After the disaster, the Daiichi workers had to spend their time off within the Daiichi building or in the Daini gymnasium. Some workers had to respond to the continuous recovery efforts; some employees had no time to return to their home between shifts; other workers had lost their homes and were unable to find a new place to live. They were working continuously, slept on floors or chairs, and were unable to use showers and had to share their linens. The workers had limited variety of food and had been eating canned/vacuum-packed foods for over a month.

Since the disaster, I had imagined the struggles of the workers and had hoped that someone, probably from the government or the electric company, must have been providing ample mental health care to the hardworking heroes. This was not the case, however, and the mental health support system had yet to be implemented. In order to provide mental health support to these workers, Dr. Tanigawa and I agreed to collaborate; on May 6, 2011, I became the first mental health professional to enter the Fukushima plant after the disaster [7].

Upon speaking with the workers, we learnt about their stressors. A significant majority of them said, “I thought I was going to die” and showed a wide variety of posttraumatic stress responses including intrusive flashbacks, avoidance of their plant, hypervigilance toward aftershocks, fear of irradiation, and dissociative episodes. Grief was a major issue in their workplace along with their personal lives. The workers were severely discriminated against and harassed by the local residents. One man said that his neighbors saw him in TEPCO uniform and verbally abused him. Another worker reported that a real estate company refused to rent his family a house; another employee added that his neighbor insulted him for parking his car near the neighbor’s home.

With knowledge of these experiences, we conducted a study 2–3 months after the disaster examining the mental health status of 1495 full-time TEPCO workers (Daiichi, n = 885; Daini, n = 610). The data showed the workers had experienced essentially these four stressors. About half (n = 470, 53.1 %) of the Daiichi and a quarter (n = 153, 25.1 %) of the Daini workers had life-threatening experiences; about two-thirds of the whole group (n = 999, 66.8 %) had their homes evacuated. Two to three out of ten workers (Daiichi, n = 378, 25.3 %; Daini, n = 117, 19.2 %) had high posttraumatic stress responses (PTSR; ≥25 on the Japanese version of the Impact of Event Scale-Revised [8]). In multivariate analysis, those with discrimination/slur experiences, compared with those without, were two to three times more likely to have high PTSR (Daiichi: adjusted odds ratio, 2.17; 95 % confidence interval, 1.43–3.30, p < 0.001; vs. Daini: adjusted odds ratio, 2.70; 95 % confidence interval, 1.47–4.96, p = 0.001) [9].

An in-depth study [10] examined the pathway from nuclear disaster exposures, distress during and immediately after the event (peritraumatic distress; PD), to posttraumatic stress to PTSR. For both Daiichi and Daini groups, PTSR was highly associated with PD (Daiichi: adjusted β, 0.66; p < 0.001; vs. Daini: adjusted β, 0.67; p < 0.001). While most disaster-related variables were likely to be associated with PD (and not with PTSR), discrimination/slur experience was associated with both PD and PTSR (Daiichi: adjusted β, 0.11; p < 0.001; vs. Daini, adjusted β, 0.09; p = 0.005).