Hiroaki Harai
Integration of health care services for practitioners, consumer and systems

 From the advent of human species, we have been suffering from various problems. Medicines, talk therapy, and healing methods have been described and evolved ever since human developed literatures. The demand for these, namely health care services has been so large that we never seize to invent new illnesses, new theories, new therapeutics, new professions, and new organizations. This is also true to the psychosocial interventions. After the turn of the century of 20th, psychoanalysis got its birth and championed for decades. We are witnessing ever proliferating schools of therapies even in 21st century. This is generally considered as good news for the general public media and academics. However this is not necessarily good news for the people to which “Science of Human Services (SHS)” is supposed to serve. Choosing the best one among the rampant therapeutics is a burden. Neither for practitioners. New therapeutics is generally more complicated, and it is necessary to attend hours of training workshops to deliver it properly.
 After 1990s, there are radical changes as to the context of health care provision. One is the need of containment of health care costs. A second is the information revolution on medical informatics. A third has to do with increasing public awareness of variations in health care services.
 We are dimly aware of the influences on the psychosocial interventions. What is clear is that the monotonous proliferation of new things is no longer allowed. The currently available evidence suggests us that the sheer summation of illnesses, theories, therapeutics, professionals and organizations is all against to the public interest influenced by the three. Natural selection must occur then, though the selection power is not from the Nature but from the social systems.
 Integration of health care services is an effort to survive this selection. Integration means; 1) integrating illnesses into functionally equivalent class of problems, 2) integrating different treatment modalities and professionals into functionally equivalent class of services. As to the therapeutics and theories, outcome oriented empiricism should operate to select the best one. Cost benefit analysis with the help of information technologies and communication skills to explore the individual value system are the essential tools to achieve the goal. And this integration should go with influencing social systems in large.
 I hope Human Services Research Center (HSRC), Ritsumeikan University would function as a hub for this integration, and I believe it does.

Hiroaki Harai M.D.