Kanagawa prefecture developed a unique medical care system for patients with coronavirus disease 2019 (COVID-19) based on its experience responding to the outbreak on the Diamond Princess Cruise ship in February 2020. In this system, named the "Kanagawa Model", the severity of the symptoms determines which hospital the COVID-19 patient is referred to. Facilities treating "moderately ill" patients (i. e., those in need of oxygen inhalation but not artificial ventilation), comprising the largest number, were designated as" priority medical institutions", one of which was a 180-bed temporary medical facility constructed by the prefecture for this purpose.
 Before the infection became widespread, Kanagawa Psychiatric Center began its infection prevention and control (IPC) measures such as implementation of thorough standard precautions, prohibiting inpatients to go out and banning visitors, restriction of face to face consultations, suspension of group activities, and procuring medical supplies including personal protective equipment (PPE). Two negative-pressure rooms were planned to be utilized for infected psychiatric patients whose physical conditions did not require transfer to a general hospital.
 When a COVID-19 cluster broke out in a psychiatric institution in Kanagawa, no hospitals accepting involuntary patients with moderate symptoms of COVID-19 were available. This was because the unpredictable behavioral disturbances of mentally ill patients cannot be dealt with safely in general hospitals, but the treatment of an unknown infectious disease like COVID-19 was impossible in psychiatric hospitals without specialists or experienced staff.
 In order to solve this dilemma, the prefecture set up psychiatric beds in the temporary medical facility where strict IPC measures were implemented, with emergency care specialists treating the patients. Consequently, the Kanagawa Model was expanded to establish "priority psychiatric institutions for coronavirus."
 According to this new model, Shonan Kamakura General Hospital (entrusted with the management of the temporary medical facility) and Kanagawa Psychiatric Center both agreed to cooperatively treat psychiatric patients with moderate symptoms of COVID-19. As stated in the contract, a team of psychiatrists and psychiatric nurses at Kanagawa Psychiatric Center was sent for consultation whenever a psychiatric patient was admitted to the temporary medical facility.
 In the present paper, we present issues and future directions of psychiatric hospitals to respond to the spread of COVID-19. As we look back on the efforts of Kanagawa Psychiatric Center for the establishment of medical care provision system for psychiatric patients with COVID-19, as well as the development of internal IPC measures during the period from February 2020 (the beginning of the outbreak) through June 2020 (the lull phase), the following elements were noted as essential in taking effective IPC measures: 1) rapid decision-making by hospital leaders and sharing information with all the personnel, 2) diligent health monitoring of patients and staff, 3) modification of hospital rules and regulations according to the infection phase, 4) IPC education for both staff and patients, and 5) sufficient provision of PPE and other medical supplies.
 In the era of the COVID-19 pandemic, it is especially important for psychiatric hospitals to establish a partnership and cooperation agreement with general hospitals by requesting local government aid as a mediator, if necessary, in order for psychiatric patients whose physical condition is deteriorating to be transferred quickly to receive appropriate medical management.
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