UCSF Experts Aim to Provide Mental Health Services in Japan

More than a dozen Japanese physicians and research fellows who have come to UCSF for medical training and to conduct research have expressed interest in learning how to provide mental health counseling.

Families take shelter in Japan. Photo courtesy of Save the Children Canada.

When they return to Japan, their aim is to help relief efforts in the ongoing crisis triggered by a massive earthquake and tsunami on March 11, although some hope to provide help online from the United States, too.

John I. Takayama, MD, MPH, a UCSF pediatrician who worked in Tokyo from 2002 to 2007, where he established the Department of Interdisciplinary Medicine at the National Center for Child Health and Development, leads the effort. Key organizers include Craig Van Dyke, MD, director of the global mental health program, who responded to the 2008 Sichuan earthquake in China; and Mary-Ann Shafer, MD, vice chair of professional development and associate director of adolescent medicine. 

Widespread Mental Health Suffering

During pediatric grand rounds at the UCSF-affiliated San Francisco General Hospital recently, Takayama reviewed the scope of the crisis and ongoing relief efforts. Many types of relief services managed by the Japanese government and non-governmental organizations have begun to operate more smoothly in recent days and weeks, but mental health suffering is widespread among people in affected regions and has been receiving less attention, according to Takayama. Children are especially vulnerable, he says.

There are plenty of sources of ongoing stress, beyond traumatic events experienced during the initial disasters. Large numbers of people are in shelters. Uncertainty persists about the dangers posed by the crippled Fukushima Daiichi nuclear reactors. On Tuesday, Japan declared the Fukushima Daiichi crisis a Level 7 event on the international system for rating nuclear accidents, putting the incident on par with the 1986 Chernobyl disaster in the former Soviet Union. 

People also are affected by the electricity and gas shortages and concerned about the safety of food and water. The economic impact of the disaster is great.

Takayama notes that it is especially important for parents to be attentive and patient with their children at such times of stress, even as they themselves may be struggling to take care of basic needs in an ongoing crisis situation. Being patient with an upset child may seem to conflict with needs of the larger community; parents in shelters want to keep their children quiet so that they do not disturb others. Some government employees are dedicating many hours to the relief effort while relinquishing parenting to grandparents and other adults, Takayama said.

It is important to recognize common reactions and sources of stress during a disaster, Takayama emphasized. He introduced the guiding principals for parents and other caregivers – listen, protect and connect – outlined in a pamphlet by UCLA psychologist Merritt Schreiber, PhD. 

In the wake of a disaster children often worry about family members, friends and pets. They worry that disaster may recur. They become confused about their own safety and the safety of parents or other caregivers, and they worry about becoming separated from caregivers. 

Common signs of a stress response include decreased concentration and attention; changes in sleep, appetite or mood; depression, psychological withdrawal and temper tantrums. Individuals, especially children, who have witnessed people die or become severely injured, or who have been trapped in damaged buildings or by debris for any length of time, or who have lost homes or other things held dear are especially vulnerable to stress, according to Takayama.

In Japan there is stigma associated with mental health concerns, Takayama explained. Individuals often feel guilty or ashamed about discussing psychological pain, although they may understand very well what they are feeling inside. Because mental health issues come up less often in medical practice, even seasoned physicians may be unable to distinguish a stress reaction to an immediate disaster – a normal response – from post-traumatic stress syndrome (PTSD), a lingering stress reactivity that persists after the immediate threat is gone. One of the aims of the training Takayama is organizing is to help physicians and other volunteers improve their response to individuals who may be vulnerable to PTSD.

There also is a stigma associated with exposure to radiation. Those who are exposed may be shunned. Some individuals displaced from Fukushima are already being discouraged from seeking refuge in other prefectures, Takayama revealed. Children displaced by the disaster may be subjected to bullying as the school year begins this month.

Despite the stigma, some Japanese who are affected by the crisis are going online to ask questions about baffling psychological or psychosomatic symptoms. Japanese physicians at UCSF have noted questions like, “Why can’t I stop shaking,” “How can I relax,” and “How can I make these feelings go away.” Some women are worried because they have stopped menstruating – a response to severe stress, Takayama described.

Takayama, together with Van Dyke and Shafer, are developing a series of public service announcements (PSAs) for professionals in Japan on how to effectively address such queries. UCSF will post these PSAs on its website and YouTube when they are completed.

Takayama is next scheduled to deliver grand rounds about the crisis in Japan on Thursday, April 14 at 8 a.m. in the UCSF School of Nursing, room N 217, on the Parnassus campus. His talk is titled "Early Lessons and Current Concerns."

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