Public Interest IncorporatedAssociationMiyagi Prefecture Social Welfare
AssociationMiyagi Disaster Mental Health CareCenter2016
Bulletin
5th edition

Miyagi Disaster Mental Health Care CenterMiyagi Disaster Mental Health Care CenterLiving in the Community
Hiroo Matsuoka
President of Miyagi Prefecture Association of Psychiatric Social Workers,
Public Interest Incorporated Association(Department of Preventive Psychiatry, Tohoku University Graduate School of Medicine)
The prefatory note in 2015, entitled “Five Kinds of Stress,” introduced scholarly advances
concerning the various kinds of stress that people experience. I am presenting today because very
interesting research has recently been reported relating to mental health problems that people havebecause of stress, and the kinds of regions where difficulties are arising as those problems intensify.
Many psychological disorders do not suddenly appear one day but begin gradually over years
from nonspecific symptoms and behavioral changes, which put increasing strain on one’s ability tohave a social life, until it collapses into a state of “illness.” Looked at another way, people areconfronted with various stresses, and although at first they have used their strength to battle toovercome stresses (recently referred to as “resilience”), when the power relationship of stress andresilience starts to reverse, this leads to various changes that make stress intolerable. Even now, thepeople who live in areas impacted by various problems have repeatedly battled stress withresilience. People persevering in this situation may simply not talk about their symptoms, and theirmental health problems may go unnoticed. However, when difficulties arise with living in thecommunity, gradual changes in social functioning can also present themselves, and this can lead tobehavioral changes presenting themselves without the individual being aware of it.
Very interesting research has examined community functioning after the onset of full-blown
schizophrenia. This research was carried out in Israel; although healthy young men aged 16–17
were recruited for the study, psychiatric follow-up surveys were carried out on average 25 years
later, and follow-up evaluations were carried out over a long period of time in three domains ofcommunity functioning: “social activity,” “independent behavior,” and “functioning in school orwork.” Social activity evaluated the ability to make friends (“How many good friends do youhave?,” ”Do you generally prefer to be with or without a group of companions?,” etc.);
independent behavior evaluated the ability to solve problems in social life (“How do you deal withinterpersonal stress?”); and functioning in school or work evaluated the ability to fulfill obligations
and responsibilities at school or at one’s place of work (“Do you follow a routine at school orwork?”). Those who had been hospitalized for schizophrenia had lower social activity andfunctioning in school or work 8–15 years before the onset of the illness, and about 5 years before
the onset of the illness their social activity had suddenly dropped and their independent behavior
had also begun to decline.
These results are consistent with research into schizophrenia, and although a link cannot befound to wider mental health problems in areas suddenly struck by disasters, people who alreadyhad problems with social life and functioning in school or work may be a high-risk group for
mental health problems. Thus, when further deterioration of social life (e.g., a sudden pull towardmisanthropy) and reduction in independent behavior (e.g., bewilderment when met with thesmallest of problems) are observed, it might be possible to guess that an attack of mental illness
may be imminent. This kind of evaluation of social functioning may be helpful when evaluating
mental health problems in people who do not talk about their own symptoms.

1. DEVELOPMENTAL TRAJECTORIES OF IMPAIRED COMMUNITY FUNCTIONING IN SCHIZOPHRENIA.
VELTHORST E., ET AL.: JAMA PSYCHIATRY 73(1): 48–55, 2016

Six Years After the Earthquake
Akira Kodaka – President, Doctor
Miyagi Disaster Mental Health Center (MDMHCC)

We present here the fifth edition of the Bulletin of the Miyagi Disaster Mental Health Center(hereinafter, “this Center”). Six years have passed since the earthquake, and likewise this Center has
been active for almost six years. In that time, as with all areas struck by disaster, this Center has been
watched over, guided by, and received many kinds of support from all of the people affected. Iwould like to express our deep gratitude. We have passed the midpoint of the ten-year reconstruction
plan and the situation in the areas struck by the earthquake has changed; accordingly, our activities
have also changed, and we have entered a phase of once again sorting out the goals of our activities
moving forward.
The areas struck by the earthquake have experienced a variety of challenges on the road toresettlement. The number of people living in temporary housing (including privately-rented housing)has hardly fallen and remains high, and migration to emergency public housing has brought many
people a sense of insecurity, leading to the major questions of how to build relationships with people
in new places and how to build communities there. Support for isolated elderly people is also amajor problem, and there have been reports of people dying alone in emergency public housing.
Another major problem is supporting children who have grown up amid the stress following theearthquake disaster.
Municipal governments in all areas struck by the disaster are turning to face these issues, anddespite their troubles are fervently considering once more how to advance mental health care andpsychiatric social work in the region. We believe that from now on, activities should advance basedon support for supporters of people in areas affected by the earthquake, but at present we are once
again considering what we will leave behind for the future.
Our planned activities are limited to the remaining four years. Since 2016, we have formulated
our management plans for the remaining four years with the cooperation of all the areas and people
affected by the earthquake, and have officially carried out our public duty with the understanding ofthe Association of Psychiatric Social Workers, the steering committee, and the prefecture. We aim toimplement our plan of action with everyone’s support and guidance.
Without going into too much detail here about the management plan, the following three points areimportant:First, we aim to help to strengthen capacity and contribute in areas struck by the earthquake
while being mindful of what will remain in the future. We deal with problems in the region alongwith everyone else, so although building up activities related to mental health is itself the mostimportant item, we must also reexamine each of our activities from the point of view of what willremain in the future, and advance activities that have profound significance for people who are
suffering as a result of the earthquake.
Second, for posterity various materials or records of practice will remain in the form of researchand study activities. From the perspective of mental health care activities, recording and preserving
experiences of earthquake disasters is our obligation to history. To do so, in 2017 we carried out
organizational changes and set up a structure that has been implemented as a research division.
Concentrating internal and external efforts, we hope to move forward with the advice and guidanceof all people involved.

Third, we are tackling the issue of how to create a community psychiatric social work service
after the earthquake disaster. There are also problems that are faced in each prefecture (andnationally), not just in the towns and cities affected by the earthquake. Through our daily activities,
and through our survey inquiring into coastal cities and towns in 2016, we get the impression of astrengthening sense of impending crisis in all areas. As part of the implementation of mental healthcare following the earthquake, we keenly felt the importance of community psychiatric social work
services in the future, and have been fervently considering how to create a structure for the longterm; although this has yet to take shape, it is certainly a topic of great worry and unease.
According to a 2014 nationwide survey, the rate of increase of mental health disorders was far
greater in Miyagi Prefecture than the national average. We are preparing integrated structures forhealth care and social welfare, from primary prevention through to tertiary prevention, and webelieve that vigorous, concrete, and meticulous support will be needed in the long term to facilitate
relief activities focusing on areas struck by the earthquake, which have continued to face a variety ofproblems since the disaster. Looking toward the end of the reconstruction plan, it will be necessary
to put more efforts into advancing the work of preparing for this. New prefectural plans forcommunity medicine and disability social welfare began in 2018, growing out of a 2017 study, butthese must incorporate an ideal image of community psychiatric social work services after theearthquake.
Since 2017, the implementation of a “mental health care forum” has been included inmanagement plans. This was conceptualized as a place to discuss how to build community mental
health and welfare structures after the earthquake and, while sharing future plans and the initiatives
implemented so far by people in every city, paint a vision of the future for prefecture-wide politicalmeasures and initiatives in each region.
Through various opportunities, and united with everybody affected, we hope to look to the future,envision the form of community mental health and welfare services that fulfill people’s hopes forpeace of mind in the future in all areas struck by the earthquake, and plan activities that will beeffective.
I thank you for your continued guidance, support, and encouragement.

Contents
Chapter I

Miyagi Disaster Mental Health Center Activities .......................................................1

1. State of activities Trends over the last five years and looking ahead Report on Kumamoto earthquake disaster support activities
2. 2016 Report● 2016 Programing Review
3. Department Initiatives
 Kesennuma Regional Center‐Community Support Division Ishinomaki Regional Center‐ Community Support Division
 Stem Center‐Community Support Division
 Stem Center‐Planning Division
4. Project of Cooperating Agencies and Organizations
 Tohoku University Graduate School of Medicine, Department of Preventive
Psychiatry
 Tohokukai Hospital Japan Social Worker Association for Alcohol Related Problems
 Miyagi Danshukai
Chapter II

Research Reports & Other Manuscripts ..................................................................103

Chapter III

Contributions ...........................................................................................................165

Documents .......................................................................................................................................169
Names of staff enrolled in 2016213

Chapter I:
State of activities atMiyagi Disaster Mental HealthCenter1.

State of activities Trends over the last five years and looking ahead Report on Kumamoto Earthquake disaster support activities

2.

State of activities listed by project for 2016

3.

Initiatives of each department
 Kesennuma Regional Center Community Support Division Ishinomaki Regional Center Community Support Division
 Community Support Division, Stem Center Planning Division, Stem Center

4.

Initiatives in organizations such as partnerships and groups
 Tohoku University Graduate School of Medicine, Department of Preventive
Psychiatry Medical Corporation Tohokukai, Tohokukai Hospital Japan Social Worker Association for Alcohol-Related Problem
 Nonprofit Organization Miyagi Prefecture Danshukai

Glossary

AUDIT

AUDIT (the Alcohol Use Disorders Identification Test) is a screening testfor discovering and correcting alcohol drinking patterns to prevent damage
to health, developed by the WHO

DPATs

Disaster Psychiatric Assistance Teams, set up because of the need toprovide highly specialized psychiatric care and support mental healthactivities in cases of natural disasters or mass casualties due to incidents or
accidents.
N.B. Summarized in the Ministry of Health, Labour and Welfare’s HP
Saigaihan Seishin Iryou Chiimu (DPAT) Katsudou Youryou Ni Tsuite(Summary of the Activities of Disaster Psychiatric Assistance Teams(DPAT))DMIHSSThe Disaster Mental Health Information Support System is an information
sharing tool that uses the Internet to carry out activities efficiently during adisaster; it is a system with functions for callouts and allocation ofdeployment, recording activities, and tallying. During a disaster, using
DMHISS, all kinds of information can be reported concerning adjustments
to DPAT deployment and activities.

HAPPY program

The HAPPY Program (Hizen Alcohol Problems Early Intervention
Program) is a program developed by National Hospital Organization
Hizen Psychiatric Center for intervention with high-volume drinkers. Itcomprises three short-term programs tackling this through means such asvideo lessons and health diaries. HAPPY stands for: H - Hizen, A Alcohol, P - Problems, P - Program, and Y - Dr. Yuzuriha Takefumi.

PFA (children’s and adults’)(Psychological First Aid)

Psychosocial methods linked to support needs to prevent mental anguishfrom worsening among victims during emergencies such as disasters andterrorist attacks. Children’s PFA refers to age-appropriate psychosocial
methods for children’s developmental stages.

BIBrief Intervention refers to individual, short-term counselling (5–30minutes) carried out as a method of preventive intervention for alcohol use
disorders. The goal is to bring about changes in the target person’sdrinking behavior using interview (intervention) methods such as
motivation interviews and coaching. The target people are heavy drinkers,
and the goal is often not to abstain from alcohol but to reduce intake.
Outward refusal and resistance are relatively rare.

–3–

LSA (Life Support Adviser)

LSAs do things for elderly people who live in public housing such as
silver housing (assisted living facilities for elderly people) such as minding
services (checking on their wellbeing), civic guidance or consultation,
responding in times of emergency, communicating with relevantorganizations, and support with community-building. The standard is tohave one LSA for every 30 households. They belong to organizations suchas social welfare service corporations, and in many cases they are qualifiedfor roles such as care work.

Resilience

Resilience can mean flexibility, stability, or the ability to recover. In theterminology of psychiatry and psychology, it is described as “the ability toendure, flexibly respond to, or overcome external shocks such as adversity,
hardship, or strong stress,” and it is often envisioned as “bouncing backlike a bamboo plant, which does not snap even when strong winds blow.”

World Cafe

A method for shared discussions about each person’s experience and ideas,
with an atmosphere just like being in a café; participants engage in free
dialogue in small groups at tables, and everyone other than the café masterchanges seats.

–4–Miyagi Disaster Mental Health Care Center activities are carried out supported by the following
six projects.
Each bulletin mainly reports on one of the following projects.

Residentsupport
Raising
publicawarenessSupport forsupporters

Research

Human
resource
development
Support forvarious
activities

Resident support

Support for supporters

Consultation and support aimed atpreventing mental illness and improving
mental health in victims of disasters

Support maintaining supporters’ own
health and mental health activities, forgovernment personnel and temps

Consultation and support activities for victims(interview consultation, telephone consultation)
Planning and managing events for residents ofaffected areas

Sending professionals to municipal governments
Consultation, supervision, and participation incase meetings
Establishing mental health services for supporters
Support with clerical work

Raising public awareness
Human resource development

Public awareness and information about
mental health

Spreading information and training formental health professionals andsupporters

Workshops and lectures for ordinary residents
Salon activities for residents of affected areas
Making and distributing pamphlets for publicawareness
Distributing information through PR brochures,website, etc.

Training related to post-disaster mental healthTraining in support skills
Case meetings
Social gatherings for disaster mental health care

Research

Support for various activities

Investigations and research tounderstand the circumstances ofaffected areas and victims

Cooperation with support groups
Sponsorship and backing aimed at
supporting activities–5–