他誌掲載原稿

World Child & Adolescent
ISSUE 10, June 2016

WPA, Child and Adolescent Psychiatry Section's Official Journal
5 years after the 2011 Tohoku earthquake and tsunami/Disaster Psychiatry/

第Ⅵ章

調査研究報告および他誌掲載原稿

第Ⅶ章

寄稿

After I confirmed that the number of inpatients requiring emergent/urgent medical and psychiatric caredecreased, I decided to go out of the hospital to provide mental health care for people in the community. I
joined the local support team and went around the disaster areas. We went to the evacuation sites andcared for survivors. We wore pink parkas to identify ourselves as mental support team members andapproached them to offer mental health support, but they declined our offer despite the fact that many ofthem obviously seemed upset and confused due to this disaster. We did not realize that there was thisdegree of stigma against mental health services. We took off our pink parkas the next day and cleaned thefloors of evacuation sites so that people in the community could trust us and reduce their resistances toaccess to mental health services when required. Most of the evacuation sites were school gyms. There
were some children who gathered nearby the power outlets at the evacuation sites and who played portablevideo games all day.

第Ⅴ章

地域センターごとの活動報告

Could you please describe how the earthquake and tsunami in March 2011 impacted the city and thepsychiatric hospital you were working at that time? Could you also tell us what your role was for the first
couple of weeks and for the first couple of months, respectively?
At the time of the disaster in March 2011, I was working as a child psychiatrist in a hospital where I served
as the chief psychiatrist in the child psychiatry unit. Despite the fact that the hospital was built just 4 years
prior to the earthquake (and thus it was considered a new building), the damage due to the earthquake wasso tremendous that a large part of the ceiling fell down and the water pipes were ruptured, leading to severe
water leakage. I was relentlessly providing emotional support, and I continued treatment for 20 hospitalized
children on the unit at that time. Because no information was available, children were not aware of thisunprecedented disaster immediately following its occurrence, and they did not exhibit any signs ofemotional disturbances. Along with serving as a physician, my other roles there were to provide them withaccurate information and brief psycho-education and to contact their families.

﹇事業項目別の経年活動報告﹈

I am currently working in the Miyagi Disaster Mental Health Care Centre, the main facility that focuses on
the care and the recovery of people affected by mental health problems caused by the Great East Japan
Earthquake in 2011.

第Ⅳ章

業務統計報告Dr. Fukuchi, first of all, thank you very much for agreeing to do an interview for “World CAP.” It is ourpleasure to interview you. Before we discuss details of your work in Tohoku region, Japan, could please tell
us a little bit about yourself?
I initially started working as a paediatrician in the northern area of Japan. I was mainly engaged in theassessment of developmental problems in infants and young children. A few years following my career as apaediatrician, I changed my major to psychiatry and have since worked in the field of community mental
health ever since. I also obtained a Ph.D. in Public Health for suicide prevention in rural areas of Japan.
Shortly after the earthquake and tsunami in Japan in 2011, I went to the affected areas and provided mental
health care for the victims. Since then I have been deeply engaged in the field of disaster psychiatry.

第Ⅲ章

全体の事業展開について

Interview with Dr. Naru Fukuchi

第Ⅱ章

当センターを立ち上げるまで

Psychiatry

復興までの道のり

第Ⅰ章資 料− 169 −復興までの道のり

第Ⅰ章

当センターを立ち上げるまで

第Ⅱ章

全体の事業展開について

第Ⅲ章﹇事業項目別の経年活動報告﹈

業務統計報告第Ⅳ章

World Child & Adolescent

Psychiatry

ISSUE 10, June 2016

WPA, Child and Adolescent Psychiatry Section's Official Journal(Interview with Dr. Fukuchi, cont.2)
They were mostly playing fighting games. I tried to talk to them, but most of them did not pay muchattention or even look at me. After many visits, they slowly opened up to me and their attitudes changed.
They told me that their parents were away to take care of their damaged houses and also that their parents
were very busy getting the official documents required for financial support from the government. I thoughtchildren could not find anything to make them feel safe while parents were unavailable and they thus
seemed to be trying to escape into the virtual world. They seemed to be fighting with monsters just as they
were struggling to survive.
My role for the first couple of weeks was connecting survivors with mental illness to medical institutions andgiving survivors appropriate psycho-education. A couple of months later, my role changed. I started to assist
supporters who did not have knowledge of mental health. I also began managing the Miyagi Disaster
Mental Health Care Centre, the new facility that could provide people in the community with mental healthservices in the long run.

第Ⅵ章

According to our data, the number of residents who started showing signs of mental disorders, including
schizophrenia and depression, shortly following the disaster and who received our support, increased
considerably right after the disaster. Residents who did not initially show psychiatric symptoms and who
tried to endure their painful situation started exhibiting depressive symptoms a few years following thedisaster. The number of clients who have had depression after the disaster has been increasing these days.

地域センターごとの活動報告

第Ⅴ章

Please tell us what psychiatric problems, symptoms, and diagnoses you saw during those periods? What
were the challenges and obstacles in providing mental health support/care? How did you deal with them?
We found some people who had mental health problems prior to the disaster and who had not been
receiving appropriate treatment. For example, they were socially withdrawn due to an autism spectrum
disorder or due to negative symptoms of schizophrenia. In some of the communities affected by theearthquake and tsunami, families of these individuals were ashamed of them and tried to hide them in theirhouses. Many of them, therefore, received no mental health care. However, given that all residents,
including these individuals, had to escape from the affected areas to survive, they ended up evacuating to
the school gyms and appearing in public. Most of them eventually returned to their destroyed houses orescaped in their cars due to their difficulties engaging with people in the community.

調査研究報告および他誌掲載原稿

第Ⅶ章

寄稿

The rural areas were most heavily affected due to this disaster, where insufficient medical institutions andpublic awareness of mental health disorders existed. Due to this lack of awareness, residents in theseareas had strong stigma against mental illness and tended to refuse conversations with regards to mentalhealth. To overcome this challenge, we attended local events, such as agricultural events and festivals, tounderstand the culture of the community, and then, through these events, we could have opportunities tospeak on mental health problems related to the disaster. We also arranged several social gatherings for theresidents, including tea parties, cooking events, and mah-jongg tournaments, where we attempted toprovide them with opportunities to learn about mental health problems.
Would you be able to describe the differences in psychiatric signs, symptoms and problems that you
currently see five years after the disaster in comparison with ones you encountered during the acute andsub-acute phases of the disaster?
I met many individuals who talked about their emotional experiences at the evacuation sites. They vividly

資 料− 170 −World Child & Adolescent
ISSUE 10, June 2016

WPA, Child and Adolescent Psychiatry Section's Official Journal(Interview with Dr. Fukuchi, cont.2)﹇事業項目別の経年活動報告﹈

第Ⅳ章

業務統計報告第Ⅴ章

地域センターごとの活動報告

第Ⅵ章

調査研究報告および他誌掲載原稿

Could you please describe your current work and future projects you would like to accomplish at the Miyagi
Disaster Mental Health Care Center?
I would like to put my efforts in support of children, since they bear the future in the disaster affected areas.
Although there are several ways to support their well-being, I think providing psychoeducation with the aimof enhancing their resilience is most important of all. If they could appropriately acquire healthy coping skills
and subsequently adapt to any stress caused by the 2011 disaster, they would likely cope well with future
potential difficulties and challenges. We have been consistently holding workshops for high school students
in some cities located in coastal areas where the earthquake and tsunami hit in 2011. These workshops
include discussions about how to rebuild their cities, lectures about how to cope with stress, and relaxation
technique practice sessions. We also have been holding outdoor camp activities for elementary school
children. For safety reasons, the camping facility is not located in coastal areas. The camping programs
include cooking, outside play, group talks, campfire experiences, and psychoeducation on disaster mental
health. We use traditional Japanese toys, such as “picture story” and “blowing pipe,” for psychoeducation.
The psychological burdens on children following camp participation seem to be reduced, suggesting thatthese activities might be useful for improving the psychological well-being of children who experienced the2011 disaster.

第Ⅲ章

全体の事業展開について

described their experience in forceful tones. In hindsight, I think they were in a hyperarousal state at thattime due to emotional trauma. Traditionally, following their belief that affecting others by showing emotions
is rude, Japanese tend to hide their emotions. They often are not willing to speak to others about theirexperiences and their feelings, even though they have just experienced tragic accidents or disasters.
Although huge numbers of residents were affected by the disaster, we were challenged by the fact thatmost people did not desire to seek help from medical and psychiatric facilities. Younger elementary school
children started opening up and speaking about their experiences a few years after the disaster. Theirparents and teachers became surprised by this fact, because these children were preschoolers who could
not fully express their feelings in the moment of the disaster because of their lack of verbal abilities. At thattime they instead showed behavioral problems, including excessive crying and enuresis. I think the processof speaking to mental health professionals is important for these children to deal with their experiences andthe associated emotional trauma.

第Ⅱ章

当センターを立ち上げるまで

Psychiatry

復興までの道のり

第Ⅰ章

第Ⅶ章

寄稿

Nawatobi in camping

Psychoeducation session
This interview was conducted by Dr. Tomoya Hirota (Assistant Editor)

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