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Psychiatria et Neurologia Japonica Vol. 124, No. 12 (2022), pp. 839-848

Community Support Needs Assessment after a Major Disaster: Insights fromthe Activities of the Miyagi Disaster Mental Health Care Center
Naru Fukuchi1,2), Shusaku Chiba2–4), Mitsuaki Katayanagi2), Akiko Obara5), Hidekatsu Shirasawa2,6)

Natural disasters have occurred frequently in Japan, and in recent years, recognition of
the need for psychological support for residents affected by those disasters has been
increasing. A public health perspective is needed in supporting disaster victims, and in manycases, support roles are taken on by local municipal offices, public health centers, andmental health and welfare centers. However, when the community as a whole has
experienced severe damage, sufficient support cannot be provided by existing mental healthservices, and a “mental health care center” may be established. In Japan, six mental healthcare centers have been established since the Hyogo Prefecture Mental Health Care Center
was established following the Great Hanshin–Awaji Earthquake, and efforts have been
made toward the mental health care of disaster victims. During the Great East Japan
Earthquake in 2011, Miyagi Prefecture suffered widespread damage. The Miyagi Disaster
Mental Health Care Center, established in December of the same year, has provided mental
health care for disaster victims over the course of about 10 years. This study presented
seven years of activity statistics, from FY 2013 to FY 2019, of the Miyagi Disaster Mental
Health Care Center. The total number of support cases was around 6,000–7,000, increasingover time until 2015, after which it decreased. The several years after the earthquake disasterinvolved many home visits for residents, who were extracted from screenings, and therecords showed an increase in the number of residents who independently came to theCenter seeking support. Additionally, the most common illnesses among those with mental
illness were F1, F2, F3, and F4 in the ICD-10, with these four diseases accounting for amajority each year. The data showed an increasing tendency over time of F3 cases that
occurred after the earthquake disaster. The issues faced by residents leading to support andcommunity needs from support organizations changed depending on the reconstruction
phase. Support organizations needed to carefully observe changes in the community andprovide timely and necessary support. Continuous human resource development is neededat the national and prefectural levels, while keeping in mind medium- to long-term support
following a disaster. Health authorities must also understand needs depending on therecovery period by analyzing the activities of mental health care centers across the country.

Index terms:

Great East Japan Earthquake, mental health care, mental health care center, outreach

Author affiliation: 1) Department of Psychiatry, Tohoku Medical and Pharmaceutical University2) Miyagi Disaster Mental Health Care Center3) Department of Child Psychiatry, Iwate Medical University Hospital4) Faculty of Education, Graduate School of Education, Tohoku University5) Miyagi Mental Health and Welfare Center6) Tohokukai Hospital
Date received: August 19, 2022
− 39 −

This study aimed to provide an overview of theactivities of the MDMHCC and compile the activity
content over time to examine the ideal form ofmental health activities in the medium- to long-term
recovery following a large-scale disaster.

Introduction
Natural disasters, such as earthquakes and floods,
have frequently occurred in Japan, and thesedisasters have various effects on the mental andphysical health of residents. Psychological support
following emergencies has come to be referenced
under the common term of “mental healthcare” since around the time of the 1995 Great
Hanshin–Awaji Earthquake. In the current mental
health system of Japan, disaster psychiatricassistance teams (DPAT) engage in efforts in theacute phase immediately after a disaster. Subsequentmedium- to long-term support is provided byexisting community mental health services. In casesof damage that goes beyond the capacity of existing
mental health services, a “mental health care center”
may be established. Mental health care centers are
not organizations based on a legal foundation; they
are often funded by private organizations fromnational reconstruction funds on an emergency basis
and serve the function of supplementing the mental
health services in the prefecture.
Six mental health care centers have been
established to date, each conducting distinctive
activities. Management policies are entrusted to eachprefecture, with different organizations having
different management policies.
The Miyagi Disaster Mental Health Care Center(MDMHCC) has been engaged support activities in
the mental health field in the disaster-affected area
for approximately 10 years).
Figure 1 shows the number of consultations related tomental health in Miyagi Prefecture before and after theearthquake disaster. The overall number ofconsultations increased after 2011, and the MDMHCC
has mostly overseen these increased numbers of cases.
Many years have passed since the establishment of the
MDMHCC, and as the status of recovery in thecommunity has changed, the content of support
needed from the MDMHCC by each local governmentand related institution have also changed.

1. Background
Discussions on establishing a “mental health carecenter” began in early May 2011, during meetings ofmental health medical professionals held regularly at
the Miyagi Prefectural Office immediately after theearthquake disaster. In July, stakeholders submitted
a request for securing financial resources to the
Ministry of Health, Labour and Welfare of Japan. In
September, ecided that the established organization
would be entrusted to the Miyagi Prefecture Mental
Health and Welfare Association. By December, the
MDMHCC opened, using a room in a multi-tenantbuilding near the Miyagi Prefectural Office as a baseof operations. In April 2012, this room wasestablished as the Stem Center. The Ishinomaki
Regional Center and Kesennuma Regional Center
were established in the Ishinomaki Joint
Government Building and Kesennuma Health andWelfare Office, respectively, with operations startingin earnest approximately one year after theearthquake disaster.
Figure 2 shows the changes in the number of
MDMHCC staff. The scale of operations was small at
first, with only seven staff members when the
MDMHCC opened. The number of staff increased
gradually, and by the time of full-scale operations in
April 2012, the MDMHCC had 30 full-time staff (16 at
the Stem Center, 10 at the Ishinomaki Regional Center,and four at the Kesennuma Regional Center). Staff
members were people from many different professions,
including psychiatrists, psychiatric social workers,
public health nurses, clinical psychologists, nurses, andoccupational therapists. Of the 30, 10 were from outside
Miyagi Prefecture.

Table Mental health care centers in Japan
January 1995
October 2004

March 2011

April 2016

Great Hanshin–Awaji Earthquake (magnitude 7.3)
・Hyogo Prefecture Mental Health Care Center established in June 1995
・Reorganized and added research and medical functions, still operating today
Niigata Prefecture Chuetsu Earthquake (magnitude 6.8)
・Niigata Prefecture Mental Health and Welfare Association Mental Health Care
Center established in August 2005
・Concluded activities in March 2015, after 10 years of activities
Great East Japan Earthquake (magnitude 9.0)
・Miyagi Disaster Mental Health Care Center established in December 2011
・Iwate Prefecture Mental Health Care Center established in February 2012
・Fukushima Mental Health Care Center established in February 2012
Kumamoto Earthquake (magnitude 7.3)
・Kumamoto Mental Health Care Center established in October 2016
Psychiatria et Neurologia Japonica Vol. 124, No. 12 (2022)− 40 −

(cases)Number of support cases

35,00030,00025,00020,000

1,034

1,763

1,977

2,038

6,347

6,236

7,135

1,257

2,262

2,607

18,387

17,182

16,670

2012

2013

2014

6,671

7,122

1,772

2,218

17,836

15,87816,162

2015

2016

2017

2,340

1,888

10,00010,767

5,000
0

2009

13,6452011

Municipality

Public healthcenter

1,922
6,366

7,589

617

15,000

2,301

2,246

Mental health care center

1,585

20,0572018

Outreach (Ishinomaki district)Figure 1. Number of counseling cases regarding mental health in Miyagi Prefecture before and after
the earthquake(provided by Mental Health Promotion Office, Miyagi Prefecture Health and Welfare Department)(people)

60
1

50

40
Number of staff

1

1
1

25

30

23

23

1

1

1

1

20

22

16

18
13

20

8
6

6

10

0

4

4
2012
Clericalworker

1
1

5

6
2

3
2013
Social worker

3

1

4
2014

Occupational
therapist

8

8

6

5

3
2

2
3

2

1
1

2

1
1

8

7
2015
Nurse

2016
Clinical
psychologist

1

2

7

7

2
3

2
3

8
2017
Publichealth nurse

1

1

1
11

12

2018

2019

Psychiatric social
worker

Psychiatrist

Figure 2. Shifts in the number of staff members at the MDMHCC

The MDMHCC began to build a new organization
while its staff members were not yet fully acquainted
with one another. In terms of job types, psychiatricsocial workers comprised a majority from the firstfiscal year, and since the projects were mainly
characterized by outreach, the recruitment focusedon human resources engaged in community mental
health before the earthquake. The total number ofstaff members peaked at 50 in 2015, after which it
gradually decreased over the years.

Each time a new staff member joined the Center,training for new staff was conducted, and thoroughefforts were made to avoid “multi-disciplinary teams”
where roles are divided according to occupation.
Instead, staff comprised “super-professional teams,”
in which all members have a minimum level ofknowledge and are involved in relationships that go
beyond their job types. This way, they could provide
one-stop support regardless of who comes forcounseling.

Fukuchi et al., Community Support Needs Assessment after a
Major Disaster− 41 −

Immediate functionality was required despite
being an improvised organization, so various
innovations were required for operation. Many staff
members were unacquainted with the municipal staff,
implying a need to build relationships of trust. Teams
were formed in each municipality. The teams
showed commitment to do what they could byvisiting town halls even without any special
requirements. The large number of post-healthsurvey follow-ups was a heavy burden on themunicipal staff, and the MDMHCC began to takecharge of these high-risk individual follow-ups in theform of home visits. Through this physicallyintensive and steady work, the MDMHCC built
relationships of trust with the municipalities.
Municipalities that suffered severe damage also
experienced increased workloads, and staff members
were so busy in some cases that they were unable tocarry out even their normal duties. At the time, even
if a municipality independently recruitedprofessionals to fill their workforce, they had trouble
securing suitable personnel. Therefore, theprofessionals hired at the MDMHCC weredispatched to municipalities in the form of asecondment system. For the Ishinomaki area, whichsuffered particularly severe damage, five people
were assigned as seconded staff members at the timeof the opening of the MDMHCC (one in Ishinomaki
City, one in Ishinomaki Public Health Center, one inOnagawa Town, and two in HigashimatsushimaCity). Seconded staff members worked in theirdestination municipalities for a majority of the time
during weekdays and conducted their duties inaccordance with the instructions of the municipality.
The efforts of these seconded staff members also
played a large role in building the relationships oftrust with municipalities.

1. Subjects
We set as analysis subjects the 47,037 cases(22,883 men, 24,154 women) for whom support wasprovided by the MDMHCC between FY 2013 andFY 2019.
2.

Analysis method
We compiled data from the perspectives of
support method, consultation route, sex and age, anddisease classification. Continuous variables wereexpressed by mean values (standard deviation, SD),and categorical variables were expressed aspercentages. We only presented changes over time.
Statistical analyses were not included.
3.

Ethical considerations
This study was conducted with the approval of
the ethical review committee of the MDMHCC.

III. Results
1.

Shifts in support method (Fig. 3)

Figure 3 shows the shifts in support method.
Resident support was tabulated as “home visits,”“office counseling,” “telephone counseling,” and“other.” “Other” included accompanying patients tomedical appointments, case conferences, andsupport in group activities. The total number of
support cases corresponded to 6,000–7,000, withnumbers increasing over time until FY 2015 when
they subsequently decreased. Beginning in FY 2013,
support by “home visits” was consistently the mostcommon, with 4,400 cases in FY 2015. The
percentage of “home visits” decreased from FY2015,
whereas that of “office counseling” and “telephonecounseling” increased from the same period.

II. Methods

Shifts in consultation route (Fig. 4)
Figure 4 shows the shifts in consultation route.
Some subjects received support through multiple
consultation routes; as such, overlaps were noted in
the data. From immediately following the earthquake
disaster until FY 2019, health surveys of disastervictims were conducted in cooperation with Miyagi
Prefecture and local governments, and a majority ofcases involved “health surveys/all-household visits,”
which provided support to high-risk individuals
identified through this survey. This number showed adecreasing tendency after peaking in FY 2015.
“Requests from administrative institutions,” such as
municipalities and public health centers, increased
over time and peaked in FY 2016. Additionally,“requests from individuals” tended to increase over
time.
2.

We summarized and analyzed data from threecenters, namely, the Stem Center, Ishinomaki
Regional Center, and Kesennuma Regional Center.
We handled the total number of consultation cases
rather than the number of new consultation cases tocompare pre- and post-earthquake circumstances
more easily. When MDMHCC staff members
provided support to local residents, information
about the subject was entered into the businessstatistics system. We used seven years of data fromFY 2013 to FY 2019 to retrospectively examine thecharacteristics of such data. The activities of the
MDMHCC have been ongoing since December 2011,
but an operational structure was not in place at thetime of establishment. As such, detailed data in FY
2012 could not be collected.

Psychiatria et Neurologia Japonica Vol. 124, No. 12 (2022)− 42 −

(cases)
5,000

%
70

60
4,000

40

30

2,000

20
1,000

Home visits

Office counseling

Telephone counseling

2019

2018

2017

2016

2015

2014

2013

2019

2018

2017

2016

2015

2014

2013

2019

2018

2017

2016

2015

2014

2013

2019

2018

2017

2016

2015

0

2014

10

2013

Number of support cases

3,000

Percentage of total numberof support cases

50

0

Other

Figure 3. Shifts in support method(cases)
4,000

%
50

2,000
20
1,000

Administrative Support centers/
supporters
institutions
for temporary
housing, etc.

2013
2014
2015
2016
2017
2018
2019

Healthsurvey/allhousehold
visits

2013
2014
2015
2016
2017
2018
2019

Workplace

2013
2014
2015
2016
2017
2018
2019

Neighboring
residents

2013
2014
2015
2016
2017
2018
2019

Family/relatives

2013
2014
2015
2016
2017
2018
2019

2013
2014
2015
2016
2017
2018
2019

Requests fromindividuals

2013
2014
2015
2016
2017
2018
2019

2013
2014
2015
2016
2017
2018
2019

0

2013
2014
2015
2016
2017
2018
2019

10

2013
2014
2015
2016
2017
2018
2019

Number of consultation routes

30

Medicalinstitutions

Welfareinstitutions

Other

Percentage of total number ofconsultation routes

40

3,000

0

Figure 4. Shifts in consultation route3.

Shifts by sex and age (Fig. 5)
Across all fiscal years, the number of those aged
60 years or older among the total number of subjects
reached 43.4% (20,450 cases). We noted a tendency
for the number of women subjects to increase as theage group increased.

Figure 5 shows shifts by sex and age of thecounselees, excluding subjects with unknown sex orage. In each fiscal year, we noted no large
differences in the number of counselees by sex.

Fukuchi et al.: Community Support Needs Assessment after a
Major Disaster− 43 −

(cases)
1,200

Number of support cases for men

1,000
800
600
400

200

2018

2014
2016

2014
2016
2014
2016

60~69

2018

2018

50~59

2018

40~49

2014
2016

2014
2016
2018

30~39

2018

20~29

2014
2016

2014
2016
2018

<20 years
old

2014
2016
2018

2018

2014
2016

0
≥70 years Unknown
old

1,000
800
600
400

20~29

30~39

40~49

50~59

60~69

2018

2014
2016

2018

2014
2016

2018

2014
2016

2018

2014
2016

2018

<20 years
old

2014
2016

2018

2014
2016

0
≥70 years
old

2018

200

2014
2016

Number of support cases for women(cases)1,200

Unknown

Figure 5. Shifts in the number of support cases by sex and age
4.

Shifts in disease classification (Fig. 6)

IV. Discussion

Figure 6 shows the shifts in the diseaseclassification of counselees. For all fiscal years, “F1:
Mental and Behavioral Disorders owing toPsychoactive Substance Use,” “F2: Schizophrenia,
Schizotypal and Delusional Disorders,” “F3: Mood
(Affective) Disorders,” and “F4: Neurotic, Stressrelated, and Somatoform Disorders” accounted forthe majority of cases. The onset period of these top
four illness categories was classified into “predisaster” and “post-disaster.” The results showed that
F3 cases that developed after the disaster tended toincrease over time.

Research on mental health after a disaster hasreported that few disaster victims independently seek
counseling. Consequently, health authorities must
identify disaster victims with psychological issues
and provide support by going to the affected areas.
Therefore, since its opening, the MDMHCC hasestablished a policy of promoting home visits overoffice visits and developed support accordingly. As
shown in Figure 3, the MDMHCC recorded a
decrease in “home visits” and an increase in “officecounseling” and “telephone counseling” over time.
Psychiatria et Neurologia Japonica Vol. 124, No. 12 (2022)− 44 −

(cases) 600

500

Pre-disaster onset
400
300
200

100

0

0

100

Post-disaster onset
300
200
400

500

600 (cases)

2013
2013
2014 F1
20142015 Mental and2015
2016 Behavioral Disorders 20162017 owing to Psychoactive 20172018 Substance Use
2018
2019
2019
2013
2013
2014 F2
2014
2015 Schizophrenia,
2015
2016 Schizotypal and
2016
2017
2017
2018 Delusional Disorders 2018
2019
2019
2013
2013
2014
2014
2015
2015 F32016 Mood (Affective)
2016
2017
2017 Disorders
2018
2018
2019
2019
2013
2013
2014
2014 F42015
2015 Neurotic, Stress2016
2016 related, and2017
2017 Somatoform20182018 Disorders
2019
2019

Figure 6. Shifts in disease classification by ICD-10
residents contacted may have been biased toward
those who are at home during weekdays. However,even after considering such biases, many older
people are reported, in the Miyagi Prefecture healthsurvey, to be living alone in container-type
temporary housing and that isolation and anxiety
about their future lives are major issues. As such,they may have come to need support owing to thisanxiety9). We also noted many men in their prime
working years between the ages of 30 and 50 years
who needed support. Many of them had financial
problems, such as employment, as their main
complaint, indicating a high psychological burden inthis age group from supporting their households andthe community. Thus, depending on the nature of thecommunity, attention must be given to the isolationof older adults and employment problems ofworking-age men following a disaster.

The results indicated a decrease in the number ofsubjects who needed “home visits” over time and anincrease in the number of residents who
independently sought support and counseling.
Additionally, after the earthquake disaster, Miyagi
Prefecture conducted a large-scale screening throughhealth surveys and all-household visits, focused on
confirming the safety of extracted high-risk
individuals, and worked to support residents. Thissubject group corresponded to the “health survey/allhousehold visits” (Fig. 4), and it accounted for alarge fraction of consultation routes in the beginning
but tended to decrease over time. This trend was
because all health surveys targeted residents
receiving housing support, such as temporary
housing, and the number of residents who became
independent from this support over time increased,with the survey population itself decreasing overtime. Additionally, responses to the survey were
voluntary, and the decrease in the response rate overtime was also thought to be a factor9). From theseresults, we concluded that mental health care forseveral years after the disaster focused on a high-risk
approach by large-scale screening, such as healthsurveys, and that the necessary support for the
extracted high-risk individuals could be provided byoutreach such as home visits.

Regarding the disease classification of thoseneeding support, we found that F1, F2, F3, and F4
accounted for the majority. Many of the F1 cases
were residents with alcohol-related disorders that
predated the disaster. As has also been indicated inother research6),8), disasters do not relate to many
new cases of alcohol-related disorders; rather, thealcohol consumption of existing cases increase anddevelop into problems. Many of the F2 cases wereschizophrenia cases, often developed before thedisaster. A variety of factors were thought to be
involved, including exacerbation by the stress of thedisaster itself, disturbances in what was already afragile lifestyle foundation, and worsened access to
medical care. We observed an increasing tendency

The shifts by sex and age (Fig. 5) showed that
support for higher age groups was higher for both
men and women. Many of the activities of the
MDMHCC occurred during weekdays, and most of
the methods were home visits. As such, the local
Fukuchi et al.:Community Support Needs Assessment after a Major Disaster− 45 −

over time of F3 cases (often depression) thatdeveloped after the disaster. Although theearthquake disaster may not necessarily be themain cause of onset in all cases, there may havebeen a slight time lag before cases were identified.
People were in a psychologically tense state
immediately after the disaster, and as such,
symptoms of depression and anxiety did not
manifest. As material recovery progressed, thetension eased, and the psychological symptoms
then surfaced. Our results indicate a need foroutreach to residents with pre-existing mental
illnesses until several years after the disaster andhighlight the support needs for residents withdepression that developed several years after thedisaster.
This study has several limitations. For one, it issimply a compilation of activity statistics; nostatistical tests were conducted. As such, alldiscussions are simply speculation. The current
tabulation is the total number of support cases andnot the number of people in need of support. The
actual circumstances of the region may not be
accurately reflected. Additionally, the state ofcommunity mental health differs by prefecture,and the changes experienced may not necessarilybe the same in all regions. Next, the local
residents with whom we were involved were only
a portion of the people who needed support, andthe tabulation results may not express thecircumstances of disaster victims as a whole.
Finally, the MDMHCC is not a treatment facility.
We have endeavored to connect individuals toexisting resources in the region to the extent
possible. As such, we have not been able to see
through the recovery of all people in need ofsupport, and we are not able to analyze how ourinvolvement is leading to the recovery ofindividuals.

an early stage and to create an environment where
staff members can securely work.
Additionally, in terms of management, theorganization was established as an emergency
response to a sudden disaster. Thus, all staff
members greatly endeavored to advance theprojects in the same direction. Although highly
motivated, each of the professionals gatheredfrom all over the country had their own strong
feelings, and careful communication for building
a team required a considerable amount of time.
The number of meetings within each department
inevitably increased, and all-staff meetings were
initially held once a month. There was a need toform an organization while unable to accurately
judge the aptitude and abilities of each staff
member. We felt that there was not enough timeto prepare for the activities. This kind of disasteris likely to happen again in the future. Thus, thegovernment should consider training humanresources at the national and prefectural levels
and keeping them in reserve to create anorganization like the MDMHCC.
When the MDMHCC first opened, our focus wason confirming safety through outreach, and wewere engaged in physically and mentally taxing
activities. Staff walked around roadless paths
with a map in hand. The proportion of humanwave tactics decreased over time, and there wasan increasing number of activities that required
professional skills, such as supervision of casestudies and advice on health promotion for theentire community. In other words, the role thatwas demanded of the MDMHCC changed overtime. Therefore, we had to allocate a large amountof our budget every year to training our staff inorder to steadily acquire the skills that we
anticipated would be necessary. We conductedcommunity monitoring according to the recovery
period. We confirmed the necessity of allocating
human resources in anticipation of needs. We also
noted the need to conduct a long-term analysis of
mental health care centers, including the
MDMHCC, to elucidate the community recovery
process and the needs in each period.

V. Recommendations
We would like to indicate precautions in the formof recommendations when attempting similar
efforts as the MDMHCC. At the time of its
opening, perhaps because we had no idea howmuch the MDMHCC would contribute to thecommunity, the national and prefectural
governments had not accurately communicatedthe expected period of activity, and all staff
members were on single-year contracts. It was
extremely stressful to work in a job where we did
not know how long it would last and while our
status for the following year was in jeopardy. As
we continued our activities, we gradually gained
recognition from the community, and in 2020,
which was our 10th year of activity, thegovernment announced that the MDMHCC
would be extended for another five years, for a
total of 15 years, which finally enabled us toenvision on a broader scale. We recognized thenecessity of analyzing the scale of the disasterand mental health care center activities, as well as
the need to provide a guideline, to some extent, at

Conclusion
The issues faced by residents that lead to support
and the needs of the community from support
organizations change depending on the phase of
post-disasterreconstruction.
Supportorganizations for supporters need to carefully
observe changes in the community and provide
the necessary support at the appropriate time.
Many organizations in the community support
disaster victims, and the tabulations of the
MDMHCC are not representative of thecommunity. Therefore, the discussions based on
the tabulations are hypotheses, highlighting theneed for more detailed analyses in the future.
− 46 −