This is a photo of him before he turned 1 year old.

He was a child who walked very fast, and if you took your eyes off him, he would go farther and farther by himself.

"He sometimes behaves in a way that is problematic, but he is a kind and obedient son who helps with housework without complaining" (mother) Kosuke

, who is now 1 years old, is in a state of "severe behavioral disorder" in which he frequently behaves such as hurting himself and those around him and breaking things. During the day, I commute to the work site.

The government has decided to strengthen its support from the next fiscal year.

table of contents

  • Kosuke's life is

  • There are also restrictions on the use of welfare services

  • What is "Intensity Behavioral Disorder"?

  • "Not enough services are provided, which places a heavy burden on families"

  • In the field of support, there is a series of turnovers

  • The government will strengthen support such as adding remuneration to business establishments

  • Expert: "Consistent support system as a team"

  • Basic Policy on Revision of Welfare Service Remuneration for Persons with Disabilities

Open Table of Contents

table of contents

table of contents

  • Kosuke's life is

  • There are also restrictions on the use of welfare services

  • What is "Intensity Behavioral Disorder"?

  • "Not enough services are provided, which places a heavy burden on families"

  • In the field of support, there is a series of turnovers

  • The government will strengthen support such as adding remuneration to business establishments

  • Expert: "Consistent support system as a team"

  • Basic Policy on Revision of Welfare Service Remuneration for Persons with Disabilities

Kosuke's life is

Kosuke Akiyama (28), who lives in Higashi-Kurume City, Tokyo, has severe intellectual disability and autism, and is in a state of "severe behavioral disorder".

During the day on weekdays, he commutes to a work site more than 30 minutes away from his home, but when he becomes emotionally unstable, he sometimes rips off wallpaper or slaps staff.

The curtain that Kosuke tore

In addition, there was a time when he escaped from the workplace and entered a nearby convenience store, ate a product that he had not yet purchased, or pressed the emergency button at the hospital, and was reported to the police.

Her mother, Tsugumi, 61, says she has to explain her disability to store clerks and police officers each time, and she keeps an eye on her except during the hours when she is using welfare services such as helpers.

There are also restrictions on the use of welfare services

In addition, when Kosuke goes out on weekends, he asks a helper to accompany him, but he is often refused to use it because the staff who can understand and respond to his characteristics is limited.

This means that the service, which should be available for 30 hours a month, is currently only available for about 1 hours once a month.

Kosuke's mother, Tsugumi

In the past few years, Tsugumi has begun to feel physically weak and worried about whether she will be able to take care of Kosuke, so she has started looking for a group home where Kosuke can live.

The group homes of social welfare corporations that I am familiar with are full, and I have applied for use twice when there are vacancies, but I have not been able to move in either time.

Kosuke at the workshop

Some of my acquaintances who have children with severe intellectual disabilities have had to move them to facilities in other prefectures far away because there are no vacancies in group homes near their homes.

Tsugumi is starting to feel anxious about whether Kosuke will be able to find a safe place to live in the future.

My mother, Tsugumi, used to spend a day going out with Kosuke, but recently my physical strength and energy have declined,
and I feel that watching for half a day is the limit. I am still blessed because I can go to the work site during the day, but when I get older, I don't know when I will get sick.

Mother, Tsugumi

On top of that, he says:

Kosuke may behave in a problematic way, but at home he is a kind and obedient son who helps with household chores without complaining. Even if it is not a high level of support, I would like to have an environment where I can listen to music whenever I want, go for a walk, and live happily and happily.

What is "Intensity Behavioral Disorder"?

"Severe behavioral disorder" is a condition in which behaviors such as hurting oneself or those around you or breaking things are frequently seen, and are not a disorder that originally exists.

It is said to be common in autistic people with severe intellectual disabilities, and it is estimated that there are at least 7,8000 people in total nationwide.

According to the Ministry of Health, Labor and Welfare, it is characterized by being picky and hypersensitive, and it is caused by feeling stress and anxiety about the response and environment of the people around you.

Therefore, it is possible to improve the condition by talking to them based on their characteristics and adjusting the living environment.

However, in a survey conducted as a national project in Ototoshi (Reiwa 3), when the family of a person with "severe behavioral disorder" who suspended the use of facilities was asked about the reason, the answer was "I was refused to use the facility because I injured a staff member," and it became clear that there were cases where they did not receive sufficient support.

"Not enough services are provided, which places a heavy burden on families"

In addition, when municipalities nationwide were asked about the use of welfare services for people with "severe behavioral disorders," 739 municipalities responded as follows.

▼ "I do not know whether my needs are being met": 49%
▼ "I know of one or more people who are connected to welfare services but whose needs are not met": 1%

An email sent to Kosuke's mother, Tsugumi

In a report compiled in March, the government's study group on "severe behavioral disorders" pointed out that
"the lack of a system for accepting people and the lack of adequate services is a heavy burden
on families living with them," and that it is important to develop human resources to further improve the expertise of human resources who provide support.

In the field of support, there is a series of turnovers

At welfare service establishments that accept many people with severe behavioral disorders, some employees have left their jobs due to difficulties in providing support, and there have been calls for the government to take measures to secure manpower.

Workshop "Gathering Place"

Most of the 39 users at the "Gathering Place" at the daytime work site in Suita City, Osaka, are severely mentally handicapped, and 22 have "severe behavioral disorders."

Users make small items that can be used as products, but depending on the physical condition of the day, there are many people who hit other users and staff members or break things, and staff provide one-on-one support for users with "severe behavior disorder".

In addition, we have created a comfortable environment for users who are unable to continue working due to emotional instability, such as setting up a dedicated break room so that they can regain their composure.

Securing manpower is an issue

On the other hand, it is said that the challenge is to secure manpower.

About 30 of the 20 employees are non-regular employees and are supported by part-time staff, but depending on the workplace, there are many people who leave their jobs due to the responsibility and physical strength required, such as not being able to take their eyes off the users.

Staff turnover continues



施設長 山下徹さん





Specifically, when a "core human resource" is assigned to play a leadership role that determines the content of support by analyzing the behavior of a user with "severe behavioral disorder" in detail,

"wide-area support human resources" with specialized knowledge of "severe behavioral disorder" It is a policy to be eligible for accrual if you repeatedly visit group homes where it is difficult to provide support and provide guidance and advice.

The Ministry of Health, Labour and Welfare (MHLW) will compile a specific revision plan for remuneration based on the budget compilation for the next fiscal year.

Expert: "Consistent support system as a team"

We interviewed Professor Masahiko Inoue of the Graduate School of Tottori University, who is familiar with support for people with "severe behavioral disorder" and served as a member of the national study group.

Professor Masahiko Inoue, Graduate School of Tottori University

Professor Masahiko Inoue, Graduate School of Tottori University, "
Many parents of children with severe behavioral disorders have been isolated due to the experience of sending their children to welfare service offices, but being complained about causing problems or being refused use. It is very important to acquire knowledge about people with severe intellectual disabilities and autism, and to understand the characteristics of the person before providing support.

On the other hand, regarding the growing shortage of labor in the field of support, he said, "There is also a need for a remuneration system that pays salaries commensurate with their expertise, a system that allows people to consult when they are in trouble, such as mental health, and a system to protect those who are providing support on the front lines." On top of that.

"Severe behavioral disorder" needs to be supported throughout the life stage, and it is not a level that can be dealt with by a single office alone. It is essential to create a system in which the community, including schools and medical institutions, can provide consistent support as a team. For this reason, it is very important for local governments to first understand how many cases welfare services are not being adequately delivered.

Basic Policy on Revision of Welfare Service Remuneration for Persons with Disabilities

In preparation for the revision of remuneration for welfare services for persons with disabilities in the next fiscal year, a meeting of experts held on June 6 compiled basic policies for revisions for each item, such as welfare services and the characteristics of disabilities. The following is an introduction to each item.

Facilities for Admission

The focus of this revision is to strengthen support for people with disabilities to live in the community of their choice, rather than in large-scale residential facilities in the suburbs.

In response to this, remuneration will be added to facilities that confirm the intention of all residents to live outside the facility and arrange visits to local group homes according to their wishes.

In addition, from FY8 Reiwa, we will make it mandatory to appoint a person responsible for confirming the intentions of residents and formulate individual plans for moving to local group homes, and we will reduce remuneration for facilities that do not do so.

Group Homes

For group homes, which are the main source of life in the community, remuneration will be added to the business establishment that provides support to secure housing after confirming the intention of the user who wishes to live alone.

In addition, in order to ensure the transparency of the operation of group homes, from next fiscal year, a committee consisting of local residents and welfare experts for the disabled will be set up, and regular visits will be made to check the status of support and give advice.

Visiting services

Remuneration to the workplace will be added if the helper of "Behavioral Support" who supports people with disabilities with limited judgment ability to go out is assigned to a user with a more severe disability, such as a person with "severe behavioral disorder," or if the helper receives specialized training on "severe behavioral disorder."

Consultation support

There is a shortage of "consultation support specialists" who respond to consultations from people with disabilities and their families, connect them with appropriate welfare services, and create plans for the use of services, due to the growing need for welfare services for persons with disabilities.

In order to solve this problem, we will launch a new system called "Consultation Specialists".

Establishments that have a certain level of staff and have already assigned "consultation support specialists" with a high level of specialized knowledge will be able to designate full-time social workers and mental health workers as "consultation support staff" so that they can prepare usage plans.

Compensation Improvement Addition

In order to realize a wage increase for welfare service staff, establishments that meet the requirements can receive three types of "treatment improvement surcharges", but according to the Ministry of Health, Labor and Welfare, it is necessary to apply for each addition, so the clerical work is complicated and puts pressure on the work, and there are many establishments that do not obtain the additional addition.

For this reason, from the next fiscal year, we have decided to reduce the clerical work by combining the three types of treatment improvement additions into one.

Child Development Support and After-School Day Services

A new remuneration will be added to efforts to support the transfer of children with disabilities to local daycare centers according to the child's condition and needs.

In addition, amid the shortage of nurses who provide medical care at business sites, we plan to increase the remuneration of nursing care staff who have received the necessary training and are now able to suck sputum and other tasks to support children.

In addition, from the perspective of supporting children's development, daily life, and families, a new remuneration will be added for bathing support in addition to developmental support for "medically cared for children" and children with severe mental and physical disabilities who require sputum suction and ventilators on a daily basis.

Support for visiting daycare centers, etc.

In order to establish a system for accepting children with disabilities at local daycare centers, we will add a new remuneration for "children in medical care" and children with severe physical and mental disabilities who need more specialized support for "visiting support at daycare centers, etc.," in which visiting support staff provide specialized support so that children can adapt to group life at daycare centers and kindergartens.

In addition, in order to provide support according to the characteristics of the disability, remuneration will also be added if multiple people from different occupations work together to provide support.