- 自立支援医療の診断書をお願いできますか。 — Jiritsu shien iryō no shindansho o onegai dekimasu ka? — Could I have the certificate for the outpatient psychiatric support scheme?
- この薬を続けたいです。 — Kono kusuri o tsuzuketai desu. — I would like to stay on this medication.
Where to confirm this
- Ministry of Health, Labour and Welfare mental health portal
- TELL Japan
- Our guide to visiting a Japanese clinic
Guides are dated rather than undated: last reviewed 21 August 2026. This is an organisational aid, not legal or immigration advice — always confirm anything consequential with your ward office, the Immigration Services Agency, or a qualified professional.