Jiritsu Shien Iryo: The Mental Health Subsidy Almost No Foreigner Knows About
If you are in ongoing psychiatric treatment in Japan, a national program called Jiritsu Shien Iryo (自立支援医療) cuts your share of the cost from the standard 30% to 10%, and adds a monthly ceiling on top. The law sets no nationality requirement; what the application asks for is your address in Japan, your My Number and your health insurance.
What is it, and who qualifies?
A national subsidy for people in ongoing outpatient psychiatric treatment; the bar is continuing treatment, not a severe disability. Jiritsu Shien Iryo means "independence support medical care," and its psychiatric part is called outpatient psychiatric care (精神通院医療, seishin tsuin iryo).
You qualify if all three apply:
- You live in Japan (the law sets no nationality requirement)
- You are enrolled in Japanese health insurance (National Health Insurance or employee insurance; what it covers), or receive public assistance (生活保護, seikatsu hogo)
- You are in ongoing outpatient psychiatric care (your psychiatrist's certificate is part of the application)
The covered conditions include the common diagnoses: depression, anxiety disorders, bipolar disorder, ADHD, and other psychiatric conditions, with epilepsy included. Whether your situation fits is your psychiatrist's call.
One income note: your monthly ceiling depends on household income, and at the highest income band the program applies only to conditions classed as severe and continuing (重度かつ継続, judo katsu keizoku).
What does it actually cover?
Your psychiatric visits and medication at the designated clinic and pharmacy you name on the application, usually one of each, with your share reduced from 30% to 10%. That includes consultations, prescribed psychiatric medication, and related care at those locations. On top of the lower percentage, an income-based monthly ceiling caps what you pay in any month; past the ceiling, you pay nothing more.
Two boundaries to know:
- It covers outpatient psychiatric care only, not hospitalization and not unrelated medical care.
- It works only at the clinic and pharmacy named on your certificate. If you want to switch, apply for the change and have the new clinic or pharmacy added before you are seen there; a visit to a clinic that is not on the certificate is charged at the normal rate.
How do I apply?
Three steps: your doctor's certificate, one visit to your local city or ward office, then the certificate arrives.
- Ask your psychiatrist. The clinic must be a designated institution for the program (指定自立支援医療機関, shitei jiritsu shien iryo kikan), so confirm this when choosing a clinic. Your doctor prepares the required certificate.
- File at your local city or ward office. The desk varies by municipality: often the disability welfare desk (障害福祉課, shogai fukushika), sometimes a public health center (保健センター, hoken center), so check your city's website or call ahead. Bring the doctor's certificate, your health insurance details, your My Number (個人番号, kojin bango), the income documents the office specifies, and the names of your chosen clinic and pharmacy.
- Wait for the recipient certificate (受給者証, jukyushasho). Processing time varies by municipality; Tokyo, for example, says about two months. Apply early rather than waiting for the card: in Tokyo the lower rate counts from the day the office accepts your application, and until the certificate arrives, show the clinic your copy of the application and ask how they will charge you.
If your Japanese is limited, ask the clinic for help with the forms.
How does renewal work?
Once a year, and the renewal can be filed from three months before the expiry date. The certificate is valid for up to one year. A new doctor's certificate is usually needed only every other year: if your condition and treatment plan have not changed, the renewal after one filed with a certificate can be filed without one. If you move within the same prefecture, report the new address to the office; if you move to another prefecture, apply at your new city or ward office. If you change your clinic or pharmacy, apply for the change first, as described above.
Put the expiry date in your phone. If the certificate lapses, you apply again as a new case with a new doctor's certificate. In Tokyo, for example, the lower rate then restarts only from the day the office accepts the application, so visits in the gap are charged at the normal 30%.
Is there a downside?
Very few. Your application is handled by the municipal welfare office as personal and medical information, the certificate needs renewing once a year, and the lower rate applies only at the clinic and pharmacy named on it. For anyone in ongoing treatment, the saving outweighs these.
Frequently asked questions
This article is general information, not medical advice for your individual situation. Program details vary slightly by municipality; your local city or ward office has the final word.
Medically reviewed by our psychiatrist (M.D.). Updated October 16, 2026.