The Japanese have had several severe earthquakes in recent decades, and each one has helped them learn ways to improve their response.

"After the Kobe earthquake [in 1995], we used psychological first aid, rather than the psychological debriefing model as suggested by the Inter-Agency Standing Committee [IASC] guidelines," said Yuriko Suzuki, M.D., M.P.H., Ph.D., of the Disaster Mental Health Section in the Department of Adult Mental Health in Japan's National Institute of Mental Health.

"We learned after the Kobe earthquake how to manage mental health professionals who voluntarily come to the affected area to provide professional help," she said in an interview. "Although this was spurred by their willingness to help, the flood of professionals sometimes caused more confusion than help, as we saw later at the time of the Indonesian tsunami."

The lessons learned from the Kobe quake were also helpful after the Mid-Niigata Prefecture earthquake in 2004.

The Hyogo Institute for Traumatic Stress in Kobe was founded after the 1995 earthquake there and has provided information helpful for psychiatric care after the current disaster.

The Japanese developed guidelines and manuals to coordinate work by Japanese mental health teams from outside the affected region.

In addition, unlike in other disasters, the presence of foreign therapists is unlikely to be of much use because Japan is an advanced country with a well-developed medical infrastructure. Also, language and cultural barriers would complicate their work.

Some outside organizations, like the International Medical Corps (see Japan's Resilience Eases Impact of Natural Disaster), are providing technical and training assistance.

To cite another example, a seven-page bulletin on psychological issues following a radiation event prepared by the Center for the Study of Traumatic Stress at the Uniformed Services University of the Health Sciences has been translated into Japanese.

The Web site of the Hyogo Institute for Traumatic Stress is <www.j-hits.org/english/hanshin_awaji/save/index.html>.