Disaster Support for Children
Miyagi Disaster Mental Health Care Center(Tohoku Fukushi University Sendan Hospital, Child Psychiatry)(Tohoku University Graduate School of Medicine, Department ofSocial Medicine, Department of Public Health)Community Support Division, Director – Naru Fukuchi
Tohoku Fukushi University Sendan Hospital, Child Psychiatry
Asako Murai
Key words: disaster area support, psychological education, child support
1. Introduction
After the unprecedented, unheard of disaster that occurred on that day, numerous organizations
rushed to Miyagi Prefecture and began to provide support to affected areas. We were among theindividuals who did so, and as child psychiatrists—a special role—we joined a mental health careteam in Sendai early on. As former pediatricians, we served as go-betweens between prefectural
pediatricians and neurologists. Thus, here, we would like to report on the practices of child mental
health care in local areas.
There are fewer than 200 child psychiatrists throughout Japan. It is one of those specialties inwhich education simply cannot catch up to demand. For this reason, despite being relatively young,we were given rather large roles and asked to handle very important tasks. Day in and day out, we
worked with the understanding that we were “rare animals,” so to speak. In addition, the aforementioned circumstances had a deep impact on us, and ever since the disaster occurred, we were convinced that “we simply have to do something.” Thus, with our sympathetic nervous systems on
overdrive, we visited disaster-affected areas day after day, and oversaw the lives and conditions ofmany children.
2. Disaster Psychology Education(1) An Environment Protected from Outside Information
After the disaster, the first thing we thought of was how to respond to the needs of the children
admitted to the Child and Adolescent Ward of our hospital (the Tohoku Fukushi University Sendan
Hospital). For several days after the disaster, power outages prevented these children from watching
TV, and thus, they were almost entirely cut off from outside information. As a result, they were farless perturbed than we had expected, and they were even calm in their responses to their parents’calls regarding their wellbeing. After the power eventually came back on, we fibbed and told themthat we needed to “save energy,” and did not allow them to watch TV. We neither wanted them tosee footage of their beloved homes being swept away by the muddied torrents nor witness the tearful, sobbing interviews given by people who had lost their families.
Miyagi Prefecture has psychiatric hospitals located along the coast, and several of these wereseverely damaged by the tsunami 1). Patients and staff alike lost their lives, and many struggledvaliantly to save those who were left with what limited medical resources they had. Further, it
became quite reckless to attempt to stay in these essentially defunct hospitals, and we received
many requests for patients to be transferred to our hospital, which was relatively undamaged. If we
accepted those requests, we realized that the children in our Child and Adolescent Ward would nolonger be protected from outside information; we imagined it would be turned into a mixed ward,
filled with adults escaping from tsunami damage. If that were to happen, it was only a matter oftime before the children would learn of the damage suffered by nearby areas, and that they would
soon be exposed to information from the TV and newspapers.
(2) Implementation of Disaster Psychology Education
As a result, it became difficult to continue to hide the truth of the post-disaster damage fromthese children, and we decided to begin an impromptu “disaster psychology education” program
for them.
- 114 -

At the time, while power outages had been resolved, gas had not yet returned, and the heating
system remained unusable. Thus, we brought heated carpets from our homes, laid them out on thefloor of the ward, had the children and staff huddle together with each other to keep warm, andused slides to hold an approximately one-hour impromptu disaster psychological education program. The program was divided into three parts: telling the truth, how feelings come about, andrelaxation. We also distributed self-check worksheets designed to supplement information on CBT.
We explained the extent of the disaster in full detail, hiding nothing, and also told the children
about what might happen next. However, we made sure to comprehensively communicate the message that “no matter what happens, we will protect you.” The children reacted much better than we
had expected, and they exchanged opinions with great interest. After the program ended, they all
pitched in in the cleanup of their own will, and they ate their food that night without wasting asingle morsel.
The slides we used that day have been linked on the “Child Mental Health Treatment Hospital
Organization Project” website, from where they can be downloaded for free 2), 3).
3. Children During School Visitations(1) Effects of Post-Disaster Hyperarousal
About three months after the disaster, the education board of an elementary school that had
suffered severe damage sent out a request for child psychiatrists to be dispatched to their campus.
As the school had been used as an evacuation shelter prior to reopening, we were already acquainted
with several of the children and teachers there, and we transitioned into our roles relatively
smoothly. When we would visit and ask teachers how the children were doing, nearly all of themsaid “they’re super lively.”
Indeed, if one were to take a look at them, these children did not, in fact, seem to be experiencing any serious worries: they would speak loudly and play energetically. However, when I lookback, I think this state may have been greatly influenced by post-disaster “hyperarousal.”(2) Children Who Stay Back in Areas with Severe Damage
While this has been reported before 4), even now, one year after the disaster, the number of children who
come to medical institutions has by no means increased. Strangely enough, the number of children who comefrom coastal areas with severe damage is quite low, and the ones who get checked up are almost always
those who moved to Sendai, which remained quite “safe” relative to coastal areas.
Behind this unusual phenomenon is likely an issue with these children’s “self-perception.” Almost without exception, children who did not move out of areas with severe damage went throughthe same experiences. They all saw the tsunami and their neighbors being washed away. Many ofthem even lost a family member. However, because everyone around them had similar experiences,many of them just assume that this is normal and continue to live with that flawed self-perception.
On the contrary, children who moved or transferred schools to areas with less damage cameface-to-face with the gap between their experiences and the experiences of those around them. They
compared their experiences with those of others, and were essentially forced into the realization
that, “Wow, I really went through something horrible.” They became unable to share their experiences with others, somehow found it difficult to fit in with their peers, and ended up feeling lonelyor isolated. As a result, they began to present with a variety of physical symptoms, could even fall
into depression, and ended up not going to school. One case I took part in involved a child who had
begun going to school in Sendai, but because they found themselves unable to fit in with their peers
there, decided to return to their old school on the coast, which was now more than two hours away.
(3) Child Mental Responses
When, then, will the children remaining in coastal areas develop a mental response to what
happened to them? I believe that this will happen when the continued existence of their regional
community becomes difficult. Many schools whose facilities were damaged beyond usability by
the tsunami borrowed space from nearby schools to continue lessons. However, the possibility thatthese schools would be rebuilt was quite low, and many of the students who formerly attended theseschools moved on to others. Thus, we see a trend whereby many of these schools are being consolidated into others.
When that time comes, and when they are forced to confront problems and realize truths about
their lives thus far, how will these children react?
When I think of that question, I can’t help but wrack my brain to think of some sort of method
to provide preventive interventions to these children in what little time I have.
- 115 -

4. Camp Initiative(1) Need for a Group Therapy Approach for Children
As I have just described, at the current moment, there are countless children without psychological symptoms who, upon becoming able to form an accurate self-perception, will respond in some unknown way.
Even outside of disaster areas, at the national level, the number of specialists capable of providing mental
health care for children is horrifically low. Individual work with these children is simply impossible from apractical standpoint, making the group therapy approach the only viable option. I believe that group therapy
programs should be incorporated into school curricula.

(2) Implementation of a Camp for Children in Disaster Areas
In Sendai, I have led Table 1: Camp Overview
a research group of
Session 1
Session 2
individuals involved in Date and Time
July 23–24, 2011
October 29–30, 2011clinical practice in child(Sat–Sun),(Sat–Sun)mental health care since Place
Izumigatake Open- Asahi Open-Air
2007; thus, following
Air School, Sendai School, Yamagata
this
most
recent Child Participants
29 (16 boys/13 girls) 24 (14 boys/10 girls)
earthquake, myself andAges
5–12 years old
5–13 years oldthese members obtained(average age 8.4)
(average age 9.1)
thecooperationof
Parent Participants
12
13
severalorganizations
Total Staff
23
37(volunteer organizations,regional youth sports clubs, etc.) and decided to hold a camp for children in disaster-affected areas.
Till date, this camp has been held twice, in July and October 2011, and around 30 children haveparticipated each time (Table 1).
Further, in preparation for the possibility that these children may later develop mental illness,
we recruited participants only from areas in which participating physicians could provide followup care. Our staff consisted of a small number of specialists and student volunteers, and we arranged
it such that each child would get one-on-one time with a staff member.
The results of this camp initiative have not yet crystallized, but we plan to continue to hold it.
As we hold more and more sessions, we predict that some children will participate several times,
and we will then be able to watch over them as they grow and develop.
(1) Working with Parents and Guardians
We sent a questionnaire to children’s households prior to both sessions, and asked parents toindicate what they were worried about at home and what sorts of things they would like us to focus
on or incorporate into our work with their child. As described below, psychological education forparents and children was carried out separately.
On the day of the camp itself, we had parents and children assemble together at an agreed-uponmeeting location, where the staff took charge of just the children and took them by bus to the
campground. We asked parents to then meet us at a hall near the meeting place, where in addition
to simple psychological education from specialists, we had a tea party, where parents could share
their experiences and worries about their children in a casual setting.
The primary objective of this psychological education was to have parents experience thepsychological interventions we had planned for their kids at camp, but it also helped some parents
release mental stress. Afterward, we also set up individual booths where parents who wished toreceive individual counseling could do so. We carried out a follow-up survey approximately two
weeks after the camp, and overall, parents indicated that they were satisfied with the experience.
(2) Working with Children
The camp was quite short (two days and one night); thus, it was infeasible to expect very significant
results. However, we alternated events from three separate program types: an active program(orienteering, music performance by a professional, and group exercise re creation), a quiet
program (psychological education, yoga, and a remembrance meeting), and a ceremonial
program(opening ceremony, candle service, and a closing ceremony). Thus, we maintained acohesive flow to our activities (Fig. 1).
- 116 -

As children of various ages took part,
Figure 1:Child program Flow
we needed to design our psychologicalmusicgroup exOrientActive
education program with some skill. For
perforeering
ercise recprogram:mance
example, we conducted a semi-structured
reationart therapy session. Different children
RememPsychologiQuiet
had different levels of concentration;
brancemeetyogacal
educaprogram
several were able to follow theing
tion
instructions of the teacher and achievesome level of calm through art, while
Opening
candleclosing
Ceremonial
others were completely unable toceremony,
service
ceremony
programconcentrate on the art and simply choseto run around.
Further, in the second session of the camp, we implemented an imagination-based
psychological therapy program for upper-class children. We also carried out a follow-up survey,
and most indicated that they were satisfied with the camp.

5. Conclusion
In order for children’s mental responses to emerge, certain conditions need to be satisfied, andadults must begin to exhibit mental responses. In other words, if their parents and guardians cannot
calm down, children will become unable to even cling to their objects of affection. For example, in
evacuation shelters, we saw many kids who were unable to safely regress into a more childlike state,
and instead spent all their time immersed in videogames. Aid workers’ true task still lies ahead ofthem, as the conditions that are necessary for child responses are expected to be satisfied in two to
three years hence. We imagine that this is when the “reconstruction of Tohoku” will be clamoredfor in earnest.
Most of us know that the journey to reconstruction is a long one, and that our destination is stillquite a way off. The strength of us locals is simply not enough to ensure that the mental health ofthe children of this region will be adequately protected. Through this passage, I humbly ask all of
you for your long-lasting support.

<References>
1. Naru Fukuchi (2011). The Reality of Psychiatric Support in Disaster-Affected Areas. Monthly
Minna Net. October issue. 7–10.
2. Child Mental Health Treatment Hospital Organization Project Website. http://kokoro.ncchd.go.jp/saigai_senmonka.html
3. Naru Fukuchi, Mizuho Hayashi (2011). Current Status of Children in Disaster-Affected Areas.
Pediatric Psychology and Neurology 51(2). 126–132.
4. Motoi Fujita(2006). The Niigata Chuetsu Earthquake from the Perspective of a Local Child
Psychologist. Traumatic Stress 4(2): 127–134.
(Naru Fukuchi, Asako Murai. Disaster Area Support for Children. Published in Japanese Journalof Hospital and Community Psychiatry. Vol. 55, Issue 1. 2012: 56–58.)- 117 -