March 11th marked the one year anniversary of the strongest earthquake to ever hit Japan, which spawned a catastrophic tsunami and nuclear disaster. Most of Japan’s northeast coastline was wiped out and 19,000 people died, and tens of thousands are still displaced from their homes and communities. Several members of the APS Disaster Response Network have been involved in supporting Japanese psychologists as they provide support to devastated Japanese communities, and Susie Burke interviewed two of these to hear their stories.
Yoko Hayashi MAPS grew up in Japan but undertook her postgraduate degree in clinical psychology in Australia. She was living in Japan with her husband and two small children at the time of the Japanese disaster. Yoko and family initially fled Japan but decided to return not long after.
How did you make the decision to return to Japan?
We left Japan five days after the earthquake as we feared the impact of the nuclear disaster on our children’s health. The decision to go back to Japan was very difficult. My husband and I talked every night about the pros and cons. After one month we decided to return for a year to provide support for Japan in recovering from the great disaster.
What role have you had in the recovery efforts?
Firstly, I contacted the APS for assistance in gathering resources for post-disaster psychological recovery. I translated these resources and adjusted the contents to apply to the current context and to Japanese culture. I distributed these to several volunteer groups, and online.
I am a mental health consultant to some volunteer groups that help children and families recover. In this role, I provide training on basic understandings of psychological health after the disaster, and advise on how volunteers can support survivors. I am also involved in a program called Ubiquitous Counseling at Fukuoka University to offer free telephone, Skype and email counselling to survivors. I work one night a week as a volunteer counsellor. I also collaborate with a non-profit organisation to provide professional assistance on mental health matters for its work in supporting disaster survivors in various areas.
The APS Disaster Response Network (DRN) also connected me with APS psychologists with experience in post-disaster work, and these individuals have been very supportive in providing advice, mentoring and recovery resources.
What it is like now in some of the small coastal towns that were devastated by the tsunami?
I went back to several coastal towns in Iwate prefecture in early February 2012. These towns look very empty after the clean-up of the remains of people’s lives – the houses, schools, offices and shops that were destroyed by the tsunami. On the surface, I saw that people were doing their best, rebuilding their lives and towns, coping with the aftermath and their loss every day. However, during this visit, I heard of the great impact of the disaster on many individuals’ psychological health – suicide, depression and other trauma-related mental health issues which are not surprising considering the many issues they are grappling with like loss of family members, houses and community, marital separation and family discord, relocation and unemployment.
Given your experience of Australians, do you see differences in how the Japanese people respond after a widespread disaster like this?
I think that Japanese people in general tend not to show their emotions. Whilst I have seen media images of survivors and rescue professionals breaking down, and I have personally heard stories of people who are distressed or having difficulty coping, the people I met in the affected coastal towns rarely showed these feelings.
How is psychological support perceived and understood in Japan?
My impression is that psychological services are neither well established nor well recognised by the Japanese public. Compared to Australia, there is no similar mental health system in the public or private sectors in Japan. Many people I meet do not know what psychologists do. Japanese psychologists want to help, but I have heard from Japanese colleagues that professional help had initially been unwelcome in the disaster-affected towns. Reaching out to the survivors continues to be a great challenge.
The government announced late last year that they will set up a psychological care team in every prefecture, however I think that psychological support is still not incorporated into the whole picture of disaster recovery. The reality is that the majority of disaster survivors do not receive any psychosocial assistance. Many volunteer groups, however, provide support across the affected regions. Most are non-professionals, offering casual ways to connect with survivors, like visiting and holding events at evacuation centres or temporary housings.
Where do people who might be in need of specialised mental health care seek help?
Each prefecture has a mental health centre, which provides information and consultations for people with mental health issues. There are also a number of private mental health clinics and counselling centres. However, these services appear to be not well recognised by the public.
What are the biggest challenges for you as a trained psychologist wanting to volunteer support?
From my two visits to the affected towns, I found that building a trusting relationship is the key and the biggest challenge in providing psychological support. As the time passes and fewer and fewer volunteers are actually working in the field, disaster survivors seem to become even more guarded towards assistance coming from outside the affected regions. As I am a mother to two young children, it has been very challenging finding the time required, whilst still spending time with my own family.
Lyn Page MAPS is a psychologist with years of experience as a manager of a counselling service in education and private practice who was one of the APS Disaster Response Network volunteers working with the Red Cross after the 2011 Queensland floods. She has travelled to Japan twice since the earthquake to provide support and further resources to Yoko and her Japanese colleagues.
What did you do during your recent time in Japan?
I first met Yoko in September 2011 in Japan. She told me about her experiences and identified areas where she wanted more information. I returned to Japan in November specifically to assist Yoko. We spent ten days together, meeting and exchanging resources with her contacts in Tokyo, and travelling to Yamada with a volunteer group assisting the affected children’s psychological recovery that Yoko is supporting.
We met with psychology staff and postgraduate students at Senshu University who are coordinating recovery activities with various workers in the affected areas. We were told detailed and graphic stories about the disaster events and realised that many of Yoko’s Japanese psychology colleagues were also deeply and personally affected by the destruction of the lives and homes of family and friends. Working professionally to provide support for survivors is complicated by the professionals' own traumatic experiences.
In Yamada we saw endless kilometres of damage. We visited the temporary centres, helped volunteers, listened to people’s stories and distributed resources. On the last day, Yoko and her mother took me to a garden near her home town. It was mid-autumn and the most beautiful garden of its kind I have ever seen. Her mother said I needed to replace the images of destruction in my mind. It was much appreciated wisdom.
What sort of mentoring did you offer Yoko?
Positive peer support is the best way to describe our contact. I focused on strengths and capacity building with volunteers and drew a lot on positive psychology strategies. We discussed cultural issues and community issues, and strategies to increase connection and re-establish community norms. I provided Yoko with further contacts and resources from my positive education networks. At times I was also just a safe sounding board for frustrations.
What did you see as the biggest challenges facing the Japanese people in the affected areas?
By far the biggest physical challenge is the immense scale of damage and loss. Communities fear they will be forgotten, and there is much grief at losing such a large amount of incredibly beautiful country. Thousands of residents have been permanently relocated. It is difficult to draw on a community’s own capacity, resources and infrastructure for recovery if they have been completely destroyed. It's difficult to know what the long-term psychological impact of this massive scale community dislocation will be, particularly given that psychological health has never before been an established goal in these communities.
When the scale of disaster is so huge, and the needs for support are so high, how do health care providers and volunteers manage?
People need to focus on a limited number of effective activities, engage a limited number of key workers and maintain their capacity. That’s the way to not become completely overwhelmed. It’s hard but essential to remember to apply the same strategies you teach others to yourself (e.g., exercise, meditation, positive activities, routine, time-out). Using your strengths realistically and looking after yourself is the only way you can communicate self care to anyone else.
We also need to be mindful of the valuable contribution that friends and work colleagues make to keep the work sustainable, like my positive education colleague Sue Martinov, and my St George College staff who enabled me to take time off, and picked up my work when I was away. While in Japan, other psychologists and experienced Red Cross volunteers that I had met earlier in the year kept in touch with me every day. These are the layers of support that are so valuable.
What did you learn about how to provide effective assistance?
Yoko and I have learnt well that first you need to be there to make the personal connections. Only then is your offer of support welcomed. I could have offered a lot more contact and resources and there are grants available through other organisations, but the requirements have been very specific and relied on contacts and invitations. I also think there is a strong collaborative role for organisations to facilitate volunteer work. I spent a lot of time writing to airlines asking for sponsorship or for a standby empty seat on my second visit to Japan. I didn’t get any reply at all and was in a half empty aircraft both ways.
I agree with training volunteers in positive activities and as mentioned I’ve drawn strongly on positive psychology strategies. In a recent interview, the leading proponent of positive psychology, Martin Seligman, was asked: “If you had just one recommendation for someone to maintain their own wellness, what would it be?". His reply was “Do something for someone else”. Disaster zones are not for everyone but volunteers with skills such as psychologists can work from anywhere and be an enormous help.