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Proposals By the Japanese Association of Psychiatric Social Workers

Naoto Kita
Executive Director, Japanese Association of Psychiatric Social Workers

1. Opinion based on overall damage caused by the Great East Japan Earthquake

The Great East Japan Earthquake caused extremely serious damage to an extensive area, and some local governments sustained devastating damage to their ability to function. Various data has shown that persons with disabilities faced an extremely high mortality rate and difficulty in rebuilding their lives. In addition, it was possible to relatively promptly ascertain conditions at facilities such as those for persons with disabilities after the disaster, but the damage sustained by persons with disabilities, including those living at home, is still not clear.

As for persons with psychosocial disabilities, the Great East Japan Earthquake revealed that these persons live inconspicuously with their families amid deep-rooted prejudice. The coastal areas of the Tohoku region, where many people were forced to evacuate because of the major tsunami and nuclear accident, uniformly lacked sufficient mental health and medical welfare services. Although it has been one year and six months since the disaster, there is a need for support for daily-life for the long term, up to ten years.

2. Efforts and response by the association

(1) Establishing the Great East Japan Earthquake Response Headquarters

In order to conduct support activities for parties such as local residents affected by the Great East Japan Earthquake, the Japanese Association of Psychiatric Social Workers (JAPSW) established the Great East Japan Earthquake Headquarters within the association on March 12 in line with its Disaster Support Guidelines created in 2010. The headquarters undertook numerous activities including (a) collecting information related to the mental health care and welfare in the disaster area and providing information to parties such as members, (b) soliciting funds from members for activities including support activities for the disaster area, (c) and coordinating participation in support activities for members (psychiatric social workers) as requested by entities such as local government organizations in the disaster area, etc.

(2) Support activities in the disaster area

For one month, March 23 - April 22, JAPSW conducted the following support activities after inspecting Fukushima, Miyagi, and Iwate three times and coordinating with entities such as the branch offices in the disaster area. In addition, the association called on members throughout Japan while coordinating with the disaster area and began to register members able to participate in support activities in disaster areas on March 28.

  • (a) Dispatch of coordinators for mental health care teams (Kokoro no Kea Teams) in Iwaki-shi, Fukushima

There were demands for coordinators to compile information from mental health care teams providing support in Iwaki-shi, Fukushima, and to undertake various activities such as coordinating actual support activities between the teams and public health centers in Iwaki-shi. Therefore, JAPSW had one of its members, a university professor who worked in Iwaki-shi, play that role and conducted activities April 6 - May 2.

  • (b) Dispatch of staff for mental health care teams (Kokoro no Kea Teams) in Miyagi

Members of the Miyagi Association of Psychiatric Social Workers took turns working with mental health care teams, centered on Tohoku University Hospital (“Tohoku University Team”), that launched activities the week following the Great East Japan Earthquake. For one team undertaking support activities in Ishinomaki-shi, it was decided to continually dispatch one person from somewhere in Japan to work for about one week, and seven members worked on these activities from April 9 through June 1.

  • (c) Dispatch support staff to Minamisoma-shi, Fukushima

During inspections of the local area, it was discovered that Minamisoma-shi had strong needs for support as no health nurses had been dispatched from other municipalities and clinics for psychiatric services were finally ready to reopen and start seeing patients. Therefore, it was decided to provide support for the time being starting on April 18.

Minamisoma-shi has a population of about 70,000 people and mostly falls in an area 10 - 40 kilometers from the Fukushima Daiichi Nuclear Power Plant. In the city, 400 people were staying at five emergency shelters, but more than 3,000 people fled Fukushima to another prefecture, such as Gunma or Niigata, for various reasons such as evacuation orders due to the nuclear accident.

Following the earthquake, medical teams were dispatched to various areas, but only a few teams were dispatched to Minamisoma-shi, including a Nagasakiken Medical Association team, a dental school team and medical team from Nagasaki University (Nagasaki is one of the cities that a nuclear bomb was dropped on during World War II), and a Minamisoma City General Hospital healthcare team. For psychiatric hospitals located in evacuation order zones and indoor evacuation zones due to the nuclear accident, all hospitalized patients were transferred to other hospitals, and the hospitals were closed. Under these conditions, psychiatric clinics were finally able to reopen and see patients again. It was at this time that the association launched support activities.

Support activities initially consisted of visiting facilities, mainly emergency shelters, to provide counseling services but as time passed, the activities switched to visiting residents staying at temporary housing, privately rented temporary housing, and homes. Support activities in Minamisoma-shi continued until October 28, during which 68 members took part in activities which lasted for 386 days.

  • (d) Dispatch of support staff for Higashi Matsushima-shi, Miyagi

Activities started on April 25 and were based on requests by the Disabled Persons Welfare Section, Health and Welfare Department, Miyagi Prefecture, and the Disability Welfare Team, Welfare Service for Persons with Disabilities Section, Health and Welfare Department, Higashimatsushima City.

Located northeast of Sendai-shi, Higashi Matsushima-shi has a population of 42,000 people. The tsunami flooded 65% of the city, which was the largest percentage of a city affected by the tsunami. Because of the disaster, 1,800 people died or are missing, and when support activities were launched, there were more than 50 evacuation shelters and 3,000 evacuees.

When undertaking activities, including visits, there were various demands of psychiatric social workers, such as (i) connecting patients who needed to see a psychiatrist with a psychiatrist, (ii) providing counseling in cases when it was determined patients did not need to see a psychiatrist, (iii) providing counseling for persons with psychosocial disabilities and a history of receiving mental health care living in inappropriate conditions at emergency shelters, etc.

When activities were initially launched, staff took turns working in the area with one person working for one week, but starting on May 14, two staff members started to be dispatched. Support activities in Higashi Matsushima-shi continued until December 28, during which 71 members took part in activities which lasted for 401 days.

  • (e) Current efforts

The response headquarters temporary suspended support activities in the disaster area at the end of 2011, and the headquarters closed at the end of the fiscal year. However, the Great East Japan Earthquake Reconstruction Support Headquarters (“reconstruction support headquarters”) was newly established in FY2012 in order to continue the activities of the response headquarters and to work on reconstruction as the PSW association since reconstruction in the disaster area had not progressed much. Up to now, three conferences have been held in the Tohoku region and support has been provided to licensed psychiatric social workers struggling in the disaster area - in other words, searching and developing concrete activities to support people providing support.

3. Issues that came to light since directly after the disaster

Although it has already been one year and six months since the Great East Japan Earthquake, it is probably important to conduct an interim assessment of support activities related to mental health and medical welfare services following the earthquake (organizing what has been accomplished and what has not). In addition, the following are issues related to preparing for disasters that could hit wide areas in the future during regular time.

  • (a) Create activity schemes for dispatch style support teams from throughout Japan

Although numerous mental healthcare teams provided support following the Great East Japan Earthquake, it cannot be denied that in some areas, the teams did not function effectively. It is important for entities such as the Ministry of Health, Labour and Welfare, prefectural governments, hospitals, professional organizations to create an activity scheme during non-emergency times, as a “preparation”.

  • (b) Train local coordinators who can fully function under local government organizations in the disaster area

In the disaster area, the most difficult and tiring activity for workers such as government health nurses was assigning support staff dispatched from throughout Japan and coordinating with general medical teams. When there is a large-scale disaster, there must be an organization and people to serve as a control center in the local area. An urgent issue is training local coordinators and creating a system that can fulfil that role.

  • (c) Reinforce local daily-life support for persons with psychosocial disabilities during non-emergency times

If something cannot be done during normal times, there is no reason is can be done during emergencies. Creating a system that makes it possible for persons with disabilities throughout Japan to live in the local community with peace of mind should also be useful during emergencies.

4. Proposals regarding the future

The following are probably important efforts related to mental health and medical welfare services during disasters.

  • (a) Creating a system that makes it possible for D-MAT and general medical teams to work with mental health care teams immediately after a disaster.
  • (b) Establishing a system to register disaster support specialists by specialization and provide training.
  • (c) Improving the quality of outreach support activities.

With the Great East Japan Earthquake, there is no idea when people will be able to rebuild their lives, which is gradually resulting in various mental health issues such as alcohol dependency. There are also concerns about exhausted city workers in municipalities affected by the disaster quitting. It goes without saying that the most important thing is for all residents affected by the disaster, whether they have a disability or not, to have hope for the future.