Post-Disaster Mental Health and Wellbeing in Japan

On March 11, 2011, Japan was rocked by one of the most powerful earthquakes ever recorded. A massive tsunami followed, killing perhaps 20,000 people and knocking out a nuclear power plant, which subsequently led to a release of radiation.

The height of the 11 March 2011 tsunami near Sendai, Japan.

Source: Ilan Kelman

At least 470,000 people were displaced with over one-quarter unable to return for years. Tens of thousands still remain away from their homes. The national government and local authorities continue to deal with this aftermath, doing what they can for the survivors. Ineffective actions can lead to mental health and well-being difficulties.

Some guidelines exist on disaster preparedness, planning, and response to support mental health and wellbeing, especially for evacuees. The humanitarian world has decades of experience with examples in all parts of the world. Not all are transferable between locations, yet the same, basic errors are often made, hurting people again and again.

I contributed to research led by Japanese colleagues from the areas affected on March 11, 2011, aiming to learn how to do better. We sought to document and analyse the difficulties in order to provide practical advice for prevention, preparedness, and response.

One of our studies, “Post-disaster mental health and psychosocial support in the areas affected by the Great East Japan Earthquake: a qualitative study” filled a major gap in understanding what practices are actually implemented. We looked at what practitioners did and did not provide for long-term mental health and psychosocial support (MHPSS) after the disaster.

In the prefectures of Fukushima, Iwate, and Miyagi, in northeast Japan, we sent an open-ended questionnaire to local organizations that were expected to be involved in giving continuing MHPSS to disaster-affected populations. The questions requested information on the organizations’ work, problems they encountered, and possibilities for overcoming these problems.

107 useable questionnaires were returned. The difficulties and advice described were wide-ranging, with little homogeneity, indicating that activities need to be localised and contextual. One pattern was the lack of funding and personnel to do what the respondents knew had to be done.

We ended up with seven main clusters of actions for providing long-term post-disaster MHPSS:

1. Providing one-on-one support.
2. Running collective activities.
3. Improved living conditions and options for income.
4. Better public awareness about MPHSS, helping to end stigmas.
5. Personnel available and skilled for post-disaster MHPSS.
6. Resources for organizations providing MHPSS.
7. Facilitating collaboration and exchange for MHPSS activities.

Overall, collecting and sharing knowledge and improved coordination to help each other would have served disaster-affected populations much better. Many of these suggestions paralleled those from our other study, which focused on mothers around the time of giving birth.

Our second paper is called “Experiences of perinatal women and public healthcare providers in a community affected by the great east Japan earthquake and tsunami: Concerns that must be considered for the mental healthcare of perinatal women in post-disaster settings”. Little previous work anywhere in the world had examined these particular issues.

For Shichigahama, in Miyagi Prefecture, we used two rounds of semi-structured interview guides with mainly open-ended questions. 30 mothers participated in the first round, of which 11 agreed to a follow-up interview, with an average interview time of 65 minutes. Additionally, six healthcare workers (five nurses and a dietician) participated in a group interview.

We concatenated the results into eight main pathways to be enhanced and improved for supporting the post-disaster mental health and well-being of perinatal women and their children:

1. More available and accessible information.
2. Continued access to medical services.
3. Available equipment and products for perinatal needs.
4. Appropriate hygiene.
5. Prevent reticence and timidity in expressing needs.
6. Encourage positivity toward pregnancy and parenthood.
7. Ensure supply distribution and spaces for mothers and children.
8. Resume usual healthcare.

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One major aspect requiring more research is the role of men. How could fatherhood contribute to desired outcomes? What are men’s perceptions and feelings? As important a topic is children with same-gendered parents, non-parental carers, non-biological parents, and other forms of households and families. In a post-disaster setting with high mortality, such as this one, bereavement experiences might influence as well.

The overall lessons across both studies are nonetheless clear: Be prepared for catastrophe, work with the affected people on their terms, and aim to be open about and responsive to needs. Also, identify and address needs that people might not be willing or able to express themselves.

Fundamentally, it is about treating people as human beings and ensuring readiness in terms of personnel, training, supplies, and access. It is typical in disasters that transportation routes are blocked, people are unavailable, and supply chains are interrupted. Be ready for it.

Mental health and wellbeing; pregnancies and births; and parental, child, and caring needs never stop, irrespective of a disaster. As per the usual mantra for all matters related to disasters and health: prevention is better than cure.