The prospective payment system in the psychiatric acute care ward began in 1996 in Japan. This was up-graded to the psychiatric emergency ward in 2002. Chiba Psychiatric Medical Center, the model institute of these wards, has been leading the transformation from asylums to therapeutic apparatus. Although emergency/acute care wards occupy only 8% of the total psychiatric beds in Japan, they cover 41% of annual admissions onto psychiatric wards because of their high bed turnover rate. Therefore, they contributed to reduce the average length of stay to two-thirds, and for the numbers of inpatients to decrease by 11% up until 2012.
 The Ministry of Health, Labor and Welfare presented an image of future types of psychiatric bed-emergency, acute, recovery, and severe chronic beds, and a plan to reduce long-stay patients. Outcomes and improvements of patients with severe mental illness in the emergency/acute care wards may be a determinant of the future design. We propose three plans to turn it into reality: increasing the number of psychiatric emergency wards/units in general hospitals, requiring some residency program in emergency wards to become a certified psychiatric specialist, and limiting new admissions onto psychiatric emergency wards to involuntarily hospitalized patients. These plans could facilitate deinstitutionalization in Japan, sustaining the provision of continuous and responsible care.
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