Japan shows the way with disaster counselling (trauma recovery care to prevent and reduce PTSD

Japan shows the way with disaster counselling 

Japan Mental Health Professionals Trauma Recovery Care Approach to help people recover and move in their communities and in their lives; and in so doing, prevent and reduce the possible occourance of PTSD (Post Traumatic Stress Disorder) in  'Post '3D' Japan. 

ABC radio report well worth the listen. This is one of the very few positive reports to have gone to the trouble of actually interviewing a mental health professional, in this case by telephone it seems, in Japan who is actually deeply involved in the coordinated efforts of 44 national and regional mental health organizations across Japan. The Japanese psychiatrist who speaks here is Dr Yoshiharu Kim who, as well as being as this report correctly states, the director of Adult Mental Health Department at the National Institute of Mental Health of the National Insitute of Mental Health - National Center of Neurology and Psychiatry is also a leading member of the Japan Society for Traumatic Stress Studies.

The JSTSS has a membership of well over 1000 so when in the early media/well meaning but sometimes misinformed international voluntary groups first wave of reports and statements (some such as the Yomiuri Shimbun erroneous claim that there well less than 20 psychotherapists capable of providing mental health care for PTSD in the whole of Japan and with none supposedly in the Tohoku Region) were washed up from the waves of uncertainty that followed in the first early understandably highly subjective weeks we experienced here after the 3 Disasters of Eathquakes, Tsumani and the 3 Nuclear Reactors Meltdowns, well, then it was little wonder that many of these reports from people who could not speak Japanese and were not in the main people with any expert knowlegde on trauma and PTSD recover training, began bemoaning the misassumed 'lack of PTSD specialists' among the 100,000 + qualified and licensed mental health professionals in Japan. 

This report from Australia's ABC is refreshing as it shows respect for and gives credit to the knowlege and expertise of Japan's mental health profesionals approach to providing the most appropriate and culturally sensitive, careful and caring, professional and community supportive approach in providing help to families, chiidren and individuals in the worst effected farming, fishing and industrial communiites who have suffered the most from the devastion, disruption to everyday life and at times intense sense of insecurity and worry. Accurate, postive and encouraging reports on the work of Japan's tired but tirelessly working excellent and dedicated mental health professionals like this can play their part in allying fears in the mind of people with enough worry about the medium and long lerm effects from the one unnatural disaster of the 3D's, 

Having written that there are just two minorl points that I feel could be clarified from within ABC's report here:

Kate Prideaux says, "But not everyone agrees with the idea. Immediate debriefing has been used in the treatment of the disorder since the 80s and was also used after the September 11 attacks. I think the "immediate debriefing" she refers to was CISM (Critical Incident Stress Debriefing) which was an approach that was used widely in the 80's and was the darling of EAP schemes and MHC in America in the 80's and 90's. This may have had some success in individual traumatic events such as fires and car accident victims. However after 9/11 the scale of the loss of over 3000 lives and the effects on the population of New York was so great that the widespread use of immediate CISD 'crisis debriefing' with people who had witnessed the destruction of the Twin Towers and with people who had lost friends, relatives and colleagues when the towers collapsed actually seems to have had a negative effect on some of the victims and in some cases it has been reported that the added stress of being asked to recall and recount the trauma played a significant part in increasing the distress and increasing the fears, anxieties and feeling of loss of control in their lives to such an extent that I have heard reports of people who experienced panic attacks during and while waiting in turn to be 'debriefed'. 

Also I do not agree with the comment in the ABC report that "two weeks after the Japanese earthquake a report in The Lancet suggested acute intervetion was still the best way to go." I have read that report (which was first published online on March 22nd just ten days after the quake) and there was no suggestion of actue invention. The report was actually in the main on the situation as it was then that, "health and aid workers in Japan face multiple challenges in the wake of the earthquake and tsunami that have devastated the country’s northeast coast". At a time when the aid workers from other countries, who were trying their best to be of help to the people in that very devastated region, and at the same time were trying to get their minds around the immense scale of the the scenes of destructiion that they may very well never have imagined or experienced in their lives beforeof the two natural disasters amid daliy news reports of nuclear plant explosions and dangerous levels of radiation emmission spreading through the region and heading towards Tokyo, can be forgiven if, like the rest of us who have lived here all through that frightening and insecure time in Tokyo and Japan, sometimes let their emotions get the best of their usual reason and so sought to make 'authoriative' statements such as appeared just in one or two paragraphs of a very , "“Children we talk to say that whenever there's a tremor they are scared that something is going to happen”, says Stephen McDonald of Save the Children, which has set up an operations base in Sendai. Children who have been caught up in disasters can develop behavioural and mental health problems unless they receive counselling at an early stage. Left untreated, those initial fears can impinge on their development as adults".

Actually, during that time, whenever there was a tremor (aftershocks actually. of which there were hundreds in the first weeks and months following on from the magnitude earthquake of 11th March and a few of which exceeded the 6.8 magnitude level of the 1995 'The Great Hanshin earthquake', or 'Kobe earthquake' that killed 6,434 people on January 17th, 1995), - well, actually during that time children and adults, Japanese and foreign aid work volunteers, commentators and journalists, bureaucrats and politicians, community psychiatric mental health daycare members (such as the ones with whom I was faciliating our weekly Friday communication group on the 5th floor of a clinic in Ikebukuro when the quake happened at 2.46 p.m. on 11/3/11) and all mental health professionals... well, we all had one thing in common when aftershocks occoured: we were all natrually scared and worried that something was going to happen, and it was only natural to be subjective and feel insecure and make decisions based more on emotional reactions than logic or reason because we were still all still going through what may hopefully turn out to be the most frightening and unsettling time of the lives of those millions of us who experienced it. The disasters were not over at that time, and to some extent we still are living though aspects of the 3Ds: the Tsunami has come and gone but the effects of its destructive power on the lives and communities of Tohoku remain, the first day without any aftershocks recorded did not occour until early June and the nuclear disaster is stll ongoing and not resolved to the satisfaction of the worried heart-minds of the good people of Tohoku and the rest of Japan. So it is little wonder that many early reports of Japan facing massive percentage predictions of PTSD sufferers (groundless predictions as the benefit of hindsight now allows us all now that we have entered a relatively calmer period in the processing and recover stages following disasters of these nature and of one unnatural man made disaster) untreated in a country virtually lacking in any mental health professionals capable of providing psychosocial support and treatment for those who experienced the trauma of the 3Ds. Being afraid. and for many, needing months to recover a sense of emotional and mental equilibrium was/is only natural for all who went through this time in Japan. To support the children and adults who have suffered most grief and lost so much to help them in a measured, calm and healthy way to process the traumatic experinces and leave their fears behind in time is the task that licensed mental health professionals in Japan are addressing now seven days a week. And their dedication and deep committment to help and promote recovery from the truamas and bring peace of mind to all who have been effected by the 3Ds is steadfast and will be enduring until parents and familes of all the children of Tohoku and Japan can will see them smile and laugh, play and sleep peacefully once more. 

Andrew Grimes  - Sunday November 13th, 2011

Kate Prideaux reported this story on Friday, November 11, 2011 12:46:00

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PETER CAVE: This year's devastating earthquake and tsunami in Japan not only scarred the country's landscape but was expected to leave profound emotional scars on its people.

However medical personnel arriving on the scene were discouraged from immediately counselling survivors in the belief that it would not prevent post traumatic stress disorder and may in fact increase a person's risk.

While some saw the approach as controversial a review out this month suggests the Japanese are in fact ahead of the pack.

Kate Prideaux reports.

KATE PRIDEAUX: Within days of the Japanese earthquake and tsunami more than 1000 Japanese medical personnel were dispatched to help survivors.

Teams were issued with a handbook containing parts of Japan's mental health policy and told to counsel only those with existing mental health problems or those displaying obvious signs of distress.

They were told to hold off on counselling the rest.

Yoshiharu Kim is the director of Adult Mental Health at the National Institute of Mental Health in Tokyo. 

YOSHIHARU KIM: After treating the you know, the previously mentally ill people, the mental health teams started to take care of the new victims of the disaster. 

So the staff teams mainly did what we call outreach services. That means they just walked around the refugee camps and villages and just say hello and is there something I can do for you and so on and so on.

KATE PRIDEAUX: Eight months on Kim says hospitals and clinics in Japan have so far seen no increase in the number of patients with depression or post traumatic stress disorder.

The Japanese first adopted the hands-off approach eight years ago and more recently the UN's mental health policy moved in the same direction.

Last week a review from the University Medical Centre Hamburg-Eppendorf backed the Japanese method. It found psychological debriefing in the first hours after a traumatic event does not help prevent post traumatic stress.

Yoshiharu Kim:

YOSHIHARU KIM: Acute intrusive intervention such as psychological debriefing has been proved to be not effective or sometimes harmful to the people. 

So in acute phase we should not touch the deep layer of traumatic experiences of the victims. And such a you know concept of doing acute intervention will cause more confusion than benefit. 

KATE PRIDEAUX: Symptoms of post traumatic stress disorder include anxiety, flashbacks, nausea and nightmares.

But Yoshiharu Kim says only a fraction of trauma victims will develop the disorder.

YOSHIHARU KIM: To have anxiety in disaster situation is a kind of normal response. So most of those anxiety are not the target of medical treatment. It's a natural human response. 

And 80 or 90 per cent of the people have resilience. They can recover by their own will.

KATE PRIDEAUX: But not everyone agrees with the idea. Immediate debriefing has been used in the treatment of the disorder since the 80s and was also used after the September 11 attacks. 

Then two weeks after the Japanese earthquake a report in The Lancet journal suggested acute intervention was still the best way to go.

However many Australian researchers support the newer way of thinking adopted in Japan.

Professor Justin Kennedy from the University of Queensland compared emergency services workers who received immediate counselling after the Newcastle earthquake with those who didn't.

JUSTIN KENNEDY: And we found to our surprise that no it didn't have any benefit and it seemed to interfere with the normal process of recovery. 

KATE PRIDEAUX: In Australia a new treatment called "psychological first aid" was used after the Victorian bushfires and floods and cyclone in Queensland.

Like the Japanese approach it discourages immediate counselling.

Darryl Wade is from the Australian Centre for Posttraumatic Mental Health in Melbourne. 

DARRYL WADE: Really what psychological first aid encourages is firstly to establish safety of the person who's been affected, to provide them with a sense of security, to provide them with practical assistance and also to provide them with information that they need to encourage them to get back to their usual routines. 

KATE PRIDEAUX: But despite growing momentum Wade says more evidence is needed to support the modern approach.

DARYL WADE: At this stage we don't have any good scientific evidence to suggest that it actually works, you know, that it promotes people to recover more quickly or to be more adaptive. 

KATE PRIDEAUX: Japan's experience may just provide the evidence he is looking for.