"It's been four years since the Great East Japan Earthquake, but the hearts and minds of many of the victims have yet to heal. Local government officials who are struggling on the front lines are in especially serious condition," said Masaharu Maeda, a senior professor at Fukushima Medical University.
Maeda has been president of the Japanese Society for Traumatic Stress Studies since 2010, and saw a health report released in January last year detailing the well-being of officials working for a local government in Fukushima Prefecture.
At first, he could hardly believe the results of the health survey in the report. The region is still reeling from the heavy damage caused by the nuclear disaster, and based on the assessments of a range of specialist doctors, about 15 per cent of employees were diagnosed with depression and around 9 per cent were said to be at risk of suicide.
This was quite severe, as the prevalence rate of depression typically hovers at around 2 per cent.
"Pressed by the suffering of the citizens, these local government officials are locked into seemingly endless working hours. They're actually victims themselves. Unable to see what's ahead, they're being tormented by a sense of futility," the 55-year-old professor explained.
As a psychiatrist, Maeda supports local government officials based in disaster areas. He often hears such complaints as "I can't do this anymore" and "I want to quit," and works together with these patients to find solutions.
Maeda built up experience at Kurume University Hospital, based in Fukuoka Prefecture, and looked after people affected by the crash of a passenger plane during takeoff at Fukuoka Airport in 1996.
He also cared for people affected by the collision in 2001 involving the Ehime Maru high school training ship and USS Greeneville submarine.
But the massive earthquake that rocked Japan far eclipsed such incidents.
In a town that was completely engulfed by tsunami, residents stared blankly as they had been robbed of their livelihoods. "I remember thinking my past experience was useless. But I realised, now is the time when I have to do something," Maeda said.
He immediately kicked off plans to support psychiatrists and patients around the nation. In 2013, he responded to an opening at Fukushima Medical University for a lecturer in "mental health support for those affected by natural disasters."
Maeda was appointed the first senior professor of the course and moved to the prefecture. He visited local governments around the prefecture by car, racking up more than 20,000 kilometers on the road in one year.
During his childhood days, Maeda decided to become a psychiatrist after wanting to understand his father better. As the sole survivor of a suicide battalion, the man would sometimes suddenly lash out at the family. But his father only revealed his history almost 50 years after the war.
One of the main goals in therapy is to rationally face the struggles of the past so patients can move forward. To do this would require a great deal of time, as Maeda learned from watching his father.
"In the wake of earthquake disasters, it's easy for those with wounded hearts and minds to be left behind. I hope to support the people of Fukushima with long-term, specifically tailored treatment," said Maeda.