Long-term institutionalization has been the primary treatment for mentally ill patients in Japan since the early 1920s. The average length of stay in a Japanese mental hospital in 1989 was 496 days, 41 times the average stay of patients in the United States. Although the government has encouraged and supported the integration of mentally ill people in the community and the development of rehabilitation programs since enactment of the Mental Health Law of 1988, implementation of such programs has been slow. The authors summarize the history of mental health care in Japan, discuss the current availability of mental health care facilities and personnel, and recommend changes needed to improve care.