Setting Up a Workplace Mental Health Consultation Service in Japan — EAP, External Counselors, and Public Support Centers Compared
The Problem with "Stress Check Only" Programs
Many Japanese employers conduct their annual stress check, identify high-stress employees, and then... stop. They send out a notification explaining that high-stress employees may request a medical interview — but when there is no visible, accessible consultation service backing that up, most employees simply don't reach out.
The result: the stress check becomes a compliance exercise rather than an effective mental health intervention.
This article explains how to close that gap by designing a functional employee consultation service, and how to choose between the three main options available in Japan.
The Three Options: A Side-by-Side Comparison
Option 1: External Counselor (Direct Contract)
An employer contracts directly with a certified psychologist or mental health social worker (精神保健福祉士) to provide one-on-one counseling sessions for employees.
| Factor | Detail |
|---|---|
| Cost | Approx. ¥10,000–¥30,000 per 50-min session (varies by provider) |
| Coverage | Typically limited to high-stress employees or those who request it |
| Privacy | Sessions are confidential; counselor does not report to employer |
| Strengths | Deep individual support; suitable for ongoing cases |
| Limitations | Session budget limits access; not practical as a universal service |
Best for: Serious cases requiring ongoing support; supplementing EAP for high-risk individuals.
Option 2: EAP (Employee Assistance Program)
The employer contracts with an EAP provider, giving all employees access to confidential phone or online counseling — typically 24 hours a day, 365 days a year.
| Factor | Detail |
|---|---|
| Cost | Approx. ¥300–¥2,000 per employee/month (flat rate) |
| Coverage | All employees (some plans extend to family members) |
| Privacy | Individual identities are not disclosed to the employer; only aggregate utilization data is shared |
| Strengths | Low barrier to use; anonymous; accessible at any time |
| Limitations | Counselors may not be local; severe cases need to be escalated to in-person support |
Best for: Workplaces of 50–300+ employees wanting universal, low-barrier access for all staff.
Option 3: Regional Industrial Health Support Center (地域産業保健センター)
A government-funded institution operated under the supervision of local medical associations, primarily targeting workplaces with fewer than 50 employees. Services are provided free of charge.
| Factor | Detail |
|---|---|
| Cost | Free (publicly funded) |
| Coverage | Primarily workplaces with fewer than 50 employees |
| Privacy | Bound by professional confidentiality obligations |
| Strengths | Can conduct the legally mandated post-stress-check medical interview (面接指導); physician-led |
| Limitations | Appointment availability varies by region; not suited for urgent or same-day needs |
Best for: Small workplaces without an industrial physician needing to fulfill stress check follow-up requirements at no cost.
Choosing the Right Option for Your Workplace
| Situation | Recommended Approach |
|---|---|
| Under 50 employees, limited budget | Regional Industrial Health Support Center (free) as base; add external counselor for critical cases |
| 50–300 employees, universal access priority | EAP (flat rate, all staff) + external counselor for high-stress follow-up |
| 300+ employees, data-driven HR approach | EAP + external counselors, track utilization data for organizational insights |
| Stress check medical interview only | Regional Industrial Health Support Center or industrial physician (50+ workplaces) |
Designing the Internal Consultation Process
The Confidentiality Problem
If employees believe their consultation will be reported to management — or used in performance reviews — they will not use the service. This is the single biggest barrier to utilization.
Required safeguards when using internal HR staff as a consultation point:
- Written confidentiality policy: Explicitly state that consultation content will not be used for performance evaluation, disciplinary action, or workforce planning
- Structural separation: Do not appoint line managers or HR personnel with hiring/firing authority as counselors
- Data isolation: Counselors control their own records; employer has no access to individual consultation data
Making the Service Visible
A consultation service that exists but is never communicated is the same as no service. Best practices for awareness:
- Include the consultation service information in every stress check result notification
- Announce twice per year in company-wide communications — include concrete use-case examples ("You don't have to be in crisis to call")
- Emphasize that the service is for everyone, not just high-stress employees
Integrating Consultation into the Post-Stress-Check Workflow
Stress check conducted
↓
Individual results delivered to each employee
↓
High-stress employees: notified of right to request medical interview
↓ (if requested)
Medical interview conducted by industrial physician
or Regional Industrial Health Support Center physician
↓
Physician submits work adjustment recommendations to employer
↓
Employer implements measures (overtime reduction, reassignment, etc.)
↓ (ongoing support)
EAP or external counselor for continued follow-up
The key metric here is the medical interview request rate. Research consistently shows that when employees trust the system is confidential and safe to use, request rates improve significantly. Building that trust starts with a visible, credible consultation service long before the stress check is administered.
What to Include in Your Internal Policy
Document the following in your workplace mental health policy (心の健康づくり計画):
| Policy Item | Content |
|---|---|
| Consultation channels | Internal contact, EAP provider, Regional Industrial Health Support Center contact info |
| Confidentiality commitment | Explicit statement that consultation data will not affect employment status |
| Eligibility | All employees (voluntary basis) |
| Cost to employees | Company-funded or self-pay — be explicit |
| Emergency protocol | Procedure for cases involving self-harm risk or immediate mental health crisis |
Summary
| Option | Best Fit |
|---|---|
| Regional Industrial Health Support Center | Under 50 employees; free medical interviews; stress check follow-up |
| EAP | Universal, anonymous, 24/7 access for all staff |
| External counselor | Deep individual support for serious or ongoing cases |
The goal is not to pick one option — it's to design a layered system where every employee has at least one accessible, confidential route to support, and where that system connects seamlessly to your stress check follow-up process.
COCKPITOS provides stress check services including post-check consultation support, operated by a representative who holds both a certified mental health practitioner license (精神保健福祉士, a legally recognized stress check administrator credential) and a labor and social security attorney license (社会保険労務士). Contact us via our free consultation form.