Mental Health Challenges in Japan and How TELL Helps

Today, we're happy to share with you our interview with Evan Burkosky, who sat down to talk with us about TELL, an NPO dedicated to providing effective support and counseling services to Japan's international community. 

Aside from being a member of the TELL board, Burkosky is the Japan Country Manager at Dynamic Yield, helping brands deliver and test personalized, optimized digital customer experiences.

What is the history and background of TELL's work in Japan?

EVAN BURKOSKY: TELL has actually been around for quite a while. I believe it was originally founded in 1973. And it's one of the longest-running NPOs when it comes to dealing with mental health issues in Japan. It's important to make the distinction that TELL is the English lifeline and English consulting services, and it's targeted at the foreign expat community who are located in Japan. 

Originally, it was affiliated with a church group, but it has now grown to be an NPO with various revenue streams.

So, to break down the organization, there's the suicide prevention hotline. People who are experiencing distress, who are concerned, or who feel like they need to talk to someone, they can call into that lifeline. 

There are multiple operators, volunteers who staff that lifeline. We try to keep it running as much as possible. It's not quite 24 hours right now, but that's always been the goal: to keep it running as long as possible so anyone can speak with one of the operators and get assistance. 

In addition, since  2017 we also offer chat support which younger users - those aged 30 or below - prefer to use.

And then, if somebody would like to have long-term, ongoing consulting, there are the clinic services where individuals can go in and speak with a counselor until their issue is resolved. 

What sparked your interest in TELL's work and your desire to work with them?

BURKOSKY: I believed that I could help because my career has been in the digital field, and I'm currently assisting with TELL's digital transformation. 

For example, we have just finished rebuilding the website architecture behind the scenes. Also, I didn't lead this project, but a complete re-build was done of the telephone systems onto the Cisco Webex Systems, which were graciously donated (the cost was reduced by Cisco). And this was to allow operators to work from home. 

Previously, there had been a dedicated, secure phone line and phone booths, and they had to go into the office. But now, with the shift to a more digital infrastructure, our volunteers are able to assist with the calls from a home environment that's carefully regulated so that it maintains privacy and security issues. That's part of the digital transformation that's been ongoing. 

Timothy Langley, our current Chairman, invited me to assist with this mission. And I felt that it would be a good application of my skills to do so. 

From a more personal standpoint, I feel that I've reached a point in my career where I have the time to assist with this. Also, I've had some friends who've experienced distress and needed these counseling services. A close friend from my early twenties passed away fairly recently, and that was part of the personal drive—the personal mission to try and help people who are experiencing this type of distress. 

As someone who has a background in marketing, what can you share with us about how TELL is spreading the word of its existence? 

BURKOSKY: Our Communications Coordinator, Emily Brown, runs our social media and website content strategy. We create quite a lot of blog posts, webinars, and online seminars, and those are shared across Facebook, LinkedIn, and Instagram. I would say Facebook and LinkedIn being the most prevalent because they're the most relevant for the bilingual foreign community. 

We had an existing website architecture and the design was created relatively recently; it's only a couple of years old. However, the underlying architecture was a little bit out of date. It was overly heavy. There were plug-ins and Java scripts that had been deprecated but not removed. 

Without changing the look of the website, I went in and helped rebuild the architecture so that it was much lighter and it would load much faster, especially on mobile devices. This will naturally improve the organic SEO, the search engine results of this site, and we're hoping that we'll get much better search results and higher discoverability through this. 

And the next would be to look at more paid ongoing SEO and SEM campaigns. We do have some paid campaigns. There's a small advertising budget, and we're looking at trying to make that more efficient. 

You mentioned earlier the primary services that TELL provides, but are there any lesser-known services that you would like to see featured?  Or that the expat community here in Japan would benefit from being more aware of? 

BURKOSKY: It's quite important to raise awareness for the counseling services. The lifeline itself has been running for a long time, so there's good recognition of the phone services, but I don't think that many people know about TELL's counseling services. 

The counseling services are the actual clinics where you can go in and meet over multiple sessions with a counselor. That service began in 1991 and has recently expanded to provide services to people located virtually anywhere in Japan with several locations and Teletherapy capability, so I don't think that awareness is where we'd like it to be. 

And then, in addition, there are multiple ways that people can help contribute to TELL's mission. So, there are fundraising events. We have, for example, the Step Up Challenge. Of course, we are a little bit disrupted in terms of organizing those kinds of charity events now, during Covid, but on the website, there are webinars, there are seminars, there are interviews, and quite a few different resources that I think are very useful. I encourage everybody to check out the website for those lesser-known types of content.

And these counseling services, are they paid services?

BURKOSKY: They are. They are often subsidized by a person's workplace. Actually, a large part of TELL's clientele is the foreign military stationed in Japan, and so there are some military budgets that help with compensation. 

Another thing I wanted to raise awareness about is that there are also corporate counseling services available. You can have a counselor virtually run sessions for your workplace. So if you'd like to raise awareness about overall mental health in the workplace, or run a series of seminars, or if there has been a distressing event at your company, you can have a counselor set up virtual calls to discuss that with your staff. 

It's usually a group or seminar-style. But depending on the needs, it could be one-on-one as well.

Would you say that mental health where you are from is viewed differently than here in Japan? 

BURKOSKY: Yes, I think that there's a huge difference. We actually find that the expat community in Japan is affected by mental health issues that also affect the Japanese populace. There seems to be almost a transmission of that mindset. 

Where I'm from in Vancouver, Canada, I think that awareness of mental health issues is quite high. 

There are a lot of counseling services, and it's not uncommon for people to go for counseling if they've had an accident or a distressing event or something like that. Marriage counseling, couples counseling, and those sorts of services are prevalent. 

However, in Japan, I don't think there's much awareness of it. It's not really a part of the culture. It seems that Japanese culture is more がまん. Do your best to work through it yourself, or only discuss it with family or maybe close friends, rather than going and getting professional help. 

That seems to be one of the reasons why there's a distressingly high suicide rate in Japan. It's actually the Number 1 cause of death for people in their teens through their 40s. 

That culture seems to infect the foreign populace as well when they come to Japan. There could be a lot of factors for that. We don't have comprehensive data that explains exactly why, but anecdotally speaking, it seems logical that the culture of suffering in silence is not a good answer to the problem. 

People, of course, when they come to Japan, often feel isolated, like they don't have someone to talk to, they don't have their support network of friends and family from back home, and then they come to a culture where it's not encouraged to talk about problems. So those feelings tend to be internalized, and those problems manifest themselves in negative ways. 

To summarize, I would say there is a huge difference in awareness and acceptance, and willingness to talk about mental health issues between Canada and Japan. In Japan, there is a much higher level of stigma and shame surrounding the topic of mental illness which creates a barrier to speaking up and accessing services and support.

Does TELL provide advice to employers about how to encourage mental health for remote work employees?

BURKOSKY: That would be part of the corporate counseling services that I briefly discussed earlier. Because of the increasing remoteness and the isolation that people are feeling, mental health issues have been drastically spiking during the pandemic. Since early March last year TELL has been providing workshops and information about the challenges of COVID-19 and how to build resilience. In 2011 in conjunction with the International Medical Core, TELL developed psychological first aid training for Japan and rolled this out in Fukushima, Iwate, Miyagi and Sendai. This was later embraced by the Japanese government in best practice for responding to disasters. Going into COVID-19 TELL knew what the likely impact would be on everyone's mental health and were able to provide support from day one.

That’s a good example, actually, of one-on-one counseling where you would have a remote employee, who maybe has some distress, to have the company set up a one-on-one session with a counselor probably over a Zoom call or having them call into the counseling clinic phone number—as it would be difficult to meet in person because of the current lockdown, and so on. 

How is TELL tackling privacy and security in the age of Zoom counseling? 

BURKOSKY: That's a good question. Initially, at the start of the pandemic, we had to explore those options quickly. We looked at all available call services, Zoom and Skype, and so on, and unfortunately, there were security issues with many of the common providers. The Lifeline uses Cisco, but the Clinic benefits from Google Meet through GSuite. We have a BAA with Google, our clinicians have received professionally accredited training for online sessions and we use a purely HIPAA (https://digitalguardian.com/blog/what-hipaa-compliance) compliant portal for record keeping.

The Webex System is secure, and it meets both privacy and security and hackability needs that we had set up. 

Regarding TELL's corporate-style seminars, do you also provide resources or books, or do you have a recommended book list for employers that they can go through? 

BURKOSKY: I would direct employers to the website and the blog. There's a huge database of posts on the TELL website blog. There isn't a library of books that are listed on the site, but the counselors themselves could make book recommendations. And in some of the blog posts, there are links to resources and further studies as well. 

But as part of a program that could be created for a corporate user of the counseling services, essentially a curriculum can be put together with recommended reading included. 

Any thoughts on how employees can advocate for themselves when working for a Japanese company? 

BURKOSKY: Having worked as the only foreigner in a Japanese company at a previous job, I can relate. There's a lot of pressure to conform to the Japanese way of doing things. And it's difficult if you're having difficulty conforming.

There usually isn't a structure at a Japanese company to talk about this, nor much empathy in 人事部（じんじぶ）or HR department to meet the needs of foreign workers, unless it's quite a large organization or a multinational organization. 

For this reason, I would recommend, first of all, looking outside of the company to an organization like TELL. In fact, most of the calls and most of the counseling services are geared toward employees who are having a hard time at their current company because there isn't the necessary structure.

Recently, the topic of "taking a mental health day" has been in the news. But doing that here in Japan would be difficult to do. Do you have any advice for a person who is struggling with their mental health at their job in a Japanese company?  

BURKOSKY: I would encourage them not to try and take that on alone. It would be too difficult for somebody to do by themselves if they are already experiencing distress. It would also be good for companies to take the lead and hold workshops on stress,  mental health, and how to speak to someone who might be struggling. The wellbeing of employees is crucial to the success of any organization, and post-COVID this will be more important than ever.

If it’s difficult for them to have this conversation with their employer then I think it would be helpful for them to utilize the structure of an organization like TELL. To have them reach out, discuss with the counselor the strategy, and either have the counselor arm them with a talk track about how they can raise this issue, or have the counselor engage in that conversation with them, or have them recommend to the HR department that they talk with TELL's counselors about providing their counseling services for corporations. 

But I think the number 1 thing is to reach out and get help. Especially if you're already in a difficult situation, if you're already stressed out and having trouble, it may be too difficult to try and have this conversation with a traditional Japanese company alone. 

That's good advice. Thank you. Anything else you'd like to say about TELL and mental health here in Japan?

BURKOSKY: It's important to talk about the awareness of services like TELL as there isn't much awareness. In fact, even as recently as a month ago, I saw a conversation on the Tokyo English Network Facebook group, which is a support network for expats living in Tokyo. 

And in that group, somebody asked where there were counseling services available, and several resources were discussed—mostly traditional paid clinics. Somebody mentioned TELL in one of the threads and said, "Oh, it's just a phone number that you call. They don't have counseling services," and that's factually incorrect.

But this seems to be the recognition of the wider community in Tokyo. I was able to find that thread and join in. And the original poster was happy to hear that TELL actually does have counseling services. So I think it's important to raise awareness. 

Perhaps an important point left to address is how to raise awareness around TELL and its services.

And in answer to that, TELL is actually quite active both on the website and on the blog in creating a lot of content, and in seminars and events, and also on social media. So, by all means, follow the TELL Facebook page, Instagram page, and LinkedIn as well. And try and share and repost that information as much as possible so that we can raise awareness. For example, we have our upcoming Step Up Challenge which is a great way to raise awareness about mental health. Join the TELL 2021 STEP UP Challenge by walking 21,081 steps in honour of the 21,081 lives lost to suicide this year: https://telljp.com/tell-step-up-challenge-2021/