The current status and issues with the mental health of children in
Miyagi Prefecture*Reference: The Japanese Society of Psychosomatic Pediatrics,“Children’s body and mind”, 23, 1 (31-32), 2014
Miyagi Disaster Mental Health Care Center
Naru Fukuchi

I. Introduction
Approximately 400,000 individuals were forced to use shelters due to this earthquake and among thesewere individuals who required special treatment (e.g., children, disabled individuals). The chaos
immediately ensuing the disaster occupied all the mental space of the victims, and there was minimal
consideration for others at the time, with everybody simply trying to survive. Currently, the recovery
process has entered the mid- to long-term phase, and changes are rapidly occurring in terms of regional
lifestyle or support activities. Regional residents are moving from shelters to temporary housing, and eachis facing social problems. The root cause of this problem stems from the uncertainty of the future, and theproblems that individuals face have changed with time and region. Children are steadily developing underthese dizzying lifestyle changes, and various reactions have been observed over time. The objective of thecurrent text is to report on the current status of disaster support in Miyagi Prefecture and to discuss issues
for overseeing child development in the region.
II. Characteristics of support immediately after a disaster
The characteristics of support immediately after a disaster are discussed first. Even if teams specialized in
psychiatric medical treatment come to shelters immediately following the earthquake to provide support, few
evacuees would request support. During emergencies, it is thought that as a general rule, people on-site go beyondtheir previous professions to do what they can do. It is thought that with time, the specialized skills of care
workers are likely to be requested, and support shifts from a “wide and shallow” to “narrow but deep” nature.
Additionally, standard mental health fields usually are based on a system where support is provided to a client,but during disasters, it is the care worker who conducts visits to clients. In other words, it is the care worker whoneeds to shift gears from their previous system.
Groups that take in support (regions, organizations, etc.) must also keep in mind the psychological changes
that occur over time. These groups became severely short-staffed once a large disaster strikes, accepting any helpthat they can get from any individual. In other words, the previous group system’s standards weakened, and theturnover of people became more frequent. However, with time, these groups recognized their situation, realizingthat it could not continue as such, and tried to return to the old system. At times, this reaction could be excessive.
In other words, groups readily accepted help immediately after the earthquake, but as more time passed, they
began to reconsider more and more the type of support they received.
The psychological changes among support teams themselves need to be considered as well. This is thepsychology that naturally is established between the early groups and latter groups. The disaster mental healthcare center at which we are active is a support organization established roughly one year after the earthquake,and in other words, was a latter group. Early groups often felt anger at latter groups, asking why they evenbothered to show up at such a late stage, whereas latter groups came in with a slightly naive attitude of trying todo their best now. To avoid this type of unnecessary discord and mutual harm, latter groups must pay theirrespects to early groups, and follow the support procedures established. This phenomenon is thought to be a
distinctive feature of the tribal mentality of Japan (Tohoku region).
－153－III. Mental changes in children
The symptoms that occur in children can vary according to their developmental age, which must be kept inmind when considering the mental care of children in disaster situations1). Generally, infants are highly sensitive
to changes in their environment and exhibit symptoms such as crying or not sleeping. Children in puberty are in
the process of developing the skills to accurately mention what is occurring to themselves and can have reactions
similar to an adult. In the period between infancy and puberty, in other words, elementary school children canexhibit various reactions. Nearby care workers have the role of both providing direct support to children andreducing uncertainty by providing specific responses to their parents.
Some children exhibited developmental regression immediately following the disaster2). Developmental
regression is effectively returning to a child and is frequently observed in clinical pediatrics, where children who
have experienced scary or difficult times regress to earlier developmental stages. Observations included babbling,
asking for hugs from parents, being afraid of the dark, and not being able to be alone. These are usually temporary
reactions, so parents must observe these calmly, and confidently provide a sense of security to these children. Careworkers explained to the supported adults that “it is not an abnormal reaction, but rather a normal reaction to anabnormal event”.
Children who were scared but endured during the early stages of the disaster sometimes began to show reactions
when adults calmed down. There were many behaviors that children conducted to draw the attention of adults.
Particularly in the case where younger siblings were present, some children tried to get their parents' attention bycompeting with their siblings. Some children developmentally regressed after some time, those who intentionallysought to be yelled at by lying or being violent, or some who even tried to curry favor by helping and contributing.
Parent-child relationships can worsen if parents do not understand this psychology, so it was necessary to provide
objective feedback for the phenomena that were occurring.
As cognitive functions rapidly develop with time, the seriousness of the individual’s experiences is gradually
self-recognized. When the uncertainty of when and where another similar event can occur takes hold, theindividual can no longer make decisions for the future and feels that fun activity is wasted if not enjoyed thenand there. Observations of children immediately using all of their allowances, prioritizing the things they like,and finishing their lunch without concern for other children were all observed. Children can no longer behave inan age-appropriate manner, and this was interpreted as rebelling against their parents. This often resulted inrebelling against the parent at home and getting into trouble with other students at school. Significantly deviant
behavior often received strict punishment, when what was needed was advising the child to express their deeply
buried traumatic experiences and to empathize with their feelings.
IV. Mental changes in parents
It was thought that there were particularly significant psychological changes in parents who raised children
with developmental disorders. Hearing surveys with families indicated all mentioned the importance ofconnecting with the region. In cases where the developmental disorders of the child are mild, families rarely took
the initiative during normal periods to inform their surroundings on their conditions, but during emergency
periods this situation flipped and it was necessary for their surroundings to understand the family’s situation. It
is difficult to have something that was not conducted during normal periods to function during emergency periods
and these families directly experienced the importance of developing networks during normal periods. Children
with disabilities often live together in regions, and it should be anticipated during normal periods as to what kindof support they will need. There was an increased need for welfare services such as after-school care following
the earthquake, and this is thought to be the changes that were needed during normal periods.
There were some remarks that a support book was necessary. Many children with developmental disorders
already receive daily treatment from a family doctor who is already informed on the upbringing and－ 154 －characteristics of the child. However, these children were exposed to lifestyles to which they were not habituatedafter the earthquake and many experienced physical symptoms such as loss of appetite or vomiting. Furthermore,these children were not always able to receive treatment from their family doctor under these circumstances, andit was often the case that they would receive treatment from dispatched doctors who were not familiar with thesituation. It was thought that a support book would allow doctors who encounter these children for the first timeto understand the child’s characteristics, and smoothly conduct treatment.
It is possible to reflect on consultation and hospital sites during normal periods. The current status in Japan issuch that there are insufficient numbers of specialist doctors who can respond to developmental disorders3). It is
often the case that families in regions with few specialists need to travel far from their homes to visit specialist
doctors. When considering the development of a child in a local region, it is thought that strengthening theconnections with nearby generalist doctors is important in addition to faraway specialist doctors. From themedical side, it is thought that it is more important to strengthen the response capabilities of a wide range ofgeneral pediatricians and psychiatrists against children with developmental disorders, rather than developing
specialist human resources.
V. Conclusion
Various preparations are useful during disasters, but not every event that occurs can be dealt with bypreparation alone. When disasters at the scale of the Great East Japan Earthquake occurred, the organization
itself that manages communities falls apart, and it takes time before standard regional mental health care systems
are restored. Creating networks composed of various professions and regions that are resistant to disasters during
normal periods allows for the development of the strongest methods of disaster prevention.
References
１） Nagamitsu, S. ： Somatic symptoms commonly seen in children. Fujimori, K., Maeda, M.(editors) ：Disasters and children’s stress. Seishin Shobo, pp.24-27, 2011.
２） Fukuchi, N., Hayashi, M. ： The current mental status of children in the disaster area. Psychiatria etNeurologia Paediatrica Japonica 51, 126-132, 2011.
３） Tanaka, H. ： The current status of training projects for child psychiatrists in Japan [in Japanese].
Children’s body and mind 17, 131-135,2008.
Note) Original text－155－