Months after Japan's devastating earthquake and tsunami, mental health experts say the psychological effects of the disaster might only now be coming to the surface. Phone counseling services are building up their presence along Japan's northeast coast for fear of increased suicides and other mental health problems.
As excavators continue to clear the wreckage along the Tohoku coastline, the physical impact of the tsunami is still clear to see. But as reconstruction efforts proceed, there is growing concern over the mental scars the tsunami has left behind.
More than 430,000 people were forced into emergency shelters. Homes were destroyed. Communities cut off.
The phone counseling service ‘Inochi no Denwa’ in Sendai, one of the worst hit cities, is beefing up its services to deal with an anticipated rise in the number of calls.
Kazuko Demura, the organization’ chairwoman, said, "Immediately after the quake and tsunami everyone was really scared. On the telephone, everyone said they were frightened, especially people with existing mental health problems. For example, in the shelters they can’t sleep, they have no medication, so their mental health is getting worse and worse."
Fallout from the nuclear plant in Fukushima prompted a Japanese farmer to hang himself.
Local media say a government worker killed himself in April, as did a father who had lost his daughter. There are fears the trickle could become a torrent.
Japan already has the highest suicide rate in the world - at more than 30,000 deaths per year for the last 13 years.
Several months since the tsunami, the mental effects are still great, said Demura.
"People are beyond the sadness,” she said. “They feel guilty about surviving. People gradually calm down, but they often have flashbacks and the tsunami becomes a trauma for them. Then they start to worry about the future."
There are still remarkable examples of the Japanese stoicism that has drawn so much admiration.
Ryuichi Suzuki carefully waters the pot plants outside his new home - a pre-fabricated unit quickly erected on some waste ground in Sendai. His family home on the shoreline was washed away without a trace by the tsunami. Suzuki and his wife spent two months in a school shelter before being given this house.
"There is no point in thinking about the things I lost’” said Suzuki. “I had better forget about it all and think about the future. I guess I will live for another 10 or 15 years, so I want to get over this disaster,” he said. “I’m going to live with positive outlook. I’ll do my best."
Suzuki said he’s happy with his temporary new home. It has a roof and walls, he said, and even a high-tech electric toilet.
"My first hope is that the Japanese government will compensate me well for my losses, for my house,” he said. “My second hope? Let me see… I hope to get a camper van. When it's cold, I’ll go somewhere warm. When it’s too hot, I’ll go to a cooler place, he said. “Like a sunflower, I’ll follow the sun."
Across this region, advertisements on buildings, buses and taxis implore the Japanese people to ganbarou - or rise up and meet the challenge.
Counselors at 'Inochi no Denwa' say that mentally, many of the survivors still are struggling to deal with the events of March 11, which changed their lives forever.