When TELL outreach organizer Saya Tanahara, 34, returned home to Okinawa in 2019, she was looking for an opportunity to help those with experiences like her own.
“It’s a very typical Okinawan girl’s story,” Tanahara recalls while sitting in TELL’s Okinawa offices near American Village in Chatan. “I married a Marine, and we lived in the States for about six years. Then I came back as a single mother of three children.
“I wanted to contribute to the community here. TELL seemed like a great opportunity to use my experiences — as an Okinawan and as someone who had experienced military life — to help people.”
TELL is a nonprofit counseling and mental health service that began in 1973 as an English-language version of Japan’s Inochi no Denwa suicide prevention hotline. In 2018, five years after receiving nonprofit organization certification, TELL opened a branch in Okinawa to serve the mental health needs of the military population. They now have two offices on the island.
As TELL’s outreach organizer in Okinawa, Tanahara is using her specific background to make inroads with local communities — a task that comes with a unique set of challenges.
“People (in Okinawa) generally don’t know how to ask for help,” she says. “We didn’t grow up discussing mental health. In our culture it’s like: ‘Suck it up — don’t show your emotion.’
“There’s also a wall between the military and local communities that needs to be overcome.”
Tanahara says the stigma against seeking therapy in Okinawa and Japan is compounded by the tendency for mental health service providers to over-medicalize care.
“Providers think: We’re gonna solve everything with (individual) psychiatry, so there isn’t so much community involvement,” she says. “We organize events like walks and other Western approaches, and they don’t understand what we’re doing. They expect seminars in a formal setting. I’m trying to increase community accessibility — that’s the purpose of outreach.”
Be wary of big expectations
While Tanahara attempts to make inroads with the Okinawan community and immigrant families, the large population of U.S. military personnel in Okinawa means a majority of those using TELL’s services there are connected with the military.
Psychotherapist Kari Fager, 36, is originally from Oregon. She came to Okinawa with her husband, an active-duty U.S. Marine. With TELL Okinawa, her practice focuses on providing mental health care for English-speakers connected with the military.
“A lot of the people who come here (with the military) have big expectations, and then it’s very different from what they expected,” Fager says. “They don’t speak the language or know the culture, and just knowing where to get help here is one of the biggest obstacles.”
Despite the challenges, Fager feels the varied backgrounds of patients, clinicians and volunteers offers a real opportunity for learning for everyone involved.
“One of the beautiful things about TELL is how much we learn,” she says. “All of my training was in the States, then I took a course here where most of the clinicians were from Japan and other Asian countries. Patients’ nonverbal communication styles can be very different.
“Each clinician is different, but we want to see the patient as a whole person and meet them where they are in life. Our approach needs to be nuanced because we may be misreading things based on our cultural background.”
As an organization, TELL is divided into three pillars: Lifeline, Counseling and Outreach.
The organization works with licensed therapists and clinicians who meet with patients in-person, over the phone and online. Their team of highly trained volunteer support workers man the phones as well as volunteer at the many community events they organize as part of their community outreach.
Those who want to become Lifeline support workers undergo thorough training and an apprenticeship before taking any calls. About two-thirds of those who apply make it through the initial screening and 10-week training course. This ensures the volunteers taking calls are committed and well-prepared to handle sensitive — and sometimes life-threatening — situations.
Even Tanahara, now a full-time outreach coordinator, decided she wasn’t ready the first time she attempted to become a volunteer support worker.
“At the time I was going through a lot, personally,” she recalls of her first attempt at support worker volunteer training. “When I talked about things I just felt so sad. So I stepped back.
“Those doing the training understand that each of us has experiences that make us feel emotional — that’s totally natural and OK.”
A growing public presence
Despite Fager and Tanahara’s efforts to provide care and raise awareness about mental health resources in Okinawa, they admit there’s still a long way to go. One of the biggest obstacles is the shortage of qualified clinicians who speak one of the many languages TELL offers services in.
“We’re trying to grow our presence in the local and immigrant communities here through outreach while servicing the growing needs of those connected to the military, but our clinic is always busy and the waiting list is piling up,” Tanahara says. “Our clinicians are overwhelmed by the demand, so we definitely need more licensed clinicians.”
Fager thinks general misconceptions about what therapy sessions involve can prevent people from seeking the help they need.
“Ideally, we want to support you and help you heal so you can move on. If you don’t want to talk about something that’s fine,” Fager says of her practice. “You may not want to uncover all those deep dark secrets. Good clinicians want to meet you where you are at emotionally. You are always in control of your story, there’s no pressure.”
Fager sees her work with TELL as an essential part of improving social relations in Okinawa.
“If we can help those in the military be as healthy as they can be, that’s my effort at peacemaking between these two communities.”
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