Sickness benefits paid through Japan's health insurance system reached roughly ¥610 billion (about $4 billion) in fiscal 2023, up 60% in five years and double the level of a decade ago. Mental health disorders now account for about 40% of all claims, the largest single category. Long hours, harassment, and a workplace culture that makes it hard to say anything. Here is the structure behind the numbers, and how Japan compares.

What Is "Shōbyō Teatekin"? Japan's Sickness Benefit Safety Net

Japan's sickness benefit system, shōbyō teatekin (傷病手当金), replaces income for employees unable to work due to non-occupational illness or injury for four or more consecutive days. It is calculated from the employee's standard monthly salary and can be received for up to 18 cumulative months.

A January 2022 amendment changed the clock from 18 months from onset to 18 months of cumulative payment. Time spent back at work no longer counts against the total, which effectively lengthens the runway for conditions that improve and relapse, mental illness among them.

The system is funded through Japan's mandatory health insurance, which covers workers at companies of all sizes through entities like the Japan Health Insurance Association (Kyokai Kenpo) for small and mid-sized businesses, employer-sponsored health insurance unions for large corporations, and mutual aid associations for public servants.

In FY2023, combined payouts across all insurers reached approximately ¥610 billion ($4 billion), up 60% from FY2018 and double the level of a decade earlier.

The Numbers Behind the Crisis

According to a FY2024 survey by the Japan Health Insurance Association, mental and behavioural disorders accounted for 39% of all sickness benefit claims, the largest single category by a wide margin. The gender split: 36% of claims from men, 43% from women. Neoplasms, including cancer, come second.

The historical trajectory is dramatic. In 1995, mental health disorders represented just 4.45% of sickness benefit claims. By 2003 that figure had risen to 10%, and by 2021 it reached 33%. As of the latest data, it stands at 39%.

On the occupational front, the Ministry of Health, Labour and Welfare's FY2024 report on karoshi-related compensation recorded 1,055 approved workers' compensation cases for mental health disorders. That is the first time the figure has passed 1,000 since records began in 1983, and the sixth consecutive annual increase. Claims filed hit a record 3,780, and 88 of the approved cases involved suicide or attempted suicide.

By age, workers in their 40s accounted for 283 approved cases, followed by 245 in their 30s and 243 in their 20s. By sector, healthcare and welfare stood out at 270 cases, ahead of manufacturing (161), wholesale and retail (120), and transport and postal services (110).

Why Is This Happening? Japan's Structural Workplace Problems

Long Hours and the "Karōshi Line"

Japan's average annual working hours stand at roughly 1,607 according to OECD data, actually lower than the U.S. (1,791 hours) and South Korea (1,901 hours). But these statistics conceal a persistent problem: sābisu zangyō (service overtime), unpaid overtime that goes unreported. Working more than 60 hours per week is classified as the "karōshi line" (death from overwork threshold), a level strongly associated with cardiovascular disease and mental health disorders.

Overtime caps were extended to physicians in April 2024. Even so, a recent study found 31% of hospital-based paediatricians still exceeding 60 hours per week.

The Harassment Epidemic

The leading cause of approved mental health compensation claims is power harassment (pawahara) by superiors: 224 cases in FY2024, up roughly 43% from 157 the year before. Next came sudden changes in job duties or workload (119 cases) and customer harassment, kasuhara (108 cases). Kasuhara roughly doubled year on year and overtook sexual harassment (105 cases) for the first time.

Customer harassment was written into the workers' compensation criteria in September 2023. In the first year, 52 cases were approved, 45 of them involving women, a stark pattern: women in customer-facing roles are disproportionately targeted.

The law is now moving. A June 2025 amendment makes preventing customer harassment a mandatory employer obligation from October 2026. A separate May 2025 amendment extends mandatory stress checks to workplaces with fewer than 50 employees, where they had only been an effort obligation, from April 2028.

The Culture of "Reading the Air"

Japanese workplace culture places a premium on kūki wo yomu, "reading the air," or sensing and conforming to the group's unspoken mood. This makes it exceptionally difficult for employees to speak up about personal struggles, especially mental health issues. While stigma around visiting psychiatrists has gradually decreased, telling a boss "I need time off for my mental health" remains a major hurdle.

This silence has measurable consequences. According to Gallup, only 5% of Japanese employees are "engaged" at work, the lowest rate among all surveyed countries, compared to a 23% global average. Rigid structures, limited autonomy, and few opportunities for advancement quietly erode mental well-being.

The Financial Toll on Health Insurance

The surge in mental health-related sickness benefits is straining Japan's health insurance finances. Mental health cases tend to involve longer leave than physical ailments, driving up cost per claim. In Kyokai Kenpo's FY2023 cash benefit recipient survey, mental disorders accounted for 42.3% of payouts by value, dwarfing cancer at 16.1%. Average duration of payment ran to 158.2 days, roughly five months. On an annual basis, mental health claims alone accounted for around ¥267 billion of Kyokai Kenpo's sickness benefit payouts in FY2023, according to reporting on the association's data.

For companies, each mental health-related leave case triggers cascading costs: finding replacement staff, redistributing workloads, and supporting the employee's eventual return. Some Japanese studies estimate that the total societal cost of mental illness runs into the trillions of yen.

Corporate Responses, From Hay Fever Leave to Mental Health Programs

Facing this crisis, some companies are pioneering new approaches. Beyond mandatory annual stress checks, initiatives include expanding Employee Assistance Programs (EAPs), increasing access to occupational physicians, and offering specialized mental health counseling.

Some creative examples have emerged. Certain companies now offer remote work during peak hay fever season, recognising that allergy-related discomfort compounds workplace stress. Others have introduced "refresh leave," dedicated long vacation periods designed to encourage genuine recovery.

Since 2014, Japan's "Certified Health and Productivity Management Organization" program has recognized companies that invest proactively in employee health. This certification creates market incentives, as it signals to investors and job seekers that a company takes well-being seriously.

Where Does Japan's Work Style Reform Stand?

The Work Style Reform Act of 2018 capped overtime at 45 hours per month and 360 hours per year as a general rule, while introducing the principle of "equal pay for equal work" to narrow the gap between regular and non-regular employees.

The reforms have shown measurable results. Japan's average annual working hours declined from 2,097 in 1986 to 1,607 in 2022. The proportion of workers logging more than 60 hours per week has also fallen. The impact varies wildly by industry, though. As the sector breakdown of compensation claims suggests, with healthcare and welfare at the top, chronic overwork remains standard in healthcare, transport, and construction.

Remote work saw a temporary surge during the pandemic, but by 2023 only 24.8% of employees were working remotely, down from 27% in 2021. Manufacturing and retail industries are largely incompatible with remote work, and cultural resistance to permanent flexible arrangements remains strong.

New experiments offer reason for cautious optimism. Tokyo's metropolitan government launched a four-day workweek pilot for civil servants in 2025. And Microsoft Japan's 2019 trial of a four-day workweek famously boosted productivity by 40%, suggesting that shorter hours and higher output are not mutually exclusive.

Global Comparisons

Europe: The "Right to Disconnect"

EU countries are leading efforts to protect workers' mental health through structural policy. France pioneered the "Right to Disconnect" in 2017, legally exempting employees from responding to work communications outside of business hours. The concept is spreading across the EU.

In the UK, roughly 964,000 workers suffer work-related mental health conditions annually, producing around 34 million sick days. Mental health absences average 22.9 days per case, against 6.5 days for physical injuries. The pattern of long absences looks much like Japan's; the policy scaffolding around it is further along.

South Korea: A Parallel Crisis

South Korea's average annual working hours stand at approximately 1,901, among the highest in the OECD. Long hours are particularly severe in the tech sector, and mental health challenges mirror those in Japan. During the pandemic, remote work in Korea was linked to increased anxiety, depression, and insomnia among workers, according to research published in the European Journal of Public Health.

The United States: Burnout Nation

In the US, 59% of employees reported experiencing burnout in 2024. Among millennials the figure reached 66%, against 39% for baby boomers. The top causes, heavy workload (32%) and long hours (27%), are structurally similar to Japan's, even if the cultural expression differs.

Remote Work: Blessing and Burden

Globally, remote work has delivered flexibility while introducing the pressure of always-on connectivity. EU research shows teleworkers frequently working during personal time, raising stress and burnout risk. Remote work alone does not solve the problem. It needs pairing with policies like the right to disconnect and clear boundaries.

The Road Ahead

Japan's rising sickness benefit costs are not a financial problem. They are what happens when a culture that glorified overwork, widespread harassment, rigid hierarchies, and an atmosphere where admitting distress feels impossible all show up on the same balance sheet.

The OECD estimates mental health issues cost more than 4% of GDP across member nations. Japan is not unique here. But with a rapidly ageing population, a shrinking workforce, and a labour shortage stacked on top, each worker's health carries more weight for national sustainability than it does elsewhere.

The rules are moving: mandatory customer harassment measures from October 2026, mandatory stress checks at every workplace from April 2028. But laws do not change the air in a room. Whether the ¥610 billion figure starts falling depends on that.

Workplace mental health has become one of Japan's most pressing social issues. What about in your country: how does your workplace handle mental health? Are sickness benefits available for mental health conditions? What is the stigma like? We'd love to hear your perspective.

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