Unsettled Expertise: Mental Healthcare in the Long-Term Aftermath of the 2011 Nuclear Disaster in Japan

Background and Purpose: A large body of research has explored the importance of mental healthcare in the wake of disasters. However, there is limited research on the experiences of disaster mental healthcare professionals. This paper describes how these professionals respond to various challenges to their expertise in the long-term aftermath of a nuclear disaster.

This paper presents findings from an ethnographic study of disaster mental healthcare in the aftermath of the nuclear disaster in Japan in 2011. After extreme disasters, the Japanese government establishes Disaster Mental Healthcare Centers to address the long-term psychological aftermath of disasters. These centers usually consist of a combination of social workers, nurses, public health nurses, clinical psychologists, physical therapists, and part-time psychiatrists. However, the ad hoc way in which these centers are assembled and plugged into communities as well as the multidisciplinary nature of their staff pose multiple challenges to the expertise of disaster mental health workers. This paper examines the conflicts, compromises, and risks these professionals experience as they learn to negotiate their “expert” roles.

Methods: Ethnographic fieldwork was conducted for 19 months (January 2017 to July 2018) at a disaster mental health organization in an area affected by the nuclear accident in Japan. Thirty-five in depth, semi-structured interviews were conducted with the organization staff and with professionals at other disaster mental healthcare organizations that were recruited through snowball sampling. Field notes were kept throughout participant observation and interviews were transcribed verbatim and analyzed inductively.

Results: Professionals in disaster mental healthcare experience challenges to their expertise in two key interactions: between staff members as well as between the center and the existing healthcare system and communities. Staff members often have different approaches to the same issue. They experience this conflict as a threat to their professional identity, as they cannot carry out interventions according to their professional ideals. Since the centers are newly established after disasters, the staff members also have a difficult time gaining acceptance from the existing healthcare system and communities.

To address these challenges, the staff learn not to insist on their expertise and do everything that was asked of them. They put aside the medical model of intervention and become more open to the local ways of life, until they gain enough trust to act according to their expertise. In the context of a nuclear disaster, this led caregivers to accept the risk of radioactive exposure to provide care.

Conclusions and Implications: The professionals at the Disaster Mental Healthcare Center face multiple challenges to their expertise. Openness to other expertise and community immersion become key for successful interdisciplinary and inter-organizational collaboration, both between staff members and across the existing healthcare system. Training for healthcare professionals could include working in communities and multidisciplinary teams, to allow them to become acquainted with the guiding principles that drive other professional fields, tailor their expertise, and adjust expectations to the practice context. Further research is required to address the ethical implications of social work in a context of environmental exposure.