Health and Global Policy Institute (HGPI) Associate Mr. Kai Shigeno contributed a column titled “Make Preparations for a Disaster Mental Health Support System” to the regional government newspaper, Jichi Nippo.

In the article, Mr. Shigeno described the key characteristics of the field of disaster mental health, issues facing it, and concrete solutions to those issues. The issues discussed were based on “Assessing the State of and Examining Future Approaches to Mental Health and Welfare Support Systems at Local Governments,” which the HGPI Mental Health Policy Project team conducted as part of the FY2021 Ministry of Health, Labour and Welfare Project for the Promotion of Comprehensive Welfare for Persons with Disabilities (Third Stage); as well as a public symposium the team hosted in October 2022 titled, “Mental Health Support in Times of Disaster – The Ideal Form of Supporter Collaboration From Emergency Response to Continuous Response.”

An English translation of Mr. Shigeno’s column is provided below.

Health and Global Policy Institute (HGPI), the organization to which the author belongs, is a non-profit, independent, non-partisan think-tank that was established in 2004 with the mission of “Achieving citizen-centered health policy.”

In an FY2021 study conducted by HGPI that aimed to assess conditions surrounding systems for disaster mental health, healthcare, and welfare support in place at local governments, we discovered that mental health support provided during periods of non-emergency is insufficient. We also found that the regular personnel transfers and siloed organizational structures that are characteristic of governments are hindering efforts to provide mental health support in times of disaster.

In one community that experienced the heavy rains in the Kanto and Tohoku regions in September 2015, the local government devoted a specific section to managing evacuation centers. That section had to completely suspend normal operations, but this ended up delaying recovery and reconstruction efforts in the community. Based on those experiences, for future emergencies, the local government decided to split duties related to evacuation center operations among its entire staff. Later, when responding to a typhoon in 2019, every department worked together to respond to the disaster while also carrying on with normal duties. Mounting a response in this manner makes it possible to increase the number of personnel who can respond to disasters while reducing the impact of regular personnel transfers. It also enhances crisis management capabilities and improves coordination practices across the entire local government by expanding the scope of duties that individual staff members understand and have experience with.

Japan has experienced frequent disasters in recent years, and its local governments have steadily gained experience responding to emergencies. While this has improved their response capabilities, only making general improvements to local governments’ disaster response capabilities will not be sufficient for ensuring they are prepared to respond to the unique challenges in disaster mental health. Recognizing this, to mark World Mental Health Day on October 10, HGPI held a symposium for raising awareness toward disaster mental health with people living with mental disorders and other multi-stakeholders. At that symposium, we deepened discussions on the seamless support systems that are needed to maintain daily living after disasters and help people take steps toward recovery. During that discussion, it was pointed out that mental health issues are diverse and require personalized support. Because damage varies among people and homes, we reaffirmed that supporting mental health support in times of disaster means providing support that meets the needs of each individual. This highly-individualized nature of disaster mental health support makes it difficult for governments to provide. Two solutions offered at the symposium were to make effective use of and share disaster case management practices, and to create face-to-face relationships that include the parties most affected. We must sort issues facing disaster mental health support that have been seen in past disaster responses in a systematic manner and set our sights on solutions that can be applied nationwide. Furthermore, recognizing that interest in these disaster mental health issues is not limited to Japan, HGPI published a multilingual translation of “Lessons and Future Implications of Disaster Mental Health Support in Japan: Reflecting on Disaster Responses in Communities From 1995 Through 2020” on its website.

However, both the previous example and building face-to-face relationships are premised on the condition that support will be provided by a limited number of team members who can undergo training and hold meetings many times in advance. Because disasters lead to unpredictable situations, I believe the goal should be to enable consistent standards for the level of response at all times regardless of the situation, time, location, and personnel involved.

One mechanism for overcoming such issues is the Incident Command System (ICS), which has been adopted overseas and in the field of medicine. Regardless of the situation type or scale of disaster, ICS provides standards regarding roles and content of responses needed in emergencies using shared rules that anyone can implement to establish chains of command. Some countries are working to introduce ICS nationwide. For disasters that cause complex, widespread damage, like Nankai megathrust earthquakes, having a shared set of rules will facilitate support from other countries. There are also high expectations for ICS to be utilized effectively when dispatching disaster support within Japan, regardless of the dispatching party.

Building face-to-face relationships in preparation for disasters is an extremely important perspective, but the nature of disasters means that the face-to-face relationships we build during periods of non-emergency are not necessarily the ones we will encounter during an emergency. Even for a country with vast experience in disaster response like Japan, in addition to face-to-face relationships, establishing rules that can be followed even when those faces are not visible and building systems for providing highly-personalized support will make it possible to have multiple layers of preparation for crises in disaster mental health.