Vocational Rehabilitation and Occupational Therapy in Japan Emiko Kikuchi, MS, OTR Assistant Professor Occupational Therapy Department Tokyo Metropolitan College oj Allied Medical Sciences Tokyo, Japan
It was after World War II that vocational rehabilitation truly began in ] apan. In the years since then, various systems, institutions, and professions have been established and different levels of services provided, ranging from competitive employment, self-employment, and sheltered employment to participation in work activities for people with disabilities. Today, vocational rehabilitation in] apan is confronting serious problems including an increase in the severity and number of disabilities, aging, and more diverse needs for employment of people with disabilities, as well as radical changes in society affecting both businesses and employment opportunities. What is called "lack of hands" (or manpower shortages) and advances in office automation are detrimental to the expansion of employment of people with disabilities; even home-bound employment, started by some businesses, may be exploited as an easier method to meet statutory employment quotas, and thus will reduce opportunity for people with disabilities. At the 19th session of the Japanese Association of V ocational Rehabilitation, it was concluded that today's clients are not only the physically impaired, but indeed all of those who have any vocational handicaps. Furthermore, the approach to be taken should emphasize assistance to overall vocational life, sup-
ported by concerted efforts of the Ministries of Health and Welfare, and Labor and Education, rather than solely by vocational evaluation. This article reviews the present situation in vocational rehabilitation in Japan from the viewpoint of occupational therapists working in physical rehabilitation.
EMPLOYMENT CONDITION OF PEOPLE WITH DISABILITIES IN JAPAN The estimated number of people with disabilities in Japan is 4,118,500. This represents about 3.41 % of Japan's total population. Working-age (18-65 years) people with physical disabilities number 1,346,000 (55.6%). Of this number, the largest segment is people with "crippling conditions" (60.5 %) (Vocational Rehabilitation Services for People with Disabilities inJapan, 1990). Figure 1 shows changes in employment rates of people with physical disabilities for every five years. The employment of people with disabilities has always been affected by business fluctuation; Figure 1 demonstrates that over the past 30 years, the employment rate of people with disabilities has remained as low as 50-q5 % of that of ordinary workers. The number of people with disabilities in ordinary employment today is about 250,000, accounting for 29.6 % ofthe total number of working-age people with disabilities. The employment rate for the general labor population in Japan is 59.9%; thus, the rate of employment of people with disabilities is about half that of those in the WORK 1993; 3(1):69-74 Copyright © 1993 by Andover Medical
70
WORK I WINTER 1993
0/
n
70
70.6
-_x-
___
x~x~
68.8
64.4 -x
57.~
~9.0
~ 46.7
46.7
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x GellE-flll popullllioll
The physically disabled 18-64 years of age
32.3
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29.0 The physically disabled 18 years and above.
III ()~----~~--~~----~~
1!l60
Figure 1.
1965
1970
____~~____~______L-_ 1975 1980 1987
Employment Rate of the Physically Disabled.
general population. In addition, the increasing severity of disability seen in clients in recent years will tend to lower the employment rate from now on. However, it is reported that, in addition to the above figures, many people with disabilities are involved in vocational activities of some form in places such as public facilities and small businesses having less than 30 employees to which the employment rate is not applied. Such forms of occupation comprise 39.5 % of competitive employment, followed by 24.4 % of self-employment and 10.8% of family workers in 1987.
SYSTEMS RELATED TO VOCATIONAL REHABILITATION Laws Concerning the Employment of People with Disabilities Vocational rehabilitation inJapan is based on the Recommendation Concerning Vocational Rehabilitation of the Physically Disabled (ILO Recommendation No. 99, 1955) (Yasui, 1989; Japan Labor Office, 1991 ; Vocational Rehabilitation Services for People with Disabilities in Japan,
1990). The Physically Handicapped Person's Employment Promotion Law of 1960 (amended in 1987 as the Law for the Promotion of Employment of the Disabled) provided for the aforementioned employment quota system, an employment levy system (to rectify the financial burdens arising from employment of people with disabilities, a levy is collected from employers who have failed to achieve the statutory employment rate; the collected money funds grants to employers who satisfy the quota). Figure 2 enumerates important laws concerning vocational rehabilitation and their responsible authorities. Vocational rehabilitation legislation is characterized by its complexity and involvement of several ministries and agencies, such as the Ministries of Labor, Health and Welfare, and Education. Each ministry shares in the implementation of the legislation according to its function. The Ministry of Health and Welfare encourages those disabled applicants for employment having difficulty in participating in the competitive labor market to enter different rehabilitation institutions (such as sheltered work institutions and welfare workshops for people with disabilities) established under the Law for the Welfare of Physically
Physical Disability in Japan
Ficld system for the ,Ii,;abled
Laws
71
Competent Authorities
~\lota
Job placement, \'oc~tinnal guidance Vncalional training, v()c'ltional education Prevention of occupational discases and accidents • Employment assistance for the disabled Incentives for employers who employ disabled workers Sheltered workshops, industrial workshops
----..,. Law For The Employement Promotion, Etc. Of The Disabled r----;f-+_ Employment Security Law
Human Resources Development Promotion Law
Employment Measures Law 8-+-+1- Workmen's Accident Compensation Insurancp. Law Employment Insurance Law Law For The Welfare Of Physically Disabled Persons Law For The Welfare Of Mentally Retarded Persons School Education Law
Figure 2.
The Ministry of Labour
Occupational Safety And Health Law
lJ
The Ministry of Health and Welfare
The Ministry of Education
Main Laws Related to Vocational Rehabilitation.
Handicapped Persons. The Ministry of Education provides career guidance to students with disabilities.
Professions and Institutions Related to Vocational Rehabilitation Figure 3 shows institutions and facilities related to vocational services and the process from application to employment for people with disabilities. Occupational therapy is considered a medical profession under the Medical Service Law. Therefore, occupational therapists are often involved in facilities, institutions, and programs in and around vocational rehabilitation (enclosed by dotted lines, Figure 3). The main professions involved in vocational rehabilitation are in labor administration (vocational counselors for people with disabilities, vocational guidance officers, vocational training
guidance workers) or in health and welfare administration (psychological evaluators, vocational aptitude evaluators, case workers, and daily life guidance officers). Professionals from related fields are also involved, including medicine (physicians, physical and occupational therapists), special education (career guidance officers), and social rehabilitation (child welfare officers, welfare officers for people with disabilities).
AN OVERVIEW OF VOCATIONAL REHABILITATION SERVICES Role of the Occupational Therapist Occupational therapy supports people in developing balanced function in activities of daily life. An occupational therapist's interests are not lim-
72
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Employers
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Vocational Training Centres (For the general, the disahled)
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It was after World War II that vocational rehabilitation truly began in ] apan. In the years since then, various systems, institutions, and professions have been established and different levels of services provided, ranging from competitive employment, self-employment, and sheltered employment to participation in work activities for people with disabilities. Today, vocational rehabilitation in] apan is confronting serious problems including an increase in the severity and number of disabilities, aging, and more diverse needs for employment of people with disabilities, as well as radical changes in society affecting both businesses and employment opportunities. What is called "lack of hands" (or manpower shortages) and advances in office automation are detrimental to the expansion of employment of people with disabilities; even home-bound employment, started by some businesses, may be exploited as an easier method to meet statutory employment quotas, and thus will reduce opportunity for people with disabilities. At the 19th session of the Japanese Association of V ocational Rehabilitation, it was concluded that today's clients are not only the physically impaired, but indeed all of those who have any vocational handicaps. Furthermore, the approach to be taken should emphasize assistance to overall vocational life, sup-
ported by concerted efforts of the Ministries of Health and Welfare, and Labor and Education, rather than solely by vocational evaluation. This article reviews the present situation in vocational rehabilitation in Japan from the viewpoint of occupational therapists working in physical rehabilitation.
EMPLOYMENT CONDITION OF PEOPLE WITH DISABILITIES IN JAPAN The estimated number of people with disabilities in Japan is 4,118,500. This represents about 3.41 % of Japan's total population. Working-age (18-65 years) people with physical disabilities number 1,346,000 (55.6%). Of this number, the largest segment is people with "crippling conditions" (60.5 %) (Vocational Rehabilitation Services for People with Disabilities inJapan, 1990). Figure 1 shows changes in employment rates of people with physical disabilities for every five years. The employment of people with disabilities has always been affected by business fluctuation; Figure 1 demonstrates that over the past 30 years, the employment rate of people with disabilities has remained as low as 50-q5 % of that of ordinary workers. The number of people with disabilities in ordinary employment today is about 250,000, accounting for 29.6 % ofthe total number of working-age people with disabilities. The employment rate for the general labor population in Japan is 59.9%; thus, the rate of employment of people with disabilities is about half that of those in the WORK 1993; 3(1):69-74 Copyright © 1993 by Andover Medical
70
WORK I WINTER 1993
0/
n
70
70.6
-_x-
___
x~x~
68.8
64.4 -x
57.~
~9.0
~ 46.7
46.7
4-1 . I
x GellE-flll popullllioll
The physically disabled 18-64 years of age
32.3
:1O
29.0 The physically disabled 18 years and above.
III ()~----~~--~~----~~
1!l60
Figure 1.
1965
1970
____~~____~______L-_ 1975 1980 1987
Employment Rate of the Physically Disabled.
general population. In addition, the increasing severity of disability seen in clients in recent years will tend to lower the employment rate from now on. However, it is reported that, in addition to the above figures, many people with disabilities are involved in vocational activities of some form in places such as public facilities and small businesses having less than 30 employees to which the employment rate is not applied. Such forms of occupation comprise 39.5 % of competitive employment, followed by 24.4 % of self-employment and 10.8% of family workers in 1987.
SYSTEMS RELATED TO VOCATIONAL REHABILITATION Laws Concerning the Employment of People with Disabilities Vocational rehabilitation inJapan is based on the Recommendation Concerning Vocational Rehabilitation of the Physically Disabled (ILO Recommendation No. 99, 1955) (Yasui, 1989; Japan Labor Office, 1991 ; Vocational Rehabilitation Services for People with Disabilities in Japan,
1990). The Physically Handicapped Person's Employment Promotion Law of 1960 (amended in 1987 as the Law for the Promotion of Employment of the Disabled) provided for the aforementioned employment quota system, an employment levy system (to rectify the financial burdens arising from employment of people with disabilities, a levy is collected from employers who have failed to achieve the statutory employment rate; the collected money funds grants to employers who satisfy the quota). Figure 2 enumerates important laws concerning vocational rehabilitation and their responsible authorities. Vocational rehabilitation legislation is characterized by its complexity and involvement of several ministries and agencies, such as the Ministries of Labor, Health and Welfare, and Education. Each ministry shares in the implementation of the legislation according to its function. The Ministry of Health and Welfare encourages those disabled applicants for employment having difficulty in participating in the competitive labor market to enter different rehabilitation institutions (such as sheltered work institutions and welfare workshops for people with disabilities) established under the Law for the Welfare of Physically
Physical Disability in Japan
Ficld system for the ,Ii,;abled
Laws
71
Competent Authorities
~\lota
Job placement, \'oc~tinnal guidance Vncalional training, v()c'ltional education Prevention of occupational discases and accidents • Employment assistance for the disabled Incentives for employers who employ disabled workers Sheltered workshops, industrial workshops
----..,. Law For The Employement Promotion, Etc. Of The Disabled r----;f-+_ Employment Security Law
Human Resources Development Promotion Law
Employment Measures Law 8-+-+1- Workmen's Accident Compensation Insurancp. Law Employment Insurance Law Law For The Welfare Of Physically Disabled Persons Law For The Welfare Of Mentally Retarded Persons School Education Law
Figure 2.
The Ministry of Labour
Occupational Safety And Health Law
lJ
The Ministry of Health and Welfare
The Ministry of Education
Main Laws Related to Vocational Rehabilitation.
Handicapped Persons. The Ministry of Education provides career guidance to students with disabilities.
Professions and Institutions Related to Vocational Rehabilitation Figure 3 shows institutions and facilities related to vocational services and the process from application to employment for people with disabilities. Occupational therapy is considered a medical profession under the Medical Service Law. Therefore, occupational therapists are often involved in facilities, institutions, and programs in and around vocational rehabilitation (enclosed by dotted lines, Figure 3). The main professions involved in vocational rehabilitation are in labor administration (vocational counselors for people with disabilities, vocational guidance officers, vocational training
guidance workers) or in health and welfare administration (psychological evaluators, vocational aptitude evaluators, case workers, and daily life guidance officers). Professionals from related fields are also involved, including medicine (physicians, physical and occupational therapists), special education (career guidance officers), and social rehabilitation (child welfare officers, welfare officers for people with disabilities).
AN OVERVIEW OF VOCATIONAL REHABILITATION SERVICES Role of the Occupational Therapist Occupational therapy supports people in developing balanced function in activities of daily life. An occupational therapist's interests are not lim-
72
WORK / WINTER 1993
-
""i-., 'I ~ ,I r-', -.r. , I
I
.: .. ~~:I
.:r."C
,
Q'
I
L. ___ J
C
r---'
: 2!
:
I
I
: !::!
.~. ~
I
I I
::
:I:
I I
I L ___ J
I---
'"Yo"
J.
1
Local Vocational Centers for the Disabled Vocational counselling, guidance. vocational evaluation
Employers
On·the· job adjust· ment training
Vocational Training Centres (For the general, the disahled)
I
~
1
I t
:--
,_:: I
:,~ ';;
Quota system
Job application (registration). Positions available. Job placement. "ocational adjustment guidance
I
r---'"
I
I
Public Employment Security Offices
Emplo)'ment of the disabled
