Primary Prevention Mental Health Support by Non-Institutional NPOs: Structure and Philosophy of Tokyo Mental Health Square's Practice

Abstract

Japan has experienced rising suicide rates, particularly among youth and women, following COVID-19, while institutional mental health services face barriers including geographical constraints, stigma, and limited accessibility. This study examines the feasibility of primary prevention mental health support models developed by non-institutional NPOs, using NPO Tokyo Mental Health Square as a case study to identify components for sustainable support outside institutional frameworks. A descriptive qualitative case study was conducted using semi-structured interviews with one board member directly involved in support philosophy formation and system construction. The 60-minute interview covered organizational background, support services, counselor training, and cultural intervention perspectives, with data analyzed using Braun and Clarke's thematic analysis. Five key themes emerged: comprehensive dual-axis structure combining support for distressed individuals and activity opportunities for potential helpers, embodying "creating a society where listeners are nearby"; multi-layered access design through paid counseling, free telephone hotline serving 90% users aged 30+, and SNS counseling serving 80% under 30; operational challenges including funding limitations constraining service capacity to approximately 100 cases monthly despite estimated 3,000-4,000 demand; cultural intervention goals challenging masculine norms inhibiting help-seeking and fostering normalized consultation culture; and technology-enhanced expansion using AI for triage prioritization and self-help groups enabling 1-to-10 facilitation ratios. This study demonstrates that citizen-led NPOs can construct viable primary prevention mental health support as flexible alternatives to institutional systems, offering insights for expanding support options through distributed, culturally-responsive approaches.