Taking Mental Health Leave in Japan: Kyushoku, Sickness Allowance, and Coming Back
Mental health leave in Japan has three parts: a psychiatrist's medical certificate starts it, a public insurance benefit replaces roughly two-thirds of your salary while you are off, and your return follows your company's rules. Leave of absence (休職, kyushoku) is a system each company defines in its own work rules rather than a right set by national law, so the details vary by employer. The wider system is in our guide to mental health care in Japan.
How does kyushoku work?
You hand your employer a medical certificate (診断書, shindansho) from a psychiatrist recommending rest for a stated period, and leave is granted under your company's work rules (就業規則, shugyo kisoku). Whether a company has a leave system, and on what terms, is written in those rules, so read them early.
The sequence:
- See a psychiatrist, and the certificate is issued (how to ask for one is in our medical certificate guide).
- Hand it to HR or your manager.
- Leave begins, usually within days.
Certificates typically state one to three months at a time and are extended by follow-up certificates if needed. How long leave can last in total depends on your company's rules.
Under a typical leave system, kyushoku suspends your duties, not your employment, and your contract continues.
How does the sickness allowance (傷病手当金, shobyo teatekin) work?
It pays roughly two-thirds of your salary from the fourth day off, for up to 18 months in total for the same illness. Employees enrolled in employee health insurance (社会保険, shakai hoken) claim the allowance from their insurer. The first three days off are an unpaid waiting period, and the allowance covers the fourth day onward. The three days must be consecutive, and weekends, public holidays, and paid vacation all count toward them, whether or not you were paid for those days. The claim is made on a form that you, your doctor, and your employer each complete, usually monthly.
The amount is worked out from your insured monthly salary rather than from your payslip. The calculation, and how the 18 months are counted, are in our sickness allowance guide. Nationality has nothing to do with eligibility: if you are enrolled in employee health insurance, you claim on the same terms as a Japanese colleague.
Two boundary conditions:
- It belongs to employee insurance. If you are on National Health Insurance as a freelancer or business owner, a sickness allowance is optional for each municipality, so ask your city office whether one exists.
- Your insurance continues while you are off. You stay enrolled during leave, so premium payments continue; ask HR how they are collected while no salary is paid.
What should you do during leave?
Rest, sleep, and eat, with treatment continuing: that is the priority in the early weeks. Later, a regular daily rhythm, movement, and daylight come in, and before the return the aim is to rebuild the stamina for a working day before you go back, not after.
Agree with your employer on one channel and a frequency for contact during leave. Workplaces with fifty or more employees have an occupational physician (産業医, sangyoi), who becomes part of the return process; that system has its own guide.
What does returning to work look like?
Whatever your company's rules say. Many employers ask your psychiatrist for a statement that you are ready to resume; not all of them require one. At workplaces with an occupational physician, that doctor reviews your psychiatrist's statement and gives a separate opinion, and at some companies that opinion carries more weight. The health ministry's return-to-work guidance recommends a phased return, with shorter hours or lighter duties at first. Mental health conditions can recur after a return, and the guidance builds follow-up into the return itself, so plan the timing with your psychiatrist as part of treatment. The full process is in our return-to-work guide.
Frequently asked questions
This article is general information, not medical advice for your individual situation. It is not legal advice either; company systems vary, and your work rules and HR have the specifics.
Medically reviewed by our psychiatrist (M.D.). Updated October 16, 2026.