Taking Mental Health Leave in Japan: Kyushoku, Sickness Allowance, and Coming Back
Japan has a well-developed, formalized system around mental health leave: a psychiatrist's certificate triggers it, a public insurance benefit replaces roughly two-thirds of your salary while you're off, and a structured process governs your return. If work is what's breaking you, this system exists precisely so you don't have to push through to collapse.
How does kyushoku actually work?
A medical certificate (診断書, shindansho) from a psychiatrist recommending rest for a stated period is the trigger, and it is standard everywhere. 休職 (kyushoku, leave of absence) is not a statutory right written in national law; it's a system defined in each company's work rules (就業規則, shugyo kisoku), which is why the details vary by employer, but in practice nearly all established companies have one.
The sequence:
- See a psychiatrist, and the certificate is issued (see our shindansho 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 and often on your tenure, so it's worth quietly reading those work rules early.
One point about employment status: kyushoku suspends your duties, not your employment, and your contract continues.
How does the sickness allowance (傷病手当金, shobyo teatekin) work?
Roughly two-thirds of your salary, payable for up to 18 months in total for the same illness: this benefit is the part that makes leave financially survivable. Employees enrolled in employee health insurance (社会保険, shakai hoken) can claim the sickness allowance. Payment does not start on day one. The first three days off are an unpaid waiting period, and the allowance covers the fourth day onward. Those three days have to be consecutive, and weekends, public holidays, and paid vacation all count toward them, because what the insurer looks at is the days you were unable to work rather than whether you were paid for them. From there it's claimed with a form your doctor and employer each complete, typically submitted monthly.
The two-thirds figure is set by the insurer's own formula rather than by your payslip: it works from the average of your insured monthly salary over the twelve months before the allowance starts, which means bonuses sit outside the calculation. And nationality has nothing to do with eligibility. What decides it is enrollment: if you are on the payroll and in employee health insurance, you claim on the same terms as a Japanese colleague.
Two boundary conditions matter:
- It belongs to employee insurance. If you're on National Health Insurance as a freelancer or business owner, there is generally no equivalent, which changes the planning conversation.
- Your insurance continues while you're off. You stay enrolled during leave, so premium payments continue and are usually coordinated with your employer.
What is leave actually for?
Sleep, appetite, and rest: that is the honest answer for the early weeks, with treatment continuing in the background. Everyone asks what they're supposed to do on leave, half-expecting homework. Recovery in the middle phase starts to include structure, movement, and daylight. The later phase is about rebuilding work-shaped stamina before you return, not after.
Your employer's contact during leave should run through one agreed channel at an agreed cadence; your doctor can put that in writing if boundaries need help. And companies with fifty or more employees have an occupational physician (産業医, sangyoi) who becomes part of the return process; that system gets its own guide.
What does returning to work look like?
Whatever your company's rules say, which varies more than people expect. Many employers ask your psychiatrist for a statement that you're ready to resume; not all of them require one, and at companies with an occupational physician it is often that doctor's opinion that carries the weight. What matters more than the paperwork is the shape of the return: a ramp, meaning shortened hours or reduced duties for the first stretch rather than a standing start. Rushing this step is the single most common cause of relapse and a second, longer leave, which is why we treat return planning as part of the treatment, not an administrative afterthought. 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 September 7, 2026.