Department Initiatives① Kesennuma Regional Center, Community Support Division26

Kesennuma Regional Center Activity Report
Kesennuma Regional Center, Community Support Division
Psychiatric Social Worker – Takao Tanno
Introduction
On March 3, 2011, the Great East Japan Earthquake affected a great many people in the Tohoku
region of Japan, causing irreplaceable losses. These individuals still experience difficulties in theirlives. The Kesennuma Regional Center of the MDMHCC was established on April 1, 2012 for the
purpose of undertaking initiatives to support these individuals. Here, we look back on our activities
over the past year and report our accomplishments.
1. Activities During the Founding of the Center(1) Status of the Area in April 2012
The Kesennuma Regional Center began operating one year after the disaster. While theKesennuma area (which includes the city of Kesennuma and the town of Minamisanriku) was the lastplace in the prefecture in which evacuation camps remained, at the time, the relocation of individuals
affected by the disaster to emergency temporary housing was already largely complete. However,
little to no progress had been made on reconstruction work in disaster-affected locations in the area,with not so much as an estimate of when the fragmented rail network would be reopened. While
several reconstructed, temporary shopping districts had been reopened, and hustle and bustle seemed
to be slowly returning most regions that had been flooded still presented haunting vistas of barren
home foundations, speaking softly but powerfully of the extent of the damage.
Table 1: Effects of the Disaster on the Kesennuma Area
Population
Municipality

Casualties
AssociTotal
ateddeathsdeaths

FY 2010
censusDirectdeathsKesennumaCity73,4891,063

79

Minamisanriku Town

17,429589

MiyagiPrefecter

2,348,165

9,530

Housing damage
Missing
persons

Destroyed

Halfdestroyed

Partially
destroyed

1,142

308

8,483

2,552

4,555

20

609

270

3,142

173

1,210

622

10,152

1,616

84,633

147,168

221,903

In the Kesennuma area, 1,751 lives were lost, and even now, 578 individuals are missing.
The damage to housing was also extensive, with more than 20,000 homes affected (Table 1).
(2) Makeup of the Kesennuma Regional Center
The Kesennuma Regional Center began operations with a nine-person team: four full-time staff(two psychiatric social workers, one public health nurse, one clinical psychologist) and five part-time
staff (three physicians, one psychiatric social worker, one clinical psychologist). Psychiatrists fromthree medical institutions in the area were appointed as the President, Vice-President, and Advisor,
allowing us to receive guidance on psychiatry and mental health welfare. Additionally, a part-time
psychiatric social worker and a part-time clinical psychologist were dispatched to the Center two days
per week. Day-to-day work was seen to by a staff of five (four full-time and one part-time staff), but
in June 2012, one additional full-time psychiatric social worker was added, who was then sent as adispatch to the Kesennuma City Health Promotion Division. In September 2012, an administrative
staff member (part-time) was added, and in October, a clinical psychologist (full-time) also joined us,
creating the staff makeup we have today (Table 2).
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Table 2: Kesennuma Regional Center Staff Makeup
April 2012
Full-time
Psychiatrist
0Psychiatric2social worker

Part-time3
1

Public health nurse
Clinical psychologist

1
1

0
1

Total: 9 staff

4

5

April 2013
Full-time
Psychiatrist
0Psychiatric2social worker
Psychiatric social
worker (transferred to1
Kesennuma City)
Public health nurse
1
Clinical psychologist
2
Administrative staff
0
Total: 10 staff
6Part-time
2
0
0
0
1
1
4

(3) Working with Mental Health Care Teams
Prior to the establishment of the Kesennuma Regional Center, the mental health care team had
been continuously conducting support activities. As their work came to a close, we took up part oftheir responsibilities.
At the time, the only support groups active in the area were the Okayama Prefecture PsychiatricCare Center team (Okayama), operating in Minamisanriku, and the Lake Suwa hospital team(Nagano), operating in Oshima, Kesennuma. The Okayama team had already shifted from psychiatricwork, which they had been engaging in during emergency conditions, to activities led by temporary
support staff. We engaged in group work meant to clarify the roles of temporary support staff andlighten their burdens, and we also accompanied them in their activities. Further, we were present insituations in which the town was given advice regarding declines in town staff health and heard
opinions on the importance of mental health countermeasures for municipal staff. On the contrary,
the Nagano team worked on individual home visitations and salon activities in the Oshima area of
Kesennuma. In addition, they set up a “stress counseling” service inside an internal medicine clinic.
We assisted in the transfer of these responsibilities to the Kesennuma City Authority and theKesennuma Public Health Center.
At this point, we had confirmed that we would continue to work alongside public health nurses
to provide guidance to support staff in Minamisanriku, and the method we chose was to carry out
support while participating in support staff meetings. Further, in Kesennuma, we took up the
responsibility of arranging the physicians necessary to ensure the continuation of work with some of
the individual cases taken up by the Kesennuma Public Health Center as well as of the stresscounseling service provided by psychiatrists and established by the mental health care team.
2. FY 2012 Activities in Review(1) Involvement in Disaster Survivor Support
As we began to roll up our sleeves and get to work, our first order of business was to determine
what exactly required our immediate attention. Prior to the establishment of the Regional Center, theStem Center had been conducting mental health training workshops for city residents and small-scalelessons and lectures for temporary housing tenants. However, at the time, the Regional Center had
yet to plan and provide any specific support programming.
Given that one of the core values of the MDMHCC is the provision of “support for supporters,”
we of the Kesennuma Regional Center decided to provide the assistance necessitated by requests frominstitutions and organizations involved in the coordination of resident support activities at themunicipal and regional levels. On the contrary, insofar as “individual support” to specific residents
was concerned, we determined that in light of insufficient staff and counseling infrastructure (lack oftelephone lines, absence of dedicated counseling rooms), proactive efforts in this area would provedifficult for the time being. Thus, we placed the matter of proactively responding to resident requests
for direct counseling under consideration and decided to first establish a policy of providing
individual support in accordance with requests from affiliated organizations. We cannot deny that thiscomplicated stance may have left people with a rather muddled impression of what exactly the
MDMHCC does.
- 35 -

Amidst these circumstances, the first duties we set about fulfilling were “information collection”
and “relationship building.” Initially, we did not have enough of an understanding of the community
to determine exactly what its needs were, and our relationships with various other organizations were
not cultivated enough for us to immediately begin receiving requests or contracts.
One might say that our approach in the Kesennuma area was to develop necessary support
activities while continuing to collect information and build relationships. The most important parts ofthis were meetings with affiliated organizations and participation in supporter meetings.
At the time, municipalities and support organizations were already hierarchically involved indisaster survivor support efforts. More than 17,000 people had been moved into emergency temporary
housing, and it had become difficult for municipal staff alone to address the needs of all thesesurvivors (Table 3). Supporters from various community organizations that had taken on city/town
contracts for survivor support, termed “support staff,” were sharing some of the burden of these
activities. We determined that it was imperative to build a relationship with these supporters(Tables 4, 5).
Table 3: Emergency Temporary Housing Tenants
Municipality
As of 4/30/13
Kesennuma
City
Minamisanriku Town

Miyagi Prefecter

Emergency temporary housing
Private chartered(prefabricated)housing
No. ofNo. ofNo. ofNo. ofNo. ofunits
tenants
households tenants households

Total
No. oftenants

No. ofhouseholds

93

7,704

3,215

3,699

1,263

11,403

4,478

58
406

5,770
49,062

2,122
20,668165
53,41649
20,032

5,935
111,476

2,171
40,700

Table 4: Kesennuma Supporters (FY 2012)
Name
Life counselors
Public healthnursesNurses(Support centers)
Reconstruction
coordinators

No. of Contracting organizations
ppl
21 The city contracted fourorganizations, including
the Kesennuma City
SWC, to open four
Support Centers (three in
Kesennuma and one in
Ichinoseki).
17 The city contracted theKesennuma City SWC.
40

Lifestyle support
counselors(Kesennuma
Reconstruction
Support Center)
Friendly visitors

Kesennuma
Reconstruction
Association(KRA) Welfare
Club

34 The city contracted eighthome nursing support
offices.
21 The city contracted the
KRA.

- 36 -

Project details
Support tenants of emergency temporary
housing via general counseling,
individual visitations, and exchange
activities, preventing loneliness and shutins, helping them lead a stable life.
Have public health nurses/nurses carryout health counseling.
Carry out visitations, and monitor andprovide counseling to elderly, disabled, andyoung unemployed disaster survivors.
Implement social events for residents
and coordinate volunteers for them.
Community formation support. Monitor
all households, including those intemporary housing.
Visit elderly persons and others living inemergency temporary housing, speak tothem, and help them with simple tasks,
thereby preventing loneliness and shut-ins.
Implement elderly social projects inemergency temporary housing.
Encourage proactive social participation
among elderly persons and prevent
loneliness/shut-ins. Watch overtemporary housing, organize tea parties,
and so on, help with events, and create
communities.

Table 5: Minamisanriku Supporters (FY 2012)
Name
Patrolling
supporters

Stay-insupporters

Visitation
supporters

No. of ppl

Contracting
organizations
80 The town
contracted theMinamisanriku
SWC.

Project details

Remain posted at each satellite location, workwith stay-in supporters, and periodically provide
visitation/monitoring support to the tenants ofemergency temporary housing in the assigned
district.
110 The town con- Check up on emergency temporary housing(55 teams) tracted thetenants who are old or in poor health. Work with
Minamisanriku patrolling supporters to provide counseling and
SWC.
watch over individuals as needed. Individuals
who would likely require watching over were
employed. Support was provided in two-person
teams.
10 The town
Travel outside of Minamisanriku and visit
contracted the tenants of private chartered housing (designatedMinamisanriku temporary housing); provide counseling andSWC.
ascertain their status.

We attended the support team conferences of the prefectural Kesennuma Health and Welfare
Office and had them share information about the status of the area as needed. We also periodically
met with Kesennuma (Health Promotion Division) and Minamisanriku (Health and Welfare Division)
officials. Further, we participated in supporter meetings held in each area.
In Kesennuma, we participated in supporter meetings held in each of its 10 districts (Niitsuki,
Kesennuma, Karakuwa, Omose, Matsuiwa, Hashikami, Motoyoshi, Shishiori, Oshima, andIchinoseki) and exchanged information therein. These meetings were also attended by city publichealth nurses, Support Center lifestyle support counselors, reconstruction coordinators, lifestylesupport counselors, friendly visitors, and KRA Welfare Club staff. Nonprofit organizations (NPOs),
nongovernmental organizations, and volunteer organizations providing lifestyle and community
support in temporary housing and so on were also present.
In Minamisanriku, too, we participated in the health activity meetings of the Health and Welfare
Division (Health Promotion Office/Comprehensive Community Support Center); in meetings withsupporters from the six emergency temporary housing satellites (Shizugawa, Utatsu, Togura, Iriya,
Minamikata, and Yokoyama), from designated temporary squads, and public health nurses; and inmeetings between the Survivors Lifestyle Support Center and the Health and Welfare Division(Health Promotion Office/Community Comprehensive Support Center).
The reason we participated in so many conferences and meetings this FY is that we werecommitted to spending time sharing information at these events, informing individuals about whatsort of activities the MDMHCC was engaged in as an organization, and what it was capable of doing.
Through supporters, we were able to gain a better understanding of residents’ issues, organize ourown thoughts about supporters’ issues while working with residents, and leverage this information
into the advice we offered as specialists. By supporting supporters, we were able to keep our goal ofprioritizing resident support in mind while providing accompaniment and collaboration with affiliatedorganizations in visitation activities as needed.
Subsequently, after arranging for various things, including outfitting our facilities with telephonelines (fixed/multiple lines), we set forth a policy of responding to resident requests for counseling. In
other words, one might say that the initiatives of the Regional Center slowly changed alongside thestatus and development of activities inside the region.
Next, we will describe the initiatives for disaster survivor support the Regional Center undertookin each municipality.

- 37 -

(2) Disaster Survivor Support in Kesennuma①. Support for Supportes
Our disaster survivor support in the city of Kesennuma began with health support for municipal
staff. In collaboration with the Tohoku University Graduate School of Medicine, Endowed
Department of Preventive Psychiatry (“Endowed Department”), we carried out a health survey andpost-survey interviews for Kesennuma city personnel. While the city of Kesennuma employs over
1,400 staff and officials, the scale of the damage caused by the disaster was immense, and many ofthese employees themselves were directly affected by it. As a result, their work in dealing with theaftermath of the earthquake had no doubt only increased since its occurrence. Thus, we began here
because we were worried that these personnel were exhausted. In terms of our health support, theEndowed Department carried out the planning of the project and the implementation and analysis of
the health survey, whereas the Regional Center collaborated on staff training workshops andinterviews. We also worked with the Miyagi University Department of Nursing, in charge of
Kesennuma city staff counseling, to implement some staff training workshops. We began training
managers and implementing group work in May 2012 and later conducted the health survey among
all staff. Subsequently, after conducting interviews with those who requested them, we instituted
mental health training workshops for general staff members. Finally, in order to raise health awareness,
we distributed a public awareness pamphlet to all staff members.
The same health measures were implemented for the staff of the Kesennuma City SWC.
Table 6: Kesennuma Initiatives
Initiative
Specifics
Targets
Support for Conference/meeting Municipalities
supporters
Conference/meeting Municipalities
Conference/meeting Municipalities
Conference/meeting Municipalities
Conference/meeting

Support orgs.

Conference/meeting

Support orgs.

Conference/meeting

Support orgs.

Health counselinghelpSocial event help

Support orgs.
Support orgs.

Group work Support orgs.
Health measures Municipalities
support Support orgs.
Networking Municipalities
Support orgs.
Community
resident
supportIndividual support

Individual support

Temporary
housing
residents
Residents
Residents- 38 -

Events
24
12
8
2
62
6
7
26
23
1
8
85

161

21
3

Description
Conferences with Kesennuma City
Health and Welfare Office
Conferences with Kesennuma City
Health Promotion Division
Conferences with Kesennuma City
General Affairs Division
Other psychiatric welfare-related
conferences
Meetings of temporary housing
resident supporters
Temporary subcommittee meetings
Suicide countermeasures study
sessions/training workshops
Kesennuma Ward Support Center
health counseling
Accompaniment support for KRA
activities
Self-care training
Kesennuma City staff, etc.
Kesennuma City SWC staff
Visitations/meetings withmunicipalities and support
organizations
Support via visitations/telephone
calls to high-risk residents inprivate chartered housing andtemporary housing
Individual support via phone,walk-in, and visitations
Participation in bereaved family
meetings

Public
awareness

LecturesTemporary
housing
residents
Training/lectures Municipalities
Support orgs.

94

Training/lectures

Residents
7

Coordinated “Mental HealthSeminar Traveling Lectures” with
Kesennuma Medical Association
Motoyoshi Support
Center/Kesennuma City Disabled
Persons’ Forum/Employment
Support Agency/Handheld
Parenting Association/Kesennuma
City Retirees’ Association
Akaiwa Children’s Hall/Karakuwa
Kindergarten/Kesennuma City
Mental Health Seminar(Karakuwa/Motoyoshi)

We also provided support to the staff and members of various organizations involved in support
activities for emergency temporary housing tenants and so on. This involved the following: direct
support for organizational activities, specialist advice on supporter issues and problems, andinitiatives meant to lead to supporter self-care and stress reduction.
Support for emergency temporary housing residents in Kesennuma was managed by fourorganizations contracted by the city (Kesennuma City SWC, Shunpokai Social Welfare Foundation,
Sasajin Co., Ltd., and the Nagomi Nonprofit Corporation), and was carried out primarily through the“Temporary Housing Tenant Support Center” (Table 6). Among these activities, we assisted in thehealth counseling carried out by the Kesennuma Ward Support Center. Comprehensive general healthcounseling in Shishiori Ward was performed in collaboration with other organizations (Kesennuma
City Authority, Miyagi University, and Hyogo Prefectural University). We also participated in theactivities of the KRA, which had received contracts for social events for temporary housing residents
and delivered health lectures therein. Next, while it is perhaps better classified as aid for Support
Center supporters, we visited each Support Center, understood the issues they were facing regarding
difficult cases, offered advice, accompanied them on visitations, and aimed to reduce thepsychological burden borne by supporters. We also offered specialist advice related to issues, plansof action, and interpersonal support and assistance topics raised during supporter meetings held at
Support Centers. Many of the Support Center lifestyle counselors, reconstruction coordinators, andfriendly visitors were social welfare workers, public health nurses, nurses, home helpers, and otherhighly qualified individuals who had experience with interpersonal assistance. However, somelifestyle support counseling and KRA staff members were disaster survivors themselves, and there
were also many supporters with little interpersonal experience. For this reason, we offered advice andconducted self-care training workshops that we felt would help deepen their understanding ofinterpersonal aid and reduce their anxiety during cases.
②. Community Resident Support
Most of our community resident support took the form of checkups and work with high-risk
individuals identified via the “Temporary Housing Resident Health Survey,” which was requested by
the Kesennuma City Health Promotion Division. After discussion with the Kesennuma City Authority
and the Kesennuma Public Health Center, we divided up the tasks of this project, and began handling
visitation/telephone cases among temporary housing residents in June 2012. We first began to workwith individuals with K6 scores ≥ 13, insomnia, or alcohol problems, and then broadened our scopeto those with K6 scores of 10–12 (corresponding to mood/anxiety disorders). We were involved in a
total of 161 case-related activities and events in FY 2012.
We also received requests for assistance from the Kesennuma Physicians’ Association, and we
implemented a health classroom for temporary housing residents and so on (the Mental HealthSeminar Traveling Lectures). In collaboration with the Kesennuma City Authority and theKesennuma Public Health Center, we held health classrooms (health lectures and counseling) inemergency temporary housing in nine locations throughout the city of Kesennuma between June andAugust 2012.
- 39 -

③. Raising Public AwarenessIn response to requests from affiliated organizations, we arranged for the dispatching of lecturers
and so on to training workshops and lecture sessions, and conducted lectures related to mental health.
We created pamphlets about post-disaster mental health and self-care practices for working
individuals and distributed them to affiliated organizations and persons.
(3) Disaster Survivor Support in Minamisanriku①. Support for Supporters
Initially, health support for municipal staff was considered in discussions with the Minamisanriku
Town Authority, Miyagi Psychiatric Center, Kesennuma Public Health Center, and the Kesennuma
Regional Center. Later, in July 2012, the Endowed Department joined, and these agencies worked
together to provide support. Minamisanriku suffered extensive damage during the disaster, and nearly
40 staff and supporters had lost their lives in the line of duty, highlighting the importance of healthmeasures for these vulnerable individuals. Health support was provided in accordance with
Kesennuma City staff. In terms of our health support, the Endowed Department planned the projectand implemented and analyzed the health survey, whereas the Regional Center collaborated on staff
training workshops and interviews. Manager training and group work were implemented in October
2012, and later, a health survey of all staff (approximately 250 people) was administered.
Subsequently, after conducting interviews with those who requested them, we implemented mental
health training workshops for general staff members. In order to raise health awareness, we distributed
a public awareness pamphlet to all staff members. Finally, starting in October 2012, we received arequest from the Minamisanriku Town General Affairs Division, and periodically set up a counselingcounter for town staff, where a clinical psychologist provided counseling.
The same health measures were implemented for the staff of the Minamisanriku Town SWC.
Table 7: Minamisanriku Initiatives
Initiative
Support for
supporters

Specifics
Conference/meeting

Conference/meeting

Conference/meeting

Conference/meeting
Conference/meeting
Individual support
Group work
Group work

Health measures
support

Networking

Targets
Municipa
litiesEvents17

Municipa
lities8

Municipa
lities8

Municipa
litiesSupportorgs.
Municipa
litiesSupportorgs.
Supportorgs.
Municipa
litiesSupportorgs.
Municipa
lities- 40 -

3
47
9
3
13

11

12

Description
Conferences with Minamisanriku
Town Health and Welfare
Division/Comprehensive
Community Support Center
Conferences with Minamisanriku
Town Disaster Survivors LifestyleSupport Center
Conferences with Minamisanriku
Town General Affairs Division
about staff health measures support
Conferences with Minamisanriku,
Tome, and affiliated organizations
Supporter meetings (satellite
meetings)
Visitation accompaniment andsupport for public health nurses“Senior meetings,” group work forsenior support staff
Supporter group work on the topic of
alcohol-related problems (project
entrusted to the Tohokukai Hospital)
Minamisanriku Town staff
Minamisanriku Town SWC staff

Visitations/meetings withmunicipalities and support
organizations

Community
resident
supportIndividual support

Individual support
Individual support

Publicawareness

Individual support
Training/lectures

Supportorgs.
Municipa
litiesSupportorgs.
Temporaryhousing
residents
Residents
Municipa
litiesSupport
orgs.

5
12

Health counseling for
Minamisanriku Town staff
Interviews by appointment after
health counselingSupport via visitations36
7
1

Individual support via visitations“About Self-Care”
Coordinated with Minamisanriku
Town Authority

Support for emergency temporary housing residents and the like in Minamisanriku was managed
by the town-contracted Minamisanriku Town SWC, and was carried out primarily through the“Minamisanriku Town Disaster Survivor Lifestyle Support Center.” One unique aspect of this system
was the placement of far more support staff in comparison to other regions in the prefecture (Table5). However, these positions were fixed-term employments made possible by the Urgent Job Creation
Project, and many of these supporters had themselves been affected by the disaster and moved into
emergency temporary housing. Many supporters also had no experience with interpersonal aid andengaged in their support activities while simultaneously attending training workshops.
The support activities of the Minamisanriku Regional Center began as accompaniment for publichealth nurses involved in guiding supporter meetings and support for public health nurse activities.
Amidst these circumstances, visitation accompaniment for supporters and direct, individual case work
via interviews increased.
In addition to providing accompaniment support for supporters in their work with residents andoffering advice, we worked to reduce their psychological burden. In October 2012, in response to arequest from the Disaster Survivors Lifestyle Support Center, we conducted a communication andself-care training workshop for supporters. Further, starting in November, we began to hold “senior
meetings,” group work sessions for satellite senior staff who served as supporter leaders.
②. Community Resident Support
In August 2012, in response to requests from Minamisanriku public health nurses, we
accompanied them on resident visitations and conducted interviews. Later, in September, we took
over individual cases at the behest of town public health nurses and began to conduct regular
visitations at the Minamikata Satellite Center. Subsequently, visitation accompaniment for supporters
and direct, individual case work via interviews increased.
③. Raising Public AwarenessIn response to requests from affiliated organizations, we arranged for the dispatching of lecturers
to training workshops and lecture sessions related to mental health. We created pamphlets about postdisaster mental health and self-care practices for working individuals and distributed them to affiliatedorganizations and persons.
3. Toward the Next Year
Looking back on the last year, during the first half, we engaged in activities that emphasized
relationship building with persons involved in support. This is because we determined that our firstpriority was the building of relationships with municipal public health nurses, who shoulder thecentral burdens of mental health activities, and supporters, who are directly involved in helping
disaster survivors. For this reason, we directly visited municipalities, Support Centers, and satellite
centers, and attended various kinds of conferences and meetings. Through these efforts, our work in
the latter half of the year gradually shifted toward individual requests and counseling.
- 41 -

In the future, we aim to inform affiliated organizations that we will be able to respond to requests
for individual accompaniment on difficult cases, and we also hope to carefully respond to resident
requests for direct counseling.
Further, while increasing the number of opportunities we have to work with municipalities, we
also plan to carefully continue the endeavors we undertook in our first year of operation, and tocontinue to respond to support needs.
In our meetings with supporters involved in disaster survivor support, health problems andconfirmation of safety among residents was often brought up. People also often spoke of life stresses
that had built up between community residents. While we heard the stories of those who had managed
to rather quickly rebuild their lives, we were also asked about livelihood assistance/welfare, which
we take as a sign that the livelihood gap between temporary housing tenants is growing wider. The
isolation and anxiety faced by tenants of temporary housing outside the prefecture/municipalities,
where information cannot travel as easily, is also significant. It is rather difficult to understand thestatus of private chartered housing tenants, and their voices do not reach us as easily, preventing us
from easily seeing their loneliness. We must develop a system that enables us to promptly respondwhen these individuals request the support they need.
For these reasons, initiatives that inform residents that there are places for them to seek help andadvice are most necessary. Dissemination of information both within and outside disaster-affectedareas is also critical to maintaining social interest in this issue, and we plan to proactively take part in
information broadcasting through public awareness workshops, pamphlets, and our website, among
other avenues (Table 8).

- 42 -

Table 8: FY 2013 Projects
Continued Projects• Community resident support projects (individual support)(1). Interview counseling (home visitation and walk-in counseling)(2). Visitation/continued counseling for high-risk residents in emergency
temporary housing, etc.
• Support for supporters(1). Specialist support-related advice(2). Staff mental health support(3). Training workshops for supporter mental health(4). Support Center health counseling(5). Consultation for project planning/advancement• Public awareness projects(1). Mental health lectures for residents of disaster-affected areas(2). Creation of mental health pamphlets for administrative personnel(3). Creation of mental health pamphlets for residents and supporters(4). Coordination of various events with municipalities
New Projects• Miyagi Disaster Exchange Event in Kesennuma: collaboration with andsupport for civilian activity organization

References:
1) Materials published by Miyagi Prefecture (April 2012).
2) “Minamisanriku PR Magazine,” published 11/1/2012 by Minamisanriku Town Authority,
pp. 8–9.

- 43 -

Looking Back on 10 Months of Activities
Kesennuma Regional Center, Kesennuma Transfer
Psychiatric Social Worker – Miyo Fujishima
1. Introduction
Since June 2012, I have been stationed in the Kesennuma City Health and Welfare Department,
Health Promotion Division as a transfer from the MDMHCC and have worked since then with city
staff on their various projects. As I am not originally from Miyagi Prefecture, and because this is myfirst time working in the field of psychiatric medicine inside the city of Kesennuma, I first sought tohelp my colleagues better understand what sort of work a psychiatric social worker does. I did what
I could to whatever extent was possible while endeavoring to increase opportunities for others to work
alongside me; from there, I gradually began to organize my thoughts regarding what sort of activities
should be implemented moving forward.
2. Mental Health-Related Counseling Aid for Private Chartered Housing Tenants
The first request I received was to provide support for tenants of private chartered housing. Like
those residing in emergency temporary housing, these tenants were not concentrated in any one
particular place, and were, without exception, thrust into entirely new communities. Furthermore,
there were far too few support staff to oversee them. First, I held interviews with high-risk individuals
identified via K6 score (a scale used to measure psychological stress) as measured by a health survey
conducted in Miyagi and Kesennuma; next, I confirmed the health of all tenants via visitations andphone calls. Through these activities, I was able to understand many of the needs of community
residents directly from them and to share these needs with public health nurses. I also asked tenantsof emergency temporary housing and those whose houses were not damaged by the disaster but
wished for counseling for mental health-related reasons to tell me their stories. The majority of mental
health-related counseling was provided as follow-up sessions to tenants of private chartered housing
after the health survey (Table 1).
Table 1: Counseling Overview
All types of counselingFirst-time groundwork counseling for high K6-score persons(private chartered housing*)
First-time groundwork counseling for high K6-scorepersons(temporary housing)Door-to-door visits(private housing*)
Mental health counseling
Mother-child counseling

Phone
Visitation
120
190
BreakdownInterview
52

Total
362

82

29

2

113

6

2

-

8

-

80

-

80

24
8

70
9

16
34

110
51

(*running total of all sessions with private chartered housing tenants)- 44 -

3. Mother-Child Counseling
The Health Promotion Division, to which I was transferred, was originally a counter forcounseling duties that centered around health consultation, home visitation, and other activities
related to mother-child health for families with infants; thus, I took on counseling for individuals
seeking such services. Further, I interpreted for foreign mothers unable to speak Japanese, andprovided counseling alongside public health nurses regarding life in Japan and parenting. Most of themothers who came in had complaints similar to the following: “After the disaster, my children nolonger have any places to play” and “We now live in a different home, and our children aren’t taking
it well.” Finally, many of these mothers told me that they had very little time or space to talk about
themselves and their feelings to others.
Table 2: Mother-Child Counseling Details
Subject
No. of clients
Total
sessions

1.5-yearcheckup

2.5-yearcheckup

3.5-yearcheckup

Other young
children

School-age
childrenForeigners

Total

2

3

1

2

2

1

11

3

7

2

3

26

10

51

4. Hosting the Koko Café
As I met more frequently with individuals who had been moved into private chartered housing, I
often heard that they found it difficult to acclimate themselves into their new communities, had very
few people to talk to, and often felt depressed. Thus, the “Koko Café” was held a total of four times,
starting in January 2013, to provide a place for the community to gather, talk to one another, engage
in activities that would lighten their hearts, and attend lectures they might find useful. These eventswere made possible with the invaluable help of the Volunteer Center, Mitsumine Hospital, and thetime and effort of all the teachers and lecturers who took part. I am proud to state that we were able
to receive good feedback from participants.
Table 3: Koko Café
Date(2013)
1/21
1/31

Location
Resident Health Management
CenterResident Health Management
CenterParticipants

Breakdown
Men Women

9

2

7

7

1

6

2/13

Jonan Annex

13

0

13

2/26

Hashikami Community Center

13

1

12

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Details
Lecture: “Tapping
Touch”
Lecture: “Tapping
Touch”
Lecture: “Releasing Fatigue in the Mind andBody: Relaxation”
Lecture: “Releasing Fatigue in the Mind andBody: Relaxation”

Café space

Koko Café poster(Participant Feedback)•••I don’t have very many opportunities to go outside, so I appreciated being able to talk toothers.
I’m always by myself, and I needed an opportunity to meet other people.
It helped ease my restlessness and relax.

We created a café-style space to facilitate informal interaction, which allowed participants tosocialize after lectures over tea, coffee, and other drinks. I think this home-like atmosphere enabledthese individuals to relax. In a broader sense, by incorporating a wide range of activities that
stimulated all five senses, we were able to help turn participants’ awareness and attention away fromthemselves for a little while. The results of a post-activity questionnaire indicated that many
participants wanted to hear about “health” in future events.
In the future, in an effort to help individuals who told us that changes in their environment andability to go out caused their weight to fluctuate, or mentioned that they had stopped leaving the house
because they had been feeling down, I would like to incorporate a significant amount of programs
touching on the topics of exercise and nutrition, as well as the relationship between the mind and thebody, into the Koko Café.
5. Problems and Solutions
As I look back on my work over these past 10 months, the time appears to have both flown by
and been immeasurably long. I think there are many things I was unable to fully accomplish.
Specifically, I was neither able to set long-term goals and a realistic path toward achieving them nor
do I feel I looked back enough on what I did as I was working.
Reasons for this include the fact that a disaster of this scale was simply unprecedented, and that
manpower was largely insufficient. I also have not yet formed an effective network with individuals
active in Kesennuma.
As most of my mental health counseling work was done as follow-up to health survey findings, I
did not introduce community residents to other counseling counters or inform them about the natureof alternative services. Further, barely anyone approached our counseling counter with such concerns.
I think that in this, our third year since the disaster, the difference between those whose problems
are slowly becoming chronic and long-term and those whose problems have naturally resolved overtime will become quite clear. I hope that while continuing these individual counseling activities in aneffort to listen to the voices of those whose problems have become long-term, I am able to set forth aplan to resolve such problems and work together with others to implement it to a point where I canlook back on the progress I have made.

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6. Reflections
I have tried my best to organize this report in a chronological manner, but as the vertical axis oftime grows longer, the horizontal axis of the scope of my activities has also broadened. I suppose thisis the merit of conducting disaster support in the same place over a long-term period. Without anunderstanding of the chronological flow of things or the circumstances behind a particular activity,
I think it can be quite difficult to suggest activities to be carried out when support is requested, so to
speak. This sort of timing is particularly critical both to reducing the stress of staff members and toproviding support for supporters.
As a transferred employee, I was neither a full-fledged member of City Hall nor was I fully
incorporated into the goings-on at the Kesennuma Regional Center, and at times, I found myself in alonely position. However, I am grateful that my colleagues at City Hall—busy with their own work
supporting community residents—would take notice of this and reach out and encourage me. There
are many things I have yet to accomplish, but I hope to continue to work with them, to help and to behelped by them, in the coming years.

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