Chapter 36
Disaster and Mental HealthField of expertise: Disaster Psychiatry

Yasuto Kunii & Hiroaki Tomita
Translated by Catherine Sachi Kikuchi

Summary
The need for mental health in disaster situations in Japan grew out of the Great Hanshin-Awaji
Earthquake and came to fruition after the Great East Japan Earthquake. As a result, we now havethe organization of the Disaster Dispatch Psychiatric Team (DPAT) and mid- to long-term support
activities. In the future, it will be necessary to enhance disaster preparedness by providing support
based on scientific evidence and an understanding of the reality of the situation, throughincorporating scientific methods such as remote support, biosensing, AI, brain science, robotics,and virtual reality.
Keywords: DPAT, mental health care, post-traumatic stress response, nuclear power plant
accident, affected communities, use of advanced technology

Introduction
Although Japan has a long history of major earthquakes and tsunamis, the need for mental
health care during and after disasters was not recognized until relatively recently, after the Great
Hanshin-Awaji Earthquake. After the Niigata-Chuetsu Earthquake and the Great East Japan
Earthquake, the importance of mental health during disasters has been widely recognized.

1: Problems Revealed by the Great East Japan Earthquake (Tomita, 2018)
What happened?
Because of what we learned from the Great Hanshin-Awaji Earthquake and subsequentdisasters, recognition of the need for mental health care was widespread among psychiatrists andother professionals when the Great East Japan Earthquake struck. A lot of support was provided
immediately after the disaster. In Iwate Prefecture, a total of 29 mental health care teams from inand out of the prefecture conducted activities, providing a total of 9,811 victims with 5,553
consultations and 2,083 prescriptions. In Miyagi Prefecture, 33 teams were dispatched, and 12,794
people were given consultations. In Fukushima Prefecture, the Disaster Response Headquarters
were in charge of responding to hospital transfers, while the Mental Health Welfare Center started

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consultation calls and began supporting evacuation centers together with Fukushima MedicalUniversity. Many teams from outside of the prefecture also came to provide support, with 54 teams
coming to the Soso area, where the Fukushima Daiichi Nuclear Power Plant is located. A total of
90 teams provided support in the prefecture.
The reality of the damage
The Great East Japan Earthquake was a disaster that had an unprecedented impact on thepsychiatric care system. In Iwate Prefecture, psychiatric hospitals suffered only minor damage, butin Miyagi Prefecture, 3 coastal hospitals were inundated by the tsunami, 24 patients passed away,and 300 patients had to be transferred. In Fukushima Prefecture, 1 hospital was hit by theearthquake, 1 hospital was flooded by the tsunami, and inpatients had to be evacuated and moved
within the facility. Five hospitals located in the Soso area were unable to operate due to theaccident at the Fukushima Daiichi Nuclear Power Plant following the tsunami, and 710 inpatients
had to be evacuated and transferred. The region's psychiatric care was temporarily destroyed.
Later, 2 hospitals managed to resume operations, but 2 hospitals located within a 20 km radius of
the nuclear power plant were closed, and 1 hospital was forced to open a clinic outside the radius,
resulting in most of its staff retiring and the overall staff number shrinking. Even without theextensive damage described above, there were many medical institutions that experienced
difficulties in areas such as securing food, fuel, medicines, as well as water and plumbing,telephones, and staff commutes.

2: Paradigms Destroyed by the Earthquake
Conventional wisdom and necessary responses
At the time of the Great East Japan Earthquake, many psychiatrists were aware of theimportance of disaster relief from their experience in the Great Hanshin-Awaji Earthquake, and theknowledge they had accumulated through their relief activities had been published in the form ofguidelines and preparedness manuals. However, these manuals were not shared in advance, nor
was training conducted. In addition, the system and policies for mental health care services in theaftermath of the Great East Japan Earthquake were established through trial and error after thedisaster. The efficiency of disaster response will differ greatly depending on whether basic policies
are formulated in advance by organizations involved in mental health, and whether or not thepeople involved are familiar with and share these policies, which is an issue that still needs to beresolved.
The unprecedented event of the nuclear power plant accident caused by the tsunami of theGreat East Japan Earthquake has complex and important issues that need to be examined
separately from the direct damage caused by the earthquake and tsunami. Prior to the Great East
Japan Earthquake, there was no disaster response preparedness for a nuclear disaster. Thesituation after the accident, which has not yet been resolved, has had a wide-ranging impact on themental health of local residents (Kunii et al., 2016). It is necessary to consider the possibility of anuclear disaster occurring again. The recent pandemic caused by the novel coronavirus is also adisaster that cannot be detected by the five senses and has no end in sight, and the stigma of theaffected people is similar to the situation after a nuclear accident.

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3: A New Approach
At the time of the Great East Japan Earthquake, there was no systematic support system inplace for psychiatric response and mental health support in the affected areas. The Disaster
Psychiatric Assistance Team (DPAT) (Figure 36-1) established a system for clarifying the chain ofcommand immediately after the disaster, consolidating information, building a system ofcoordination within the framework of overall disaster medical support, and introducing preregistration and training. Since then, the system has produced good results, such as the relatively
smooth transfer of patients from psychiatric hospitals in the area affected by the Kumamoto
Earthquake. In preparing for large-scale, long-term support systems for disasters such as
earthquakes occurring directly beneath the Tokyo metropolitan area and in the Nankai Trough, it isnecessary to establish policies for mental health professionals from a wider range of fields to beeffective in disaster recovery support and to share these policies with the entire community.
A joint survey conducted since the Great East Japan Earthquake by Tohoku University andShichigahama Town, Miyagi Prefecture, has shown once again that adverse effects on mental
health persist over a long period of time (Figure 36-2). The post-traumatic stress response (aresponse that occurs after a traumatic experience, such as the disaster experience), psychologicaldistress, and insomnia shown by disaster victims varied depending on their social interaction,
alcohol consumption, and exercise habits (Utsumi et al., 2020). These findings indicate thenecessity of continuing to monitor and support the affected communities for a longer period of timeafter the disaster.

Figure 36-1. The Disaster Psychiatric Assistance Team (DPAT)3

Figure 36-2. Longitudinal trends of post-traumatic stress response in Shichigahama Town, Miyagi
Prefecture, after the Great East Japan Earthquake

4: Achievements and the Future
A new approach to disaster science
Since the Great Hanshin-Awaji Earthquake, outreach and support for salons have beendeveloped by psychiatric care centers after large-scale disasters, and have shown someeffectiveness. However, the manpower of mental health professionals is limited, and there is aneed to establish new methods of disaster psychiatry, including scientifically based assessment,prevention, care, and treatment. In terms of mental health measures under the special disastersituation of the novel coronavirus pandemic, remote support that uses online tools has been
implemented, and biosensing monitoring of activity, sleep, and autonomic nerve functions havebeen tested. We expect that new intervention approaches such as AI technology, brain science,robotics, and virtual reality technology will be introduced to process the vast amount of information
obtained using these advanced technologies.

Conclusion - from the authors
The years from the Great Hanshin-Awaji Earthquake to the Great East Japan Earthquake
have instilled in those involved in psychiatry and health care the need for mental health support in
the aftermath of disasters. However, even after experiencing these disasters, there is still muchroom for improvement in preparedness and response measures. Whether the lessons we havelearned from past earthquakes can be utilized effectively in the event of an earthquake directly
beneath the Tokyo metropolitan area or in the Nankai Trough will depend on our future efforts.

References
Kunii Y, Suzuki Y, Shiga T, Yabe H, Yasumura S, Maeda M, et al. (2016). Severe psychologicaldistress of evacuees in evacuation zone caused by the Fukushima Daiichi Nuclear Power Plant
accident: The Fukushima health management survey. PLoS One, 11(7): e0158821.
https://doi.org/10.1371/journal.pone.0158821

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Tomita, H. (2018). What we have learned from the Great Hanshin-Awaji Earthquake, and how wehave responded to the Great East Japan Earthquake. Seishin Igaku, 60(12), 1363-1374.
https://doi.org/10.11477/mf.1405205734
Utsumi, Y., Nemoto, H., Nakaya, N., et al. (2020). The Impact of health consciousness on theassociation between walking durations and mental health conditions after a disaster: A crosssectional study. Sports medicine - open, 6(1), 30. https://doi.org/10.1186/s40798-020-00259-6

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