Mental Health Service Reform Post-Disaster

On March 11, 2011, a magnitude 9.0 earthquake struck northeast Japan, followed by a powerful tsunami that in turn caused a nuclear disaster at the Fukushima power station. Hospitals and clinics were destroyed, and injured individuals had very limited access to health care services after these events. The nuclear disaster posed both immediate and future threats; there was great uncertainty about the risks associated with the nuclear fallout and the effects of the contamination of homes and towns in the Tohoku prefectures. The disaster affected the mental health of individuals in the region and throughout Japan, spreading fear and concern.

Turning the lessons of disaster into opportunities for positive change is the challenge of the next decade for planners of mental health services in Japan. The triple disaster destroyed much of the health and mental health infrastructure of Tohoku and has provoked a reconsideration of the current mental health system. So much tragedy and destruction create a unique opportunity to replace an old system overly dependent on inpatient services and lacking in community mental health resources in comparison with other nations using a more modern, evidence-based system. This paper presents a framework for thinking about future development of mental health services in Japan, now that the emergency has passed. It reports on lessons from earlier disasters, describing the range of possible approaches to building an improved mental health services system.