The Kishiwada cafeteria started around two years ago with about 40 participants, but now about 100 people come to dine, according to the group.

“We may need a bigger place in the future,” Ono said, stressing the need for local governments to get involved and lend support to the group’s activities.

Without subsidies, the group has been running the program through food banks and the support network of children’s cafeterias, sometimes paying out of pocket for food.

Ono, along with some lawyers, has been assisting the “deinstitutionalization” of patients — a process in which long-stay psychiatric hospitals are replaced by less isolated community mental services for those diagnosed with mental disorders.

For Yoshinori Yamada, a doctor who treats people with mental disorders at his clinic in Akashi, Hyogo Prefecture, the key to judge whether any system serves its purpose is whether it empowers people with such disorders to socialize.

Yamada believes involuntary or long-term hospitalization disempowers patients and said the group’s activities benefit both themselves and other members of the community.

He pointed out that members of Aoitori are likely to have been empowered by interacting with visitors to the cafeteria, especially children, while empowering those people in need at the same time.

“Effects are mutual and I think that is essential,” Yamada said.

According to Yamada, most people suffering from mental disorders are burdened by trauma inflicted by others.

“People hurt people, but they also recover from it by the strength of people, through positive relationships,” Yamada said, underscoring the importance of trauma-informed peer supporters who can build positive relations with them on an equal footing by caring for other people’s trauma and their own.

Trauma-informed people have a basic understanding of how trauma can influence families, groups, organizations, communities, and individuals, according to the Substance Abuse and Mental Health Services Administration under the U.S. Department of Health and Human Services.

Yamada also insisted Japan needs a system like peer-run respites stationed by trained staff similar to those in the United States, where people with mental disorders can take refuge during times of increased stress or symptoms as an alternative to hospitalization.

“I have seen patients who will get better if they can go away from home and rest for a while, but the only available option now in Japan is hospitalization,” he said.

“I think one of the reasons for the current mental hospital system being maintained is because they have nowhere else to go. So preparing another place to stay would be important (to change the current system heavily relying on hospitalization),” he said.

Japan notably lags behind the deinstitutionalization trend, having the highest number of psychiatric beds at 269 per 100,000 people among the member countries of the Organization for Economic Cooperation and Development compared with the OECD average of 68.

The number of psychiatric beds fell from 290 per 100,000 people in 1993, which can be perceived as testament to a recent commitment to change, but Japan still falls short other countries by a wide margin, according to the OECD Health Statistics 2013.

And of the over 280,000 hospitalized psychiatric patients nationwide as of June 2017, more than 60 percent of them were staying at hospitals for a year or more, according to data compiled by the National Mental Health Institute.

Also as part of its efforts to shift away from living in hospitals to living in the community, the group and Caoru Saito, an associate professor of Philosophy and Psychiatric Social Work at St. Andrew’s University in the prefecture, have their own regular program at a community radio station run by the nonprofit organization Radio Kishiwada.

Saito is also a psychiatric social worker, but she has been supporting and getting involved with the group’s activities as a friend rather than a professional.

“Working with people at the studio and chatting for the broadcast gives people with mental disorders confidence,” Saito said. “They shine in the booth,” she said.

Radio Kishiwada is experienced in helping modern-day recluses (known in Japanese as “hikikomori”), who sometimes shut themselves in their homes for years, reconnect with society through work at the radio station.

“It is necessary to understand first that they have difficulties or disorders, then both sides need to figure out how they can reduce or remove obstacles to get the job done,” said radio chief Shotaro Kajino, adding “benefits are mutual” once they can figure out how to neutralize the obstacles.

Saito said people with mental disorders still frequently face prejudice and hardships as they try to break the stigma in society.

On one occasion a passerby handed back a flyer in disgust during Aoitori’s routine activity at the cafeteria, according to Saito.

“That’s the reality we face every day and it hurts,” she said, while they have determined to lay down roots in the community despite adversity and get involved with the people there anyway. “We have no other choice,” she said.

“We are discussing how we can change the minds of such people and let them join us at the table someday,” Saito said.