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2016年8月16日 (火)

A new guideline for psychological support after disaster is needed during the long-term period, not only the acute period after disaster

Since Kobe earthquake in 1995, I have been studying effective psychological support for children after disasters. For mental health care after the Great East Japan Earthquake, our country's psychiatric and medical teams have chosen to use –Psychological First Aid: PFA (2006) as their guideline. PFA (2006) contains excellent principles and methods for the acute phase.

 National Child Traumatic Stress Network and National Center for PTSD2006: Psychological First Aid. Filed Operations Guide 2nd edition.


I have two questions about PFA since we have been supporting children after disasters.

1. about disaster prevention education

  2. about expression of disaster experience

I will quote one paragraph in the guideline “Psychological support for children after disaster” published by Ministry of Education, Culture, Sports, Science and Technology in Japan (MEXT), edited by a famous child psychiatrist.


 “If not enough time has passed since disaster occurrence, you should not conduct group activities which may remind of traumatic experience. Group activities are evacuation training and talking about disaster experiences. Moreover, you should conduct group activities after the children’s mental health has been stabilized. Furthermore, after checking the recovery situation of the children who have lost relatives or friends, or children with PTSD, you should conduct group activities“. (Psychological support for children after disaster in school, the Ministry of Education, Culture, Sports, Science and Technology, 2014 edition, page 40)


This opinion may refer to “Protect from additional traumatic experiences and trauma reminders” which is written in PFA (PFA second edition; NCTSN, 2006: 32p.).


I disagree with “talking about disaster experiences during group activities” in acute phase too. However, the evacuation drill is necessary so that children can protect their own life from aftershocks. When strong aftershocks continue, you have to teach children how they can protect their own lives. Because, even if it prevents PTSD, if they lose their life from aftershocks, it is meaningless. After Sichuan earthquake in China, some students died from aftershocks.

Kumamoto earthquakes happened on April 14 and 16 of magnitude 6.2 and 7.0. Strong aftershocks have continued for more than two months. The people continued to fear that strong earthquakes will happen again.

We have proposed the combination of disaster prevention education and psychological support after disaster. In the stricken areas, the evacuation drill may cause children to re-experience reactions strongly if the drill is conducted without previous announcement. Therefore the evacuation drill has to be conducted with psychological support. The psychological support consists of the explanation of the meaning of that drill, gradual training, the psycho-education for stress and trauma, and stress management. For example, we tell children that the earthquake destroys houses but the word “earthquake” does not destroy them.


Because PFA described “In addition to securing physical safety, (32p.)” and “Explain the difference between the event and reminders of the event” (140p.), Japanese guideline by MEXT (2014) may misunderstand PFA.


My second question is about the expression of disaster experiences. It may not always be appropriate for care providers to ask victims to talk about their traumatic experiences during the acute phase. However, without having adequate opportunities to express their feelings and thoughts caused by the trauma, victims are more likely to suffer from stress disorders. PFA does not describe this point because it is for acute phase. The risk factors of PTSD are “strong avoidance” and “negative cognition as self-blaming”. Some medical staff in Japan think that it is not good to express and share their disaster experiences during group activities in the classroom for one to two years or more after the disaster.


In the northern part of Japan where Tsunami has repeatedly caused damage in the past, there is a tradition, called “Kataritsugu Bousai,” which means telling stories about disasters and learning from them. In fact, many schools were able to evacuate and protect children from Tsunami properly in March 2011 because they had learned from hearing about the past. Because of it, there are many people in the affected areas who would like to keep this tradition for next generations. Considering such needs and culture, it is necessary to make a new guideline that includes long-term support.


Yoshiki Tominaga

A clinical psychologist and professor at Hyogo University of Teacher Education in Japan.






PFAに関し、私は2つ質問があります。①防災教育に関して ②災害体験の表現について です。

































いま、中国、日本、インドネシア、英語圏の災害後に心理支援・教育支援に従事した方を対象に、インターネット調査:時期に応じた災害後の子どもの教育支援・心理支援 を実施中です。急性期から10年後までを視野にいれた25問からなる活動への賛否とその理由の記述を求めています。関心のある方は、yotomi@hyogo-u.ac.jp までメールをいただければ幸いです。



« View on international guidelines for mental health care after disasters(災害後のメンタルヘルスに関する国際的ガイドラインへの見解) | トップページ | Disaster prevention education and psychological support for children after disaster. »






« View on international guidelines for mental health care after disasters(災害後のメンタルヘルスに関する国際的ガイドラインへの見解) | トップページ | Disaster prevention education and psychological support for children after disaster. »