The Making of “Disaster Victim Assistance Program”

The activities of these station have come to an end by April 1995, fulfilling the role of medical service providers by responding to various needs of evacuees.
The majority of evacuees at shelters have moved into temporary housing and there was an increasing need to deal with issues which required long-term effort such as treatment of PTSD. Some strongly insisted that the public health center should take a lead to establish a mental health care system to manage long-term effects of the disaster. However, it was not achievable due to restricted resources.
At the same time, the Great Hanshin-Awaji Earthquake Reconstruction Fund was ready to be formed, and the contents of projects were under discussion. The idea of establishing a “Disaster Victim Assistance Program (DVAP)”, which was independent from local public health centers, emerged. It was determined that the source of revenue for the program would be from the special foundation.

Organization and administration

The center was run primarily by the Hyogo Mental Health Association, and to support their function, advisors specialized in psychiatric health were sent on loan. They committed to work as coordinators. Counselor positions were publicly advertised, including some 40 professionals consisting of clinical psychologists, psychiatric social workers, and nurses.
The annual budget for the center was 300 million JPY; the break down of the total was:
・Operating costs and employment costs: 200million JPY,
・Running costs for group homes and working space for mentally disabled evacuees: 100 million JPY.
　 The project period was from June 1995 to March 2000, which made total of 1.5 billion JPY was provided for over 5 years. This was an unprecedented project in terms of Japanese post-disaster mental health activities.

Service policy and strategies

“Experiences and knowledge from the Okushiri disaster and Mt. Unzen-Fugen disaster did not provide us sufficient guidelines since our activities were exceptional in nature. For some time after the opening, it was as if we were feeling our way in the dark. We just ran the center and made decisions as we went. We had to determine our own roles as well as the roles of our staff members. We began discussing what we could do, what was to be done and so on.”

Based on our intense discussions, following policies were laid out:

1. To fill the gap between government and volunteer organizations.
2. To discover problems using pilot studies.
3. To stay light-footed and focus on early interventions.
4. To improve expertise but not impose it: that is, to give unpretentious services
5. To learn from past mistakes and experiences in order to prepare for and make informative suggestions for future disasters.

Having decided on this policy, the organization found that information from the aftermath of the San Francisco (1988) and Los Angeles (1994) earthquakes proved useful.

Features in our services

Based on the first five years of the services and projects, our services can be summarized as follows:

Flexibility in projects

First, our center has been flexible enough to modify our projects on community based activities over first 5 years. Constant modification in aim and direction of the services was required to a certain extent to effectively run the projects within a given period of time. For instance, each branch of the center was located according to the administrative districts. In Kobe City, there were 6 branch centers in each local public health center in Higashinada, Nada, Chuo, Hyogo, Nagata, and Suma. These locations suffered the most severe damage, based on residence information at the time of earthquake. However, most evacuees relocated to places where the effects and damage of the earthquake were relatively mild. This created a gap between the needs of evacuees and service providers. For some months after, we were able to locate additional branches in Nishi and Kita. Considering the typical bureaucracy of government-administered organizations, this modification was very flexible.

Another example of flexibility is in the area of extended services. Many evacuees moved out of disaster affected areas such as adjacent cities or prefectures. Temporary housing was primarily built in areas where damage was minimal, and it was convenient and practical to start construction. Nonetheless there were space and labor limitations due to the great number of evacuees and the urgency of their needs. In order to resolve this issue, much temporary housing was built outside of the disaster affected areas: within Hyogo Prefecture, Kakogawa City(approximately 1200 households) and Himeji City(approximately 600 households), and in Osaka Prefecture, Toyonaka City, Osaka City, Izumisano City, and Yao City.

Prior to our involvement, there had been some location-related variation and divergence in services. The DVAP decided to offer our mental health services to these areas outside the disaster affected areas. Prior to the initiation of our services at these areas, our center had meetings to adjust what services we offered and how we offered them. As a result, we were to send our staff once a week to Higashi-Kakogawa temporary housing which had the largest population within Kakogawa City. We also placed two of our staff in the Osaka Prefecture with cooperation of Osaka Prefectual Mental Health Center. They assisted evacuees in Izumisano City (Rinku-town; 200 households), Yao City (Shiki area; 290 households), Osaka City Yodogawa Ward (Yodogawa-juhachijo; 334 households), a total of 3 temporary housing districts, until the day they were closed down.

Activity model

The significance of post-disaster mental health services can not be overemphasized. It is important for lay audiences to remove their reluctance to recognize its necessity. If this significance is not understood, then during the recovery period in which survivors are exposed to secondary stressors such as restoration of living environment, mental health service would not be readily accepted by those in need. In order to deliver services efficiently with limited manpower, the target population needs to be identified. We need to examine in what way and how we provide services to develop policies and measures. On the basis of above points, our center has articulated a policy as follows:

These fully considered policies during restoration period have been useful in various post disaster activities, and can be considered universal strategies regardless of political situations or cultures.

Transformation

The DVAP had conducted considerable research and provided information to comply with government measures. Consequently, it was renamed “Institute for Mental Health Care” as a part of Hyogo Research Institute for Ageless Society, which is an affiliate organization of Hyogo Prefecture in April 2000.
Since the Great Hanshin-Awaji Earthquake (1995), mental health needs for disaster survivors have been broadly recognized. Every time disasters or other matters occur, our activities have been referenced. Our organization is not limited to Japan: after earthquake occurred in Taiwan and Turkey, both government sent teams of professionals to our institution in order to learn from our experiences.
We feel our accomplishments are twofold: we have illuminated the importance of post disaster mental health, which had never interested professionals. Simultaneously, we have assisted group home and working space for mentally disabled people. These continuing efforts have helped these people integrate into their communities more easily.