Discussion

An elderly female evacuee compelled to leave her home in a location threatened by a nuclear radiation, who had also lost her husband shortly after the Fukushima disaster, presented with dementia and displayed severe trichotillomania. Following stints in various temporary accommodations, the supportive relationships she had established with fellow evacuees disappeared after each relocation. ^{Reference Sekiguchi, Hagiwara and Sugawara7}

Lifting of evacuation orders is obviously related to restored personal freedom and choice of residential location. ^{Reference Murankami8} However, the lifting of evacuation orders has varying impacts on evacuees. Japanese government policies focus on rapidly rebuilding disaster-hit communities based on past experiences, even though circumstances are completely different for nuclear accidents as compared to natural disasters such as earthquakes or tsunami. ^{Reference Maly, Santiago-Fandino, Sato and Maki5} It is important to focus not only on the speed of recovering but also on the reality of returning home. As Maly pointed out, being able to return home, and the problems or benefits that may bring, are directly related to the cessation of valuable support mechanisms, such as temporary housing provision and compensation payments. ^{Reference Maly, Santiago-Fandino, Sato and Maki5} The health of returnees could improve after returning home, or it may worsen, depending on variable circumstances. ^{Reference Murakami, Takebayashi and Tsubokura3} The mental health of vulnerable populations, such as the elderly, is particularly at risk, especially so if they are prevented from returning home against their wishes and if there are no family or community support networks available. It is thus not surprising that suicide rates in local populations increased following the lifting of evacuation orders in Fukushima. ^{Reference Orui, Kuroda and Yasumura9}

As already mentioned, evacuees might have difficulty establishing relationships with their neighbors for various reasons, resulting in extra stress and mental health decline. In this case, it appears that the lack or absence of close family members, in addition to the loss of support networks established in temporary housing, seriously compromised our patient’s mental health. Hori et al reported the importance of evacuees creating stable and comfort new relationships following the 2011 triple disaster. ^{Reference Hori, Morita, Yoshida and Tsubokura10} Another report confirmed that social support and neighbor ties have been important for safeguarding the mental health of residents in the aftermath of the Fukushima disaster. ^{Reference Midorikawa-Inomata, Inoue and Ishiguro11} Sekiguchi et al reported that social isolation worsened among people who moved to newly built permanent housing from prefabricated temporary housing, but did not worsen among people who remained in prefabricated temporary housing. ^{Reference Sekiguchi, Hagiwara and Sugawara7} Prefabricated housing comprised interim, relatively insubstantial structures that were comparatively uncomfortable or irritating for occupants because of noise, inadequate air conditioning, and other factors. However, they have the advantage that “psychological distance” between neighbors is reduced, as all occupants face the same basic predicament. In comparison, rebuilt housing stock re-establishes any physical or mental barriers between neighbors that may have existed previously—barriers and isolation that may multiply or increase in the post-disaster environment. This case highlighted the necessity for deeper understanding of the complex and interrelated factors affecting evacuees.

In summary, lifting of evacuation orders is important, allowing individuals to return home and attempt to rebuild their lives and livelihoods. However, depending on the circumstances and personal characteristics, returning home can either improve or harm the physical and mental health of evacuees. With respect to vulnerable groups, especially the elderly, the latter would appear more likely. This is because their loss is comparatively greater, with age-related physical decline, lost support networks, inadequate infrastructure, and possibly dangerous environments making their future prospects somewhat bleak. All of these interrelated factors need to be carefully considered and quantified in order to ensure that future post-disaster policies and strategies are best suited to safeguard or create optimum improvements in both physical and mental health.