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Gaijins of Japan: International Students Making Progress for Mental Health Awareness

Written by: Abbey Kruska

Published: October 14th, 2019

22 year old Khaled Stanbouli is challenging the Japanese mental healthcare system. He single-handedly conducted a survey on over 420 students at a prestigious Japanese university in Tokyo in order to show those in power the importance of the mental health of students.
Khaled Stanbouli presenting to Japanese university officials

Meet 22 year old Khaled Stanbouli, an Australian-Lebanese university student, and the leader of a small revolution. Khaled first came to Japan a year ago in 2018. He had been studying International Relations in East Asia and Japanese at Western Sydney University, and had recently been accepted to a prestigious Japanese University in Tokyo. It was then that Khaled, who had always had an interest in Japanese society and mental healthcare, took notice of a very serious problem among his peers, and decided to set out to make a difference.

“The traditional Japanese mindset tends to be, “if you complain, you’re weak.”


“Though Japan is criticized for poor mental healthcare systems on an international level, change still hasn’t happened,” Khaled tells us, “the traditional Japanese mindset tends to be, ‘if you complain, you’re weak.’”


Khaled took notice of Japan’s (rather inadequate) mental health support system right away. He noticed an overwhelming amount of people both internationally and in Japan were under the impression that Japan’s suicide rate was going down, when in fact an epidemic was happening. True, Japan’s suicide is the lowest it has been since 1978.

However, on the other hand, and much less likely to appear on the news, is the fact that the rate among youths is the highest it has been in 30 years, and still rising.

Khaled had heard that when it comes to issues within the school the president was more likely to listen to international student’s voices than Japanese students, and he decided it was time to speak up. He had felt a number of “walls” within Japanese society, sensed a clear disconnect between the people, and wanted to give both the foreign and Japanese students around him a chance to be heard.


Khaled's university campus, located in Tokyo

Khaled’s Research


Over the course of 3 months, Khaled surveyed over 420 Japanese and International students as well as a small number of staff at his Japanese university. Khaled’s survey included 22 questions, ranging from medical history to the causes of stress in students’ lives. The findings of his extensive research and interviews were reported to the directing manager of the university, and he spoke one-on-one with the head of the international department to discuss barriers and problems with mental healthcare systems, and how international students fit into that puzzle.

Though successful, Khaled tell us that his research was not met without opposition--both from the staff and surprisingly, even some students.


“Though over 80% of the students acknowledged a lack of services for people experiencing mental health issues, 48% of staff members interviewed stated there was no lack of services, and that the services in place were enough. The common opinion among university staff was that the means in place were already sufficient, and that it wasn’t such a problem. On the other hand, well-off Japanese students said they couldn’t trust the results--that students may lie or over exaggerate their problems.”


Should there be more social support for students? 学生のためのメンタルヘルスサービスを増やすべきだと思いますか?


Khaled’s survey also included some short answer questions which allowed students to personally express their experiences and opinions.


Here are some of the student’s answers.


“Including the people who want to talk but feel they can’t, I think there’s a lot of students who are too embarrassed. Or, for example, even if there was a place we could go, being embarrassed of being seen… In my experience, especially Japanese people … aren’t good at expressing themselves, so it would be nice if the professionals would make an effort to talk to us, or if there was an online service like LINE available for counseling.” *


“I feel like [my university] expects international students to do so many things on their own that they never had to do before, like applying to health insurance, renting a sharehouse, etc. I wish they could help us do these things more.”


An overwhelming amount of students express a desire for support systems and a place to express their worries, however there is still the rare comment saying otherwise.


“People should have the strength to deal with their problems on their own.”*


(*translated from Japanese)



Why did you decide to do this?

Khaled presenting his research to staff at his university

At first, Khaled tell us his goal was simply to start a discussion among his peers. However, he knew that he needed a platform and hard evidence to get people’s attention before he could be heard. Using his unique position as a foreign student in a Japanese university, he was able to use his connections to get as many people as possible to complete the survey. He handed out QR codes to students in his classes and asked them to take the time to fill out the survey, he connected with international students and students in clubs and asked his Japanese and international friends to spread and share the survey as well.


The end goal?


Change.


“I wanted to trigger a change; get the ball rolling. If I could bring this issue to the attention of the higher-ups of my university, then I could use my university’s popularity and influence to spread the change to other universities.”


Still, he tells us, there were some issues with the survey.

“I wish I had made the survey more oriented for Japanese students by asking questions they would feel more comfortable answering. 1 in 5 American students experience depression according to the collegiate USA. Based on my research, Japan is nearly double that. I wanted to get a collective mass of people behind this issue so that we could keep the ball rolling. I wish I could have gotten more people.”


"You don't know when is 'too late'."


While conducting his research, Khaled struggled with the anonymity of the survey, worrying that help wouldn’t come soon enough for those who reported severe depression. 31.6% of Japanese students reported having suicidal thoughts, while 20% of international students reported having suicidal thoughts, and 12% reported having suicidal thoughts beginning after coming to Japan--for a total of 32%. 6% of students reported having attempted suicide.

“I worry about the students who I couldn’t get to. Those who are isolated, who aren’t on campus or aren’t coming to class. That unseen population is the one that needs help the most, and I’m sure if they were included in the numbers that the rates would be even higher.”

Moving Forward


According to Khaled, the biggest issue with Japan’s current situation is the rift between the young and old demographics.


“Progress for young people is being hindered by the extremely large older population. Young Japanese people aren’t raised to take initiative or speak up. They may feel like they’re outnumbered, or not know how to start a conversation. They were never taught how to communicate issues, so problems don’t get brought up.”


Still, he wants to continue pushing the problem, presenting facts and hard evidence the old-fashioned way in order to show older Japanese citizens that there is a need for a better mental health care system in Japan. If a bridge can be built for the older and younger generations to connect, then the problem may finally be acknowledged and addressed in a more active way. As Khaled tells us, “sometimes a conversation can save a life.”


“To fix this problem we need to think not as ‘us’ or ‘them’, but ‘we’.”

Words of Advice


When it comes to addressing societal issues, Khaled says, “before you even start asking for support, you need to be able to offer a plausible means to fix the problem.” Showing real solutions gets results, and gets people behind the cause. Knowing his “foreigner” status, Khaled was careful to show Japanese people that he was not attacking Japan or their society, but trying to help. On the task of solving suicide world-wide, Khaled says, “to fix this problem we need to think not as ‘us’ or ‘them’, but ‘we’. Working together to save lives.”


If you need help, below we have listed some resources for those dealing with mental illness, depression, and suicidal thoughts. Always know there are people on your side, and you can get help.


Tell Japan

A non-profit organization that offers professional English-speaking counselors, a lifeline, information and resources, and more.

Tell Japan’s Lifeline: 03-5774-0992

Tell Japan’s Weekend Lifeline Chat: https://telljp.com/lifeline/tell-chat/

Tokyo Counseling Services

Tel: (03) 5431-3096.

Email: tokyocounselingservices@gmail.com

Twitter: @tokyocounseling

Japan Health Care Info

General information about healthcare in Japan including mental health resources.

Jhelp

An English and Japanese online emergency hotline and chat service.

Japan Helpline

An English and Japanese speaking emergency hotline.

Tel: 06-6313-1010