Out-of-hours access to specialist care in Japan is primarily via emergency departments. Japan has begun to address this through the fee schedule changes in 2014, but there are more options that could be explored. Where they do exist - and they are relatively widespread in OECD countries (OECD, 2014a)- crisis and home treatment services can form a central role in out-of-hours access to care. A recent Cochrane Review of crisis intervention for people with severe mental illness (Murphy et al.,