Do You Need a Referral to See a Psychiatrist in Japan?
No referral is needed: you can call a psychiatry clinic in Japan and book a first appointment directly, with no referral letter and no visit to a GP first. Health insurance covers the visit either way. Two caveats: if you are already in treatment somewhere, a letter from that doctor is worth bringing (not required, but useful), and large hospitals are the exception, not clinics; both are covered below.
Some English-language articles about Japan say you need a letter from an internal medicine doctor first. You do not.
Where does the referral myth come from?
Mainly from a rule that applies only to large hospitals. Two things feed it:
- A hospital rule read as a general rule: the surcharge for unreferred visits to large hospitals (below) is sometimes reported as if it applied everywhere.
- Habits from home: in some countries, such as the UK, the route to a psychiatrist usually runs through a GP, so booking a specialist directly sounds unlikely.
Japan's outpatient system is open-access: you choose a clinic in any specialty and book it, and that applies to mental health care in full.
What is the exception for large hospitals?
A fee, not a ban. Go directly to a large designated hospital without a referral letter and the hospital must add a non-insured surcharge on top of your normal bill. The hospitals covered are advanced treatment hospitals (mostly university hospitals), regional medical care support hospitals with 200 or more general beds, and designated referral-focused hospitals with 200 or more general beds. Patients who need emergency care are not charged the surcharge.
None of this affects clinics, and a clinic is the usual starting point: it can refer you upward if hospital-level care is ever needed.
How do you book a psychiatrist directly?
Find a clinic, then call or use its web form. A few practical notes:
- Clinics generally work by appointment rather than walk-in, and popular Tokyo clinics book out a few weeks, and more than a month at some, for first visits, so do not wait for a crisis.
- On the phone, the phrase is 「初診の予約をお願いします」(shoshin no yoyaku o onegai shimasu): "I'd like to book a first appointment."
- If you need the consultation in English, ask whether the doctor conducts sessions in English; "English OK" on a website does not always mean the consultation itself is in English.
Bring your My Number card registered for health insurance (マイナ保険証, maina hokensho) or your eligibility certificate (資格確認書, shikaku kakuninsho), any medications you are taking, and records from previous treatment if you have them. The old health insurance cards expired on December 1, 2025.
When does a referral letter actually help?
When you have a treatment history elsewhere, or when you move up to a hospital.
- Coming from treatment abroad: a short summary from your previous doctor, listing diagnosis, medications tried, and response, makes your first visit in Japan more productive. A plain English letter is fine.
- Moving up to a hospital: if you ever need hospital care, your clinic doctor writes a formal referral letter (診療情報提供書, shinryo joho teikyosho), which also spares you the hospital surcharge.
- Switching clinics: you can simply book elsewhere, but a referral letter carries your history with you.
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 October 16, 2026.