With emergency measures of some kind covering about 70% of the population, a surge in COVID-19 variants and a glacial vaccine rollout, Japan remains mired in the coronavirus crisis, even as other nations in the Organization for Economic Cooperation and Development (OECD), such as the United States and Israel, declare the global economy is “turning the corner.” It’s a situation that is exacerbating the country’s mental health troubles, experts say.

Still mid-disaster

More than one year on from the government’s first emergency declaration, the population is still subject to the same — if not greater — pandemic-related stresses and government-imposed measures implemented to contain infections. And with the country’s fully vaccinated rate among the lowest in the world at just over 3%, compared with top-runner Israel at about 57%, Japan’s outlook looks tough.

“I think a lot of us feel like we’re in a dark tunnel and going and going — and we don’t know when we’re going to come out at the end,” Resilience’s Sachi Nakajima says about people’s emotional response to the pandemic.

The founder of the nonprofit organization, which supports women affected by domestic violence, says humans have fundamental needs: to feel safe, to have hope, to stay connected and to belong. COVID-19, like any trauma, has made fulfilling those needs seem out of reach, leaving people feeling unsafe, powerless, confused or out of control. Powerlessness in particular can be detrimental to mental health, leading to “a lack of motivation, persistent low mood or depression, difficulties managing emotions and insomnia and unpleasant dreams.”

Any trauma, such as experiencing a natural disaster, will induce a “traumatic stress response,” says Vickie Skorji, director of TELL Lifeline, a nonprofit counseling service. But a prolonged trauma like COVID-19 is unprecedented, and its long-term impact on the mental health of the population is therefore unknown.

“In the 12 months following a disaster we typically see 15% to 20% of the population (in Japan) struggling with moderate mental health issues … but we’re still in (the disaster),” she says.

Globally, many are experiencing similar challenges to their mental health, which may be exacerbated by the degree of crisis and mental health service preparedness locally.

“Mental health is closely correlated to the extent of COVID-19 deaths and stricter confinement measures,” says Shunta Takino, junior counselor at the OECD. These incidents can result in a decrease in “social connection, financial stability, employment, exercise, access to services and routine,” the “protective factors” that strengthen a person’s mental health, and an increase in “risk factors” including “fear, grief, isolation, uncertainty, unemployment, poverty and inequality.”

So, what is causing Japan’s decline in mental health?

Additional risk factors for Japan include a lack of understanding of mental health among the population before the pandemic, Takino says. This may lead to people’s inability to seek or find appropriate help in a timely manner. In a 2019 survey by The Policy Institute and King’s College London, only 24% of respondents in Japan agreed that “seeing a mental health professional is a sign of strength,” placing the country lowest among 19 OECD countries. Mexico scored highest, at 81%.

Skorji, who has a master’s in counseling from Monash University in Australia, says the “stigma and shame around mental health issues is much greater in Japan,” which results in people feeling less able to speak out about it.

Disproportionate burdens

Since the onset of the pandemic, youth and women have been predominantly affected, as demonstrated in the uptick of suicides in those demographics in the past 12 months. Data from the National Police Agency reveals that nearly 15% more women took their own lives in 2020 than in 2019, and, according to Dr. Haruka Sakamoto, assistant professor in the department of health policy and management at Keio University, almost 500 elementary, junior and senior high school children committed suicide in 2020, the highest number in any year since 1978.

Sakamoto attributes the increase to economic and social reasons.

The main industries affected by pandemic-related closures were hospitality, retail and tourism, which are predominantly staffed by women, causing 740,000 women to lose their jobs last year, compared to 320,000 men, she says.

The closure of schools and nursing homes has also increased the burden of work on women. Women in Japan reported a 25% to 30% increase of time spent on chores in June 2020 compared to before the pandemic in a survey by NLI Research Institute. Men reported only a 10% to 15% increase.

Youth, meanwhile, have been hit with financial insecurity due to the loss of part-time jobs or parents being newly unable to support their education, as well as reduced social interactions, loneliness and difficulties studying online, Sakamoto says.

The total number of people who took their own lives in 2020 also exceeded the previous year, marking the first year-on-year increase in more than a decade. But experts are quick to explain that assessing the extent of mental health issues needs to go far beyond looking at the suicide rate.

“There’s a lot of research on suicide, but suicide is an outcome of an illness that is not treated,” Skorji says, pointing out that there is not enough awareness in Japan of mental health issues or how they can be treated. “With any illness, getting treatment sooner rather than later is best,” she adds.

According to Takino, countries need to improve all the data they gather on mental health — not just suicide rates — for a better understanding of their populations’ needs. In Japan, he adds, more should be done to monitor trends of anxiety and depression, two of the most common mental health conditions.

Since the outbreak of COVID-19, Japan has seen greater incidences of both anxiety and depression, as well as greater “general mental distress,” he says. Prevalence of symptoms of depression across the population was recorded at 17.3% from March to April 2020, up from 7.9% prior to 2020, according to OECD data.

In July 2020, symptoms of depression were seen most in those aged 20 to 29, at 31%, followed by those aged 30 to 39, at 24%.

Nicolas Tajan, president of the International Mental Health Professionals Japan, which specializes in psychotherapy, counseling and psychological assessments, says his colleagues have seen a significant increase in care requests since the start of the pandemic. He notes that these requests could be merely the tip of the iceberg.

“The mental strain on the population is underestimated because there are many people suffering who we do not see,” he says, pointing out the prohibitive cost of counseling in Japan as it is not covered by national health insurance. Given the close correlation between lower socio-economic status and mental health issues, it is possible that those in most need are not able to receive it.

Skorji also notes some new and relatively unknown groups facing difficulties: A third of those infected by COVID-19 report ongoing mental health issues — often due to guilt of transmission — and medical professionals are burning out.

Data-driven solutions

As more becomes known of how the pandemic is affecting mental health, policy makers are working to find better solutions. In February, for example, the Japanese government introduced a minister of loneliness to his Cabinet.

Takino says the global crisis could be an opportunity to make much-needed progress in addressing mental health.

“We’re having this society-wide discussion on mental health. Let’s think of how we can capitalize on the momentum … and translate it into policy change,” he says. By doing so, society can be better prepared to support mental health not just in the face of a crisis, but in the everyday, too.

If you or someone you know is in crisis and needs help, resources are available. In case of an emergency in Japan, please call 119 for immediate assistance. The TELL Lifeline is available for those who need free and anonymous counseling at 03-5774-0992. For those in other countries, visit bit.ly/Suicide-Hotlines for a detailed list of resources and assistance.

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