Editorial

Welcome to the third and final part of our special issue series entitled ‘State of the Psychoanalytic Nation’ which has charted the ways in which psychoanalytic psychotherapy has been developed, implemented, and researched within the public sectors of various nations around the world. This edition brings together accounts from Japan, India, Israel, Russia, Croatia and France. It concludes with a comprehensive overview of Psychoanalytic Psychotherapy in Europe over the last thirty years. We begin with a paper entitled ‘The health insurance system and psychoanalytic psychotherapy in Japan: the association with evidence-based practice’ by Akiyoshi Okada. Japan, like France, uses a system of universal public health insurance. Since 1958 this has enabled access to individual psychoanalytic psychotherapy. However, influenced by NICE, Japan has been exploring medical technology and cost-effectiveness evaluation since 2012. While the establishment of NICE in the UK was primarily intended to reduce the regional disparities in healthcare and ensure equity of access to cost-effective medical treatments, Japan appears to be primarily concerned with reducing the growing cost of medical care. This has led to clinical practice guidelines promoting ‘evidence-based psychiatry’ in Japan. Due to the lack of an evidence-base for psychoanalytic psychotherapy in Japan this has had a significant impact on its provision in the public health insurance system. Psychoanalytic psychotherapy is currently facing a crisis of survival within Japan’s health insurance system, and without research evidence the future outlook for its expansion appears to be limited. Psychoanalysis in India can be traced back to 1922, but the second paper, by Abdul Salam, Amala Shanker and Malika Verma, describes how it soon fell into decline. The authors point to a number of contributing factors, including cultural differences between European and Indian conceptualisations of relationships and the mind; the association of psychoanalysis with colonialism; and an emphasis on academia rather than clinical practice. However, the authors point to a regrowth of psychoanalytically informed clinical practice. India was one of the first developing nations to recognize the need to address mental health and launched its National Mental Health Programme in 1982. This programme was delivered at district level with the objective of providing community mental health services in primary care by training a mental health team consisting of a psychiatrist, psychologist, psychiatric social workers, and nurses in each district, along with public education to increase awareness and reduce stigma. However, the programme faced challenges integrating these services into the communities in which they functioned. Due to the very large population of India Psychoanalytic Psychotherapy, 2022 Vol. 36, No. 4, 283–287, https://doi.org/10.1080/02668734.2022.2131140