This should including availability to less mobile populations, for example with practitioners with mental health training going into elderly care facilities, or psychologists visiting the elderly in their homes or in care settings. Nonetheless, Japan’s mental health system lags behind those of other OECD countries which Japan would usually see as peers in health system quality. Inpatient care is still dominant, information on quality is poor, and patient wishes and demands are not put at the centre of care delivery. To build a modem, high quality, patient-centred mental health system Japan must be ambitious, ready to make difficult choices, and drive important and significant change. Patient wishes should be the centre of the mental health system, which can be helped by making a range of services available in inpatient settings and in the community, where they should be easily accessible and close to population centres.