Protecting the public from Psychological harm
We have significant evidence that the survivors of nuclear emergencies, and other emergencies, can have difficultly readjusting
life after the event and that their quality of life can be severely reduced.
Professor Shunichi Yamashita claimed in an
interview
that “We know from Chernobyl that the
psychological consequences are enormous. Life expectancy of the evacuees dropped from 65 to 58 years --
not because of cancer, but because of depression, alcoholism and suicide. Relocation is not easy, the stress is
very big. We must not only track those problems, but also treat them. Otherwise people will feel they are just guinea
pigs in our research”.
More locally the Fire Service is starting to recognise that there are "opportunities to improve the broader outcome of a fire, in terms of its immediate impact
and during the often lengthly post-fire period. An example is the emerging focus on the need to better consider the emotional or psychological
experience of a fire, the effects of which can be just as devastating as physical injuries" (David Wales, "Do no harm" - improving outcomes of a fire
through casualty centred care, Fire Times August/September 2015)
Similar stories are emerging from Fukushima with the
Lancet
reporting a number of deaths of hospital patients and elderly residents of nursing facilities during and shortly after the evacuation
and
media reports
of mental health issues resulting in higher than expected rates of suicide.
There are two distinct populations to be concerned about in the aftermath of a serious nuclear emergency these are:
(1) Those who are relocated from the area and are forced to restart a new life elsewhere, and
(2) Those who continue to live in the area after the accident and have to come to terms with radiation contamination all around them.
These two groups will experience different stresses but, evidence suggests that both can suffer quite bad non-radiological effects post-accident.
It is not easy, from the Fukushima reports, to unpick the effects of the Tsunami and the effects of the relocation from the effects of the radiation but that might be to miss the point.
We can understand that people's contentment would be affected by a forced move and that others might be very unhappy living in an area where
they fear that they are surrounded by an invisible killer, that the food they are eating is
contaminated as are the playing fields and schools their children use. Being bombarded with a mass of information and misinformation from the internet and broadcast media
is probably also unhelpful.
A
Lancet Report (Series I, Paper 2) Notes that
relocation, displacement and changes in living environment can all have negative impacts on health with elderly people seeming to be most affected.
Tensions include families and communities being separated due to different views on the potential for harm (they cite for example, mothers of young children wanting to move
for the sake of their children, whereas the fathers might be reluctant to do so), friction between evacuees and residents of evacuation destinations which is seen to
increase with time because of the undefined time period of the evacuees stay, population increase and increase in land prices, conflicts arising from different levels of
govenment compensation and restrictions,
and mental and physical
changes in the residents as a result on the changes to their lifestyle. It is reported that post-traumatic stress disorder (PTSD) and other mood and anxiety
disorders doubled and people had statistically significantly lower subjective ratings of health.
Many of these pressures would seem to be common for any evacuation cause but some are unique to
radiation contamination issues.
The reports of stigma and self-stigma coming from Fukushima and Chernobyl may be less usual in the aftermath of disasters. Examples of this include young women
worrying that they might be less desirable as wives due to concerns about effects of exposure on their future children. Studies have shown that self-stigma leads
to rightous anger, loss of self-esteem and indifference and is reinforced by public stigma. The Lancet calls for the development of counter measures for public
stigma to prevent affected people from further harm.
For the people who stay in the area or return to it within days or weeks of the accident the main issue is coming to terms with the contamination in the environment
and, maybe, restrictions on what you can do in the area. You might be advised not to grow your own food in your garden or collect wild food such as berries and
mushrooms. There may be areas that are closed to the public due to radiation levels. Children may be limited to a certain maximum time
playing outdoors. There may be damage to the environment due to agressive decontamination
efforts and friends and colleagues may have moved out. Media coverage may not help.
A headmaster from the Fukushima area, when justifying removing topsoil from a playground
was quoted as saying
"Most of the parents here were adamant
that we did this, even though the government keeps saying there is no risk".
It will always be difficult to convince people about the safety of an area affected by a nuclear emergency.
The phenomenon of psychological harm is not restricted to nuclear contamination but is shared, to a certain extent, with the chemical industry. A
WHO
publication from 1997
notes "the adverse responses to a toxic exposure includes ...... effects on mental health arising from real or perceived releases,
which depend on the psychological stress associated with an incident".
There is generally support to groups affected by floods and similar events in the UK
(see for example LGA press release)
but this support tends to be practical or
financial.
Any response to a major release of radioactivity must, from the very start, concern itself with ensuring the long term psychological resilience of the community.
So what can be done?
It is clear that we must:
- Seek to reduce the trauma on the day of the incident as this has an impact on PTSD
- Seek to convince those remaining in the area that the dose levels are so low that health effects will be negligible.
- Seek to repair communities that have suffered dislocation and migration.
- Seek to reduce stigma and self-stigma.
- Monitor and support affected populations during and after the event.
An
IRPA
paper from 1996 concludes that
Non-radiological protection factors as public anxiety and risk perception will play a legitimate role in the decision making.
These factors should be addressed by the decision maker and not the radiation protection community. The optimisation of overall health protection
is thus the responsibility of the decision maker. It is a great importance that the decision maker present the protection strategy to the public in a
transparent way so that all factors and their relative importance in reaching an optimised strategy are revealed. If the countermeasure decisions
are to be based on radiological aspects and public perception then a lot of responsibility is placed on the decision support system and on the final decison maker. The
decision support process would have to include advice from experts in the fields of social and psychological sciences and probably have to monitor public perception and
media and social media on the day.
A recent IAEA paper
EPR Public Communications Plan advices that national response arrangements should
Describe the arrangements for monitoring and responding to concern, anxiety, distress and
inappropriate actions on the part of emergency response workers and the public. Specific
consideration should be given to monitoring for potential rumours (including those on social
media) in real time, and arrangements should be made for responding to them quickly and
forcefully to avoid further confusion and a lack of trust in the responding organization.
There is a body of literature describing Psychological First Aid (PSA) such as the World Health Organisation (WHO) publication
Psychological first aid: Guide for field workers which
explains that psychological first aid (PFA) describes a
humane, supportive response to a fellow human being who is suffering and who may
need support". It outlines behaviours from responders that may help those affected and may be useful reading material for people manning Reception Centres and phone
help lines.
This work is based on responses to conventional disasters so does not contain the element of "radiation dread"
(See Slovik, "The Perception Gap: Radiation and Risk" for
a classic paper in this field)
that will be apparent in the aftermath of a major
radiation leak but it is a good place to start.
Another interesting idea comes from paragraph 116 of a report by the House of Commons Science and Technology Committee
Scientific advice and evidence in emergencies
Third Report of Session 2010–11 which states that: "A difficulty in risk communication is the difference between a “natural science”
perspective and that typically held by a lay audience. Overcoming this is not merely
a matter of explaining the science in lay terms—important though this is. An
important difference is that scientists usually define risk in terms of effects on
populations, while the lay audience is concerned with individuals. In addition,
scientists usually will accept the existence of a causal link only once there is good
evidence for it. Until then, links are “provisionally rejected”. The lay view is much
more likely to entertain a link that seems intuitively plausible, and only reject it if
there is strong evidence against".
Thus if we crunch the numbers and say something like "If you believe that low levels of radiation are harmful and accept the
risk coefficients used by ICRP then there is only a 1 in 10,000 of anyone in the most exposed group being harmed" what can be heard by the public is "unless
you are one of the lucky ones, you will have been harmed."
It is very easy to loose the trust of the public. See, for example the Nature article
Japan's nuclear crisis: Fukushima's legacy of fear" which reports the
efforts of volunteers, mostly researchers, who informally call themselves Fukushima Saisei-no Kai
(roughly translated as the Fukushima revitalization association), who work together to monitor and help clean-up the area around Fukushima. A spokesman for this group is quoted as saying
“Since 11 March, people haven't trusted scientists who receive funding from the government. They trust people who act
without government funding and who work together with them. Nature claims that
The roots of mistrust can be traced to the confusing days immediately after the explosions, when authorities made a series of inconsistent statements,
issuing radiation readings that often turned out to be incorrect. As radioisotopes spread from the plant, the government was repeatedly forced to raise its recommended safety limits for radiation exposure to citizens and workers — otherwise, it would have been legally required to evacuate the site immediately. As a result, some Japanese people believe that the government is corrupt; others think it is incompetent.
The prevailing feeling is that “what the government says always changes” .
A recent ICRP draft paper on the
Ethical Foundations of the system of Radiological Protection concludes that
Recent developments have suggested enlarging the aim of the system of radiological protection to the individual and collective well-being of exposed people to
include mental and social aspects. It claims that this is prticularly relevant for the management of post-accident situations.
There is some useful research going on in this area. For example a small study by Essex County Council
(here).
An interesting and useful website from the disaster Action charity can be found (here). This is focussed on dereaved
and survivor support.
A sign that psychological harm is much more recognised is the
Manchester Resilience Hub set up in 2017 to
support those affected by the Manchester Arena attack in May 2017. The service, which is for
Useful references
1. Psychological first aid: Guide for field workers (WHO)
2.
Expert guidelines: Diagnosis and treatment of post-traumatic stress disorder in emergency service workers (Austrialia)
3. UK Psychological Trauma Society
4.
Humanitarian Welfare Guidelines, Psychological Care (Kent Resilience Forum)
5.
NHS Guidance
6.
ICRP Draft on Ethical Foundations of the System of Radiological Protection.
To be developed ....
If you have any views on how to support communities post-nuclear accident then please contact infoweb1@katmal.co.uk.
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