How to Get a Medical Certificate (診断書) for Mental Health in Japan
Ask your psychiatrist directly during a consultation: that is how you get a 診断書 (shindansho), and simple certificates are often ready the same day or within a week. The shindansho is the document that makes things happen in Japan. Need leave from work, accommodations at school, an insurance claim, or a subsidy application? The answer runs through a doctor's certificate, and for mental health that doctor is a psychiatrist. Here is how the system works and how to use it without friction.
When do you need one?
Work leave, benefit claims, and subsidy applications are the usual triggers, along with school and insurance paperwork. The common situations, roughly in order of frequency:
- Taking leave from work: a certificate recommending rest for a stated period is what triggers leave (休職, kyushoku) at most employers (details in our leave guide)
- Claiming sickness allowance (傷病手当金): the claim form has a section your doctor completes, typically monthly while you're off
- Applying for support programs: Jiritsu Shien Iryo and the disability certificate each use their own designated certificate format
- School accommodations, insurance claims, and similar paperwork
Two things a Japanese clinic certificate is generally not for: court proceedings and visa applications, which need different documents and, often, different processes.
How do you ask for one?
Say it plainly during a consultation; "I think I need a shindansho for work" is a normal sentence in a psychiatry clinic, not an imposition. Simple certificates are often issued the same day or within a week; forms with designated formats (like the sickness allowance form) take a little longer. Certificates are self-pay documents outside health insurance, priced by each clinic, and if you need one in a specific format, bring the form or the requirements with you.
For use outside Japan, ask for an English letter instead: a physician's letter summarizing diagnosis and treatment travels better than a translated shindansho, and clinics used to international patients write them routinely.
What does it say, and who sees it?
Less than people fear. A work-leave certificate typically states a diagnosis (sometimes deliberately general, discussed with you), the recommendation to rest, and the period. It does not narrate your history or session content. Your employer sees the certificate you hand them and nothing else; the medical record behind it stays at the clinic.
If you're uneasy about a specific diagnosis reaching HR, say so. There is often legitimate room in how a condition is described, and that conversation is a normal part of writing the document.
Can a doctor refuse?
Only with a proper reason. Japanese law obliges a doctor who has examined you to issue a certificate on request unless there is a proper reason to decline. The proper reasons are the ones you'd expect: the doctor can't certify something they haven't clinically established. The classic case is a first-time visitor asking for a certificate covering the past month, which no honest doctor can attest to. What a certificate documents is clinical reality, so the practical advice is simple: if you're struggling, get seen early. A doctor who has followed you can write strong, timely paperwork; a doctor meeting you for the first time can only start from today.
Frequently asked questions
This article is general information, not medical advice for your individual situation. If you're unwell, please see a doctor.
Medically reviewed by our psychiatrist (M.D.). Updated August 31, 2026.