Department Initiatives
Ishinomaki Regional Center, Community Support DivisionIshinomaki Regional Center Activities in FY 2013
Ishinomaki Regional Center, Community Support Division
Psychiatric Social Worker – Hiromi Arai
1. Introduction
The Ishinomaki Regional Center opened its doors on April 1, 2012. So far, we have aided disastersurvivors and supporters in cooperation with government agencies and support organizations in the
Ishinomaki area.
It is hard to say that the reconstruction of disaster-stricken areas in the Tobu Health and Welfare
office area, which includes Ishinomaki City, is “visibly progressing.” Many of the people living inprivate chartered and container-type temporary housing are subject to various stresses, including
widening disparities and little prospect of rebuilding their lives. In such an environment, alcoholrelated problems, stress disorders, dementia-related problems, and other issues have surfaced.
Here, I describe the 2013 activities of the Ishinomaki Regional Center and discuss our future
efforts for disaster areas.
2. FY 2013 Initiatives(1) Community Resident Support① Follow-Up Support for the FY 2013 Health Survey
Miyagi Prefecture and local municipalities jointly conducted health surveys of residents
of private chartered and container-type temporary housing. As a result, the city of Ishinomaki
requested us to provide follow-up support to survivors deemed to be in need of it, and we
conducted visitation interviews with them. The status of health survey follow-up support isshown in Table 1. The number of households for which we provided continuous visits (morethan twice) was 19 for private chartered housing and 33 for container-type temporary housing.
Table 1: Follow-Up Support Requested by the City of Ishinomaki
Survey of private char- Survey of container-type temporary houstered housing tenants
ing residents
Prefectural/munici- FY2012(12/2012–3/2013) FY 2013 (9/2013–11/2013)pal health surveys
First visit conducted Mid-June–Late July 2013 Mid-December 2013–Early February 2014
Households visited

131

150

Households
19
33
receiving continuous
support (Repost)(reprinted)② Counseling Support
In 2012, we received numerous requests for counseling for disaster-affected residents
from various organizations within the jurisdiction. However, in 2013, there were many direct
requests from counselees and their families. In addition, new counseling cases on the topics
of mental illness-related problems, mother-child relationships, and alcohol-related problems
increased.
Table 2 shows the status of counseling support this year.

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Table 2: Counseling Support by Type and Support Method
Counseling Type

Visitations

Interviews

Telephone

Clients

Cases

Clients

Cases

Clients

Cases

Mental illness

33

56

16

18

21

25

Mood disorders

19

47

4

4

10

15

Alcohol-related

44

112

５

６

７

12

Mother-child

19

20

12

19

10

12

Domestic issues

3

8

5

8

1

4

Other

59

85

31

44

24

35

Total

177

328
73
99
73
103
(4/1/2013 to end of March 2014)※Data shown here do not include post-survey support for households in private
chartered/container-type housing.
The “Other” category includes problems related to trauma, housing and life reconstruction, dementia, and other residents. Some counselees requested to be interviewed by a doctor
or thought they needed to see a doctor. If necessary, either a part-time doctor at the
MDMHCC interviewed these individuals or they were referred to a medical institution.
③ Raising Public AwarenessAt the request of the Ishinomaki City District Women’s Association, we held two lectureson the topic of “listening” for local residents. A total of 27 participants attended the twosessions.
From the participants, we heard the following remarks: “I was not good at listening topeople, but I understood which points I should pay attention to when listening,” “I learned
that listening to people can make them feel better,” “I learned that it is important to connect
to a specialized agency when necessary,” and “I want to learn how to listen to people so I canhelp them.”④ Community Resident Salon Activities
a. Koko Farm ProjectWith the cooperation of agricultural managers in Higashimatsushima, the “Koko Farm
Project” to cultivate vegetables and flowers was conducted twice a month for two hours in
the morning from April to December 2013. The implementation status is shown in Table 3.
Survivors living in private chartered and container-type temporary housing were the primarytargets of this initiative. The purpose was to provide a “place for interaction” for survivors,
and this was achieved by allowing them to cultivate vegetables together, lay out on mats inthe field after cultivation and harvesting, and converse over tea.
Participants said things like, “In the old days, my family used to gather and work on thefarm. These events reminded me of that time. Coming here and doing that with all theseparticipants allowed me to enjoy myself, like I was part of a big family again,” “I forgot about
things, and I felt refreshed and energetic. It was fun just to see the vegetables grow, and I
laughed out loud for the first time in a long time,” and “I came to the field and had a goodtime and felt happy. Me being happy helps my family be happy, and that makes me really
happy.” An average of six people participated in each session.

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Table 3: Koko Farm Project
Period and Dates/Times
April–December 2013
SecondandfourthThursday, 9:30–11:30 AM

EventsVarieties (Vegetables) and FlowersParticipants

17

Pumpkins,Napa
cabbage,Men: 14
onions, daikon, cucumbers,Women: 98
tulips, etc. Tea parties were heldeach time. In December, only one
event was held, and the tea party
was held in an assembly hall.

b. Art Exhibition and Social
After the Art Exhibition held in FY 2012, we received comments from participants sayingthat they would like us to hold it again. Thus, this year, we requested private chartered housing
tenants to send us art works and held the “Art Exhibition and Social.” The implementation
status is given in Table 4.
From the visitors, we heard the following: “I was energized by seeing the work; I will do
my best,” “I am looking forward to you holding it again next year,” “I want you to hold it forone more day,” and “I would also like to exhibit my work.” Exhibitors and visitors were seeninteracting over tea.
Table 4: Art Exhibition and Social
Date and Time

Friday March 7, 2014, 12:00–4:00 PM

Place

Miyagi Prefecture Ishinomaki government building, temporary meetingroom
Ceramics, chigiri-e, paintings, calligraphy, Japanese paper dolls,

ExhibitedWorks
Socialpatchwork, cloth dolls (animals, etc.), amigurumi (yarn work) (14exhibitors)
Spring group planting and bead (strap making) experience corner, hand

Attendees

massage, magic show, tea space
85

c. Handicrafts Class
Many participants of the 2012 Art Exhibition and Social said, “I also want to make art. I
want you to create a place where we can make art while interacting with one another.” Thus,
in 2013, we decided to hold a handicrafts class for private chartered housing residents.
For this handicrafts class, we asked the Ishinomaki City SWC to refer volunteer instructors.
From October 2013 to March 2014, the class was held for two hours from 9:30 am to 11:30
am, once a month, for a total of six times. The handicrafts classes consisted of collage andbeads,and were held alternately each month. Across six sessions, the total number of participants was 33. The venue was the Ishinomaki Regional Center branch office.
(2) Human Resource Development① Supporter Training
At the request of government agencies and the SWC, we held workshops and lectures forsupporters who directly interact with survivors and people with disabilities. The training content included listening techniques, how to interact with people with disabilities, and mental
and physical self-care for supporters.
In addition, we held a lecture on the theme of “Listening to Children’s Hearts” for publichealth nurses, nursery teachers, and school nurses. The content of the workshops for supporters
is shown in Table 5, while the content of the lecture is shown in Table 6.

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Table 5: Status of Training Sessions for Supporters
LocationTargets

Training Content

Events Participants
Ishinomaki Ishinomaki
City Mental and physical self-care to15
252
Health Promotion become a good listenerofficers
Ishinomaki Intellectualand Points for year-long activities and120
disabled counselors consultation
atIshinomaki
Regional Center
Ishinomaki Ishinomaki
CitySupporter mental health: “taking
1
23
SWC staff
care of yourself”
Ishinomaki Ishinomaki
SWC staff

City How to interact with people withdisabilities and supporter self-care

1

16

Onagawa

Town Supporter self-care

1

43

1

18

Onagawa
SWC staff

Osaki

Osaki
City How to interact with people with
Community
disabilities and staff mental health
Activity
SupportCenter staff
Table 6: Lecture Session for Supporters
Date/Time & PlaceContent

Targets

October 4, 2013, Listening to Children’s Hearts:
2:00–4:00 PM, Ishi- For Effective Communication
nomaki Ion Cinema San Francisco State University
Lecturer, Professor Emeritus
Mariko Tanaka

Participants

Municipal
staff
public health nurses,
nurseryteachers,
teachers, etc.

180

② Disaster Mental Health Care ExchangeWith the aim of coordinating with related organizations and facilitating support fordisaster survivors, including educational activities related to mental care, improvement oflocal mental health and welfare, and support for supporters, the “6th Disaster Mental HealthCare Exchange in Ishinomaki” was held. The content is as shown in Table 7. The participants
were divided into three groups, each with an instructor, and exchanges were held between
each group, with the instructors functioning as mediators.
Table 7: 6th Disaster Mental Health Care Exchange in Ishinomaki
Date/Time & PlaceContent

Participants

Wednesday, November 1) Symposium: “Survivor Support from Here”
27, 2013
Symposiasts: Yukio Takahashi, Suimei
2:30–5:30 PM
Morikawa, Kazunori Konno
Ishinomaki
Grand
Hotel
2) Exchange- 34 -

82

(3) Support for Supporters① Supporter Interviews
Based on the results of the staff health survey following the Great East Japan Earthquake,at the request of the Ishinomaki City SWC, we conducted individual interviews with all staff.
The number of target staff was 177. When categorizing the responses regarding participants’problems, “Nothing in particular” was the most common at about 60%. However,approximately 10% of the staff said “I can’t sleep,” “I feel depressed,” or “I’m frustrated.”② Advice at Temporary Housing Area Meetings
We attended Temporary Housing Area Support Meetings, where government agencies,
SWCs, Regional Comprehensive Support Centers, Nursing Associations, Disability
Consultation Support Offices, and professional associations gather and get involved inresidents’ problems. We gave advice and referred persons to appropriate support
organizations.
In addition, we attended case study meetings at Ishinomaki City Hall, the Nursing
Association, and the Regional Comprehensive Support Center, supervising as needed.
③ Infant Health Checkup Support
Public health nurses and clinical psychologists were dispatched to the infant healthcheckups conducted at the Ishinomaki City general branches on request. Support wasprovided five times at the Oshika General Branch and 12 times at the Kahoku General Branch.
After checkups, we held conferences with public health nurses to advise them on the mental
care of mothers and children and to consult with those who needed continuous support.
④ Alcohol-Related Support
The number of consultations on alcohol-related problems is increasing, and in 2013, we
endeavored to raise awareness about alcoholism and build a community network incooperation with support groups, including government agencies.
a. Community Resident Training Workshops
In collaboration with Ishinomaki City, Ohashi Autonomous Society, Ishinomaki City
SWC, Miyagi Prefecture Nursing Association, and the Kaisei Temporary Clinic, we invitedmembers of the JASWA as lecturers and held a workshop for temporary housing residents.
Table 8 shows the implementation status. At the second workshop, in collaboration with
Ishinomaki City and the Ishinomaki City Temporary Housing Autonomy Union Promotion
Association, we invited Director Ishikawa of Tohokukai Hospital to hold a workshop andworked to raise awareness about alcohol problems.
Table 8: Alcohol Training Workshops for Community Residents
Date/Time and PlaceContent
Participants
Wednesday, August 28, Understanding Alcohol: How to Properly 45
temporary2013
Use Alcohol
residents,
6:30–7:30 PM
Lecturer: Mitsuyuki Sato, Sugiyama SWC/temporary
OhashiComplex Hospital ASW(Alcohol Related Problems support staff, etc.
Meeting Hall
Social Woker)
Friday, October 18, 2013 How to Properly Use Alcohol
53
persons
6:30–8:00 PM
Lecturer: Dr. Toru Ishikawa, Director, involved in the
Ishinomaki
Senshu Tohokukai Hospital
temporary
University, Room 4102
residents’association, SWC,
temporary support
staff, etc.

- 35 -

b. Supporter Training Workshops
In collaboration with Tohokukai Hospital, we held workshops for supporters on alcoholrelated issues. The content is shown in Table 9.
Table 9: Alcohol Training Workshops for Supporters
Date and Time

Content

Targets

Attendees

Tuesday,28, 2013

May Working with Alcoholism and Team Care
Nichii Care
Lecturers: Toshihiro Suzuki, Atsuko Miura, Center staff
Tohokukai Hospital, Community
Support Division

Tuesday,25, 2013

June Fundamentals of Alcohol-related Problems Ishinomaki
and Working with Supporters
City SWC 24
Lecturers: Toshihiro Suzuki, Atsuko Miura, Hebita
Tohokukai Hospital, Community District Staff
Support Division36

In addition, a workshop on alcohol-related issues was held monthly from January 2013,
co-sponsored by the Ishinomaki City Health Promotion Division and the Kaisei Temporary
Clinic. Workshop content is shown in Table 10. The subjects were the Ishinomaki City SWC
temporary support staff, medical institution staff, and support organization staff, and these
events were held eight times in total.
Table 10: Alcohol Training-Related Lectures for Supporters
Date

Content

Lecturers

ParticipantsSession 4
April 2013

・Collaboration
communities
・Case studies

Session 5
May 2013

・ Community assistance for Eriko Sako, Recovery House
41
alcohol problems (how to Ichigo, JASWA
provide support in thecommunity)
・ Case study
・
About
alcohol-related Naoto Okazaki, JASWA
Sumie Okada, JASWA
problems
62・ “Think about alcoholrelated issues with citizens
in an easy-to-understandmanner”・ About alcohol family Naoto Okazaki, JASWA
Sumie Okada, JASWA
54
support・ What kind of supportshould be given to families
with drinking problems?
・ Skills to convey alcohol Naoto Okazaki, JASWA
36
problems to the community Sumie Okada, JASWA

Session 6
November 2013

Session 7
December 2013

Session 8
January 2014

in Eiko Oshima, Nonprofit 25
organization(NPO)
Recovery, JASWA

・ Exercise: How to interact
with people with a drinking
problem※ Sessions 1–3 were held in FY 2012.
- 36 -

3. Looking Back on Our Activities in FY 2013
The Ishinomaki Regional Center has been carrying out support activities in cooperation with administrative agencies and support organizations within its jurisdiction. While attending local support meetings and sharing information, when necessary, we held case study meetings with relatedorganizations for people with various problems. In particular, the SWC and temporary support staff,
who support people living in container-type temporary housing, play an important role in forming
connections. As we have been focusing on building a local network, we endeavored to cooperate
more with the SWC.
Regarding alcohol-related issues, we will collaborate not only with related organizations but alsowith the Regional Support Department of Tohokukai Hospital, which is a specialized medical
institution; the Regional Cooperation Office of Kodama Hospital, which is a regional psychiatrichospital; and the psychiatric clinics. With the assistance of the Red Cross Hospital Regional
Cooperation Office and the Internal Medicine Clinic, we have been focusing on supporting people
with alcohol problems and their families. In addition, while providing support to those who areproviding support, we are working to build a mobile support network for the whole community.
4. Issues and Future Initiatives
Reconstruction efforts, such as the completion of public disaster housing, will gradually expand.
However, gaps in these reconstruction efforts are widening. Issues such as alcohol and dementiarelated problems, stress-related disorders, isolation, and residents’ troubles are expected to become
more severe.
It goes without saying that we will focus on individual support when we receive requests for
consultations. We will also continue the handicrafts classes and farm projects to prevent theisolation of disaster-affected residents and promote exchanges. Until now, by building face-to-facerelationships with each institution, including government agencies, temporary support staff, helper
staff, Mamoribu staff, consultation support office staff, and others who directly support local
residents, we have received many requests for workshops on mental illness, individual support
meetings, and listening courses, and the division of roles and cooperation among each institution is
being carried out smoothly. While our efforts have been slow, we have promoted activities that leadto raising the level of mental health and welfare activities in communities. Regarding support forchildren, we will continue training sessions for staff of related organizations in 2014 and build good
relationships with the concerned organizations for individual support.
Regarding alcohol-related issues, we believe it is necessary to plan, for example, a “let’s reduce
alcohol” club through a men’s cooking class to disseminate knowledge about the dangers of alcohol
consumption and promote awareness-raising activities.
In order to develop support for various problems including those related to alcohol and dementia,
it is necessary to work more closely with government agencies and support organizations. In particular, we believe that cooperation with the SWC and medical institutions is important.
In addition, the Ishinomaki Regional Center has held monthly meetings and workshops, which
are attended by all employees, including those transferred to Onagawa, Higashimatsushima, andIshinomaki. At these meetings, we have discussed the support status of the Ishinomaki area, theexamination of business issues, and problems and future directions. In the future, we hope that thestaff of the Ishinomaki Regional Center will work together to consider issues in the Ishinomaki areaand provide better support.
The earthquake caused great damage and wounded many of us deeply. Based on this, when
dealing with disaster survivors and support personnel, we will attentively listen to their stories andseek to sympathize with them and respect their feelings. Furthermore, we would like to make efforts
to build a small, mobile network to improve mental health and welfare in the region.

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Role of Occupational Therapists in the Ishinomaki Disaster Survivor Health Support Project
Ishinomaki Regional Center, Ishinomaki City Transfer
Occupational Therapist – Miyoko Kubota
1. Introduction
Three years have passed since the Great East Japan Earthquake on March 11, 2011. About 23,000
people are still living in emergency temporary housing (container-type temporary housing and private chartered housing) in Ishinomaki (as of the end of March 2014). In Ishinomaki, where I wastransferred by the MDMHCC, as individuals continue to live in temporary housing prior to thetransition to public disaster housing, a variety of problems have emerged, including a rise in thenumber of people requiring support and care because of aging, alcohol-related issues in the middleaged and elderly, and an increase in the prevalence of dementia due to loneliness and community
collapse. This paper reports on the main support activities and issues that I worked on in 2013.
2. The Role of an Occupational Therapist in the Ishinomaki Disaster Reconstruction Basic Plan
The Ishinomaki Disaster Reconstruction Basic Plan was formulated in December 2012. Under
the slogan “Relieve citizens’ anxiety and restore their livelihood” (Measures Outline 2), the Ishinomaki City Health Promotion Division has sought to implement the following measures for disaster survivors: (1) health support projects, (2) lifestyle-related disease prevention projects, (3)mental health care projects, (4) lifestyle-related disease aggravation prevention projects, (5) nutrition and dietary habit support projects, and (6) oral care countermeasures. The author is involvedin the health support project for disaster survivors developed by the Adult Health Group (AHG)
and the Mental Health Group (MHG) of the Health Promotion Division. Figure 1 shows the healthsupport provided to disaster survivors and the roles of each institution in temporary housing in
Ishinomaki City.
(1) Ishinomaki Rehabilitation Support Project (Miyagi Disaster Reconstruction Fund Project,
Health Support Project)
The AHG has been involved in the implementation of rehabilitation support, a Miyagi Prefecture Earthquake Reconstruction Fund project, since November 2011. Figure 2 shows the flow of
the rehabilitation support project. The Ishinomaki main office area’s nine districts and six generalbranch office areas are divided into eight business establishments, and rehabilitation specialists
provide guidance and consultation through door-to-door visits, including improvement of the living environment and rehabilitation consultations. My role in the rehabilitation support project in
FY 2013 was to connect individuals with orthopedic illness, weakness, suspicion of dementia,
mental illness such as depression/panic disorder, withdrawal, and so on, who were followed up
with in FY 2012 after door-to-door visitations and were unable to be referred to care insurance
services, to new rehabilitation specialists. However, regarding high-risk elderly individuals withsuspected peripheral symptoms of dementia who lived alone, we received a request from thepublic health nurse in charge to continue support through door-to-door visits, so while building a
support system for the case with public health nurses and dietitians, we provided continuous,
unbroken support to these individuals, including solicitation of participation in health counselingsessions by the health coordinator, exercise guidance during door-to-door visits by rehabilitation
specialists, and general supervision by visiting support staff. As a result of reviewing the support
system at monthly area meetings where related organizations gather, one year later, it was connected to the Regional Comprehensive Support Center, and it was decided that cases would use
outpatient long-term care insurance services. From the beginning, we have had our eye on early
treatment at specialized hospitals and have worked to build a support system with this goal inmind, but since it was often difficult to obtain consent from family members living elsewhere,
we were unable to get as far as securing treatment in specialized hospitals. However, our support
efforts continue to progress in the direction of the use of admitted long-term care insurance services.
In order to prevent the deterioration of the health condition of earthquake survivors, Miyagi
Prefecture has positioned the Rehabilitation Support Project as one to create a regional support
system. The AHG consulted with the Regional Comprehensive Support Center and, in FY 2013,- 38 -

as a response to disuse syndrome that may occur in an environment lacking a local community
and as a method to achieve long-term care prevention, we collaborated with the Long-Term Care
Prevention Class held by the Regional Comprehensive Support Center to implement the Rehabilitation Support Project. My role was to coordinate, alongside the Comprehensive Community
Support Center and between rehabilitation specialists, the collaboration plan between the LongTerm Care Prevention Class, aimed at residents of tsunami-affected areas where community revitalization was an issue, and the Rehabilitation Counseling Association, a component of the Rehabilitation Support Project. In the future, we will coordinate for the holding of exercise classes
led by residents.
(2) Ishinomaki City Disuse Syndrome Prevention Project (Yuikko Project)
Since August 2011, the Yuikko Project has been underway in Ishinomaki emergency housingdevelopments. It aims to rebuild communities in temporary housing communities through thedetection of individuals at risk of disuse syndrome. The main elements of this project are ① deepvein thrombosis (DVT) echo examination by a doctor from Ishinomaki Red Cross Hospital anda joint examination team, ② group exercise guidance by NPO corporation health support Waku
Waku Genki Net, and ③ physical fitness assessments and rehabilitation consultation for individuals at risk of disuse syndrome by rehabilitation specialists. In addition to middle-aged and elderly
people with low activity levels, unemployed/retired people, and persons living alone, all of whomwere subject to medical examinations from the beginning, disaster-affected residents living intsunami-stricken areas were added in FY 2012. In FY 2013, we additionally provided health support to disaster survivors by adding private chartered housing residents and people identified as
DVT-positive in the previous year. In addition, to determine motor function and raise exercise
awareness, the rehabilitation counseling session will be incorporated into the business content of
the 2013 Yuikko Project. I am in charge of business planning and management, tracking thehealth status of DVT-positive individuals in the previous year, and carrying out surveys.
The DVT-positive rate in Ishinomaki City is still higher than that in non-disaster areas. Since
this is thought to be influenced by lifestyles and habits in post-disaster evacuation shelters, it has
been decided that from FY 2014 onward, content from the Lifestyle Diseases Aggravation Prevention Project, itself a part of the Disaster Reconstruction Project Plan and the Health Promotion
Plan, will be added.
(3) Mental Health Care Project
The author has been cooperating with efforts for the promotion of voluntary activities by the“Kamome no Kai,” an association of individuals with higher brain dysfunction and their families,
which has been promoted by the MHG since FY 2012. Since 2008, the MHG has been planningstudy sessions and exchange meetings for people with higher brain dysfunction and their families
living in Ishinomaki City and has continued to support the activities of the Kamome no Kai. In
2013, in response to the desire expressed by the Kamome no Kai to have the parties and theirfamilies share a common hobby, practice it, and further strengthen their bonds, the MHG and theKamome no Kai collaborated to put on a handbell concert. The concert was performed in frontof about 30 spectators. In the future, to further promote voluntary activities, we will continue tosupport the Kamome no Kai.
3. Collaboration with the Ishinomaki Regional Center
Alcoholism among disaster survivors is a problem everywhere, and Ishinomaki is no exception.
Many middle-aged and elderly drinkers experience physical illness due to heavy drinking and livewith anxiety, complaining of insomnia, irritability, and sometimes forgetfulness. The Ishinomaki
Regional Center is focusing on alcohol-related issues in collaboration with the Health Promotion
Division and other organizations, and the challenge is to further strengthen cooperation and referpatients to specialized alcohol-related treatment at an early stage. In addition, at the request of the
Health Promotion Division, the Ishinomaki Regional Center provides support for high-risk cases
identified as having mental health problems via the “Survey on Health and Life” conducted among
those affected by the disaster. Some people who have mental problems also have physical problems,- 39 -

and if intervention by a rehabilitation professional is necessary, the author receives a request from the
Ishinomaki Regional Center and provides consultation support.
4. Conclusion
From the beginning, I have continued support activities under the auspices of the health support
project developed by the Health Promotion Division. According to an analysis of life function risk
among elderly individuals conducted by Ishinomaki in 2011 (from a questionnaire survey), theproportion of high life function-risk individuals in the categories of “shut-in,” “falling,” and“dementia” risk were higher among elderly individuals in Ishinomaki than the national average 1). In
Ishinomaki, consultations on dementia are increasing owing to the collapse of the existing local
community because of relocation into temporary housing and to higher ground after the earthquake.
In addition, the number of elderly people living alone who previously relied on help and supervisionfrom individuals in their community but are now forced to rely on professional third-party services
for property management and so on is likely to increase. Given this increase in the number ofconsultations regarding dementia, we will continue to promote health support projects from theperspective of dementia prevention in collaboration with long-term care insurance staff and theComprehensive Community Support Center. Our challenge is to strengthen the implementation of thedementia support system.
The scope of our health support projects for survivors has expanded from merely temporary
housing residents to all individuals in tsunami-stricken areas, and we expect that support for publicdisaster housing residents will be required in the future. Amidst these circumstances, my role is to
identify physical and mental problems in my clients from a professional perspective and to connect
them to health support projects at an early stage.
References
1) Revised edition Ishinomaki City Elderly Welfare Plan/Fifth Long-term Care Insurance Business
Plan [FY2012–FY2014], Chapter 2, Current Situation and Future Vision Concerning the Elderly,
7–23.

- 40 -

Regular exerciseclassroom: Square-step
project, dumbbell leader

Playhabilitation Project- 41 -

Miyagi Nursing Association – Ishinomaki Municipal Kaisei Temporary Clinic – Cannes Tohoku

Area meetings

MDMHCC,
Ishinomaki Regional Center Karakoro Station [Mental Health Support HQ Project]

Alcohol-Related Counseling ProjectJapan, SWC Dispatch/Supporter
Training

Mental health care counseling
Mental health lectures
Training listening volunteers
Salon support via listening volunteers
Higher Brain Dysfunction Association support
Door-to-door visits

Figure 1: Health Support for Disaster Survivors in Ishinomaki Emergency
Temporary Housing and the Role of Each Organization

Survivor health surveys
Health counseling
Door-to-door visitations

Business Implementing Corporatin,etc.
8 business offices

Oral health counselingIndividual diet counseling
Nutritional counseling

Health counseling
Health classrooms
Consultation encouragement
Public health guidance

Health Promotion Plan Basic Philosophy: “ A community that supports everyone’ s efforts to behealthy”

Yuikko Project Team, Ishinomaki Red
Cross Hospital
Waku Waku Genki Net
Miyagi association of
Occupation therapists
Door-to-door visits/RehabilitationCounseling Association[Miyagi Health Support Project][Disaster Reconstruction Fund Project]

Disuse Syndrome Prevention
Project

Long-term care prevention
classroom In collaboration
with the Comprehensive
Community Support Center

Disaster Reconstruction Basic Plan, Outline 2: “ Relieve anxiety and restore livelihood”

Health Promotion Division – Public health nurses – Nutritionists – Dental hygienists – Psychiatric social workers – Occupational therapists

- 42 -

Public health coordinator
Door-to-door visits/healthcounseling・High-risk individuals who do
not leave their house often
・Individuals with reduced energy and who have received
guidance from rehabilitation
specialists

Figure 2: Flowchart of Rehabilitation Support Projects in Ishinomaki

Reports to District Supervising Public Health Nurse (Document Submission)

Implementation
reportCounseling register

Evaluation by basic surveys

Barrier-free target individuals with limited physical capacity

FY 2011 Rehabilitation
Support Project

Information provision

・DVT-positive people
・Individuals with reduced energy and who have received
guidance from rehabilitation
specialists

Disuse Syndrome Prevention
Project (Yuikko Project)

Basic survey forms
Door-to-door visit
records
Door-to-door visit
register

Comprehensive Community
Support Center・People who cannot be connected to existing services
・People not eligible for longterm care insurance・Long-term care prevention
classroom targets

FY 2013 Activities in Onagawa and Future Issues
Ishinomaki Regional Center, Onagawa Transfer
Psychiatric Social Worker – Tomoko Arashi
1. Introduction
This is the third year since our Center started operations in Onagawa. In 2013, one new psychiatric social worker joined us. Here, we review the activities of this new two-member system anddescribe future issues looking ahead into 2014.
2. Issues Faced by Onagawa
Compared to 2012, which was shortly after the disaster, in 2013, container-type temporary
housing and private chartered housing became the primary form of disaster housing used by survivors, and various issues related to life reconstruction became apparent. Table 1 shows several representative figures from the data collected in FY 2013 that formed the foundation of our activities
in Onagawa Town.
Table 1: Post-Disaster Characteristics of Onagawa Town
Item
Figures
Rate of population decline

Comparison Dates

10,016 persons ⇒ 7,461 persons February 2011–January 2014
25.5% decrease

Individuals designated as 381 persons ⇒ 535 persons
February 2011–September 2013
needs-support or
40.4% increase
needs-nursing
Households
livingin1,194 households, 2,839 people As of November 2013container-type
temporary
housing
Households
inprivate564 households
As of November 2013
chartered housing
In light of the situation made clear above, life in container-type temporary housing and private
chartered housing, originally scheduled to last for only two years, is expected to continue into 2013and perhaps even 2014, with very little hope for the future. This worsens the inactivity of townspeople and accelerates population outflow, advances development of illnesses and designation ofindividuals as “needs-nursing” patients, and makes it difficult to maintain community stability. In
addition, the development of living and transportation infrastructure has been delayed, and themeans of transportation and movement that townspeople lost to the disaster have not been restored.
This has spurred isolation, and alcohol problems, mental illness prevalence, and the progression ofdementia have accordingly become apparent. In addition, public disaster housing, which will be thefinal residence of the disaster-affected townspeople, will only be able to house 200 households by
the end of 2013, and at present, there is no prospect for 2014.
3. Resident Support
As mentioned earlier, in 2013, the addition of a second transfer employee allowed for a twoperson system to materialize in Onagawa, increasing the number of visitation support cases we wereable to see to by about 1.5 times (Table 2). In addition, the number of accompanying visits with Health Table 2: Visitation Support Cases Per Year
Center staff and temporary support staff increased.
FY 2012191
While cases that were previously handled individually were transitioned to team-based support and subFY 2013268
sumed under visitation case totals, the number of accompanying visits to consultations increased from five to 42. The main contents of support include
guidance on abstinence and avoidance of alcohol, prevention of isolation, a medical approach accompanied by a psychiatrist, intervention in mental illness, and watching over people with mental
illness.

- 43 -

The aforementioned support was provided in 2012 and 2013. However, a split between households receiving dense support and households without any support became apparent. In FY 2014,
we are making adjustments to understand the actuality of the support provision through means including mapping to identify households that have not received support so far. Through these efforts,
we aim to become better able to determine whether a particular household has not yet received anintervention despite the need for support, or whether that household does not need support at present.
However, at the end of March 2014, 200 households began to move to public disaster housing, andalong with this, residents flowed in and out of some temporary areas, making a new support systemfor community reorganization necessary.
Separately, the number of cases we have worked with in which alcohol-related problems are an
issue is increasing. It is true that the consolidation of emergency housing into temporary housing
units has made residents more visible to one another, thus bringing existent alcohol problems to thesurface. However, there are clearly many residents whose alcohol problems are rooted in disaster
experiences and/or inactive life in temporary housing. It is, therefore, becoming necessary to work
to solve the alcohol problem in the community via individual support and guidance on temperance/alcohol reduction in collaboration with the Onagawa Regional Medical Center.
In addition, we have cooperated with the staff of the Health Center in carrying out the following
resident support activities.
In the interest of saving space, details about the following activities have been omitted.
• Follow-up with high-risk people after a health survey of residents in private charteredhousing.
• Establishment of a mental health consultation desk at gatherings of townspeople consciousof their health.
• Being present at medical examination result briefing sessions and following up based on
physical data and questionnaires.
• Cooperation with “Designated Temporary (Private Chartered) Housing Residents Exchange
Meeting” (held in Sendai, Rifu, Osaki, Ishinomaki, and Higashimatsushima).
• Appearance on disaster FM radio programs (spreading awareness regarding mental health).
4. Support for Supporters
Personnel from the MDMHCC were first permanently installed in Onagawa in April 2012, andin the following month, I received a request for assisting with mental health promotion among
Onagawa government officials. Therefore, in consultation with the health supervisor, we continue
to carry out dissemination and enlightenment activities for government officials. Specifically, every
other week, we publish the “Heart Tsushin” with advice concerning physical and mental health, andin the week when it is not published, we hold the “Heart Salon,” opening a mental health desk from4:00 to 6:00 PM on Wednesdays. In addition, we have given out our e-mail address, allowing us toaccept consultations by e-mail at any time. In Onagawa, all staff members are required to include a
self-diagnosis checklist (created by the Central Occupational Accident Prevention Association)with their own arrangements at the time of health examination. We checked the contents of thesechecklists alongside the results of medical examinations, determined the necessity of an interview
by an industrial physician, and if necessary, ensured that an interview with an industrial physician
would be held at a later date. We were present at these interviews and continued to give advice on
mental health. This system was in place in 2012 and 2013, and we believe that the same will bedone in 2014.
In 2013, at the request of the Miyagi Prefecture Tobu Health and Welfare Office, we held twoseries of lectures for supporters on support for alcohol-related problems. Upon giving these lectures,issues relevant for the future and the ideal configuration of the support system itself, including
matters such as how to intervene in the community and advisors to look back on the cases involved,
became clear. At the moment, the official stance is that these lectures will continue in 2014, but thedetails are still to be decided.
In terms of individual supporter support, interviews are held at any time, not only with HealthCenter staff but also with temporary support staff, Regional Comprehensive Support Center staff,
Kirara Onagawa (Type B Continuous Employment Support Office) staff, and so on. This is donewith the awareness that the human and physical resources of the public and private sectors areorganically linked and that these efforts involve improving the effectiveness of resident support
systems.

- 44 -

5. Area Meetings
Onagawa Town is divided into seven areas, and support staff are assigned to all areas. Supervising
officials include temporary support staff, Comprehensive Community Support Center staff,
Onagawa Regional Medical Center rehabilitation staff, government office long-term care insurance
section staff, and SWC members. Together with these personnel, we participate in area meetings
held once a month to discuss support for individual residents and regional trends. As a matter ofcourse, the problems faced in each area are different, and sharing them across professions enables
a multifaceted approach. In 2012, the MDMHCC was never truly put in charge of any area, andwhen a case came up, the Health Center was consulted first. However, in 2013, we were put incharge of areas, and case consultations came directly from the temporary support staff. I feel thishas increased the speed of case handling.
From around December 2012, area study meetings have been held in addition to usual area
meetings. This is because, as the shift to public disaster housing began at the end of March 2013,
and residents moved in and out, there were many areas that were reorganized; thus, it was necessary
for all Health Center staff to discuss how to support such areas. These area study meetings havealso been organized in response to the fact that the current special post-disaster systems are notpermanent, and support programming will eventually have to shift to voluntary autonomous
activities. Therefore, we plan to continue this initiative once per month in the future.
6. Issues
As mentioned above, relocation of survivors into public disaster housing will start in April 2014.
That same month, the Chairmen and Vice-Chairmen of several neighborhood councils will also
relocate into public disaster housing; thus, there are several areas where neighborhood council
organizations will need to be restructured. In these areas, it is inevitable for there to be a period
where neighborhood councils are not functional. In such a situation, residents can experienceanxiety at not knowing whom to consult with if something were to go wrong.
Therefore, one issue is how best to follow up when neighborhood council functions are suspended.
Also, in another area, one of the two temporary support staff stationed is planning to retire, while
the other will be transferred to another area; thus, completely new temporary support staff will be
put in charge. When support staff are replaced, residents may be worried that they will need to
explain their individual situations from the beginning once more. Also, when support staff are new
to an area, they have to start work without knowing much about the residents and existing problems,
which is a heavy burden. Therefore, we believe that it will be necessary to work more closely withsupport staff and share information so that residents can consult with peace of mind and the burden
placed on support staff will not become too much to bear.
Regarding individual visit support, previously, part-time doctors at the MDMHCC weredispatched once a month for half a day, but to fully meet the needs of the community, it was changed
to a full-day dispatch system. In addition to allowing for a more medical approach, we believe thisnew system will help expand the functional scope of the staff of the Health Center and theComprehensive Community Support Center.
7. Conclusion
Three years have passed since the earthquake, and reconstruction is progressing, albeit gradually.
However, it is an undeniable fact that a “gap” in reconstruction progress (while some residents haverebuilt their homes early and are leaving temporary housing, others have not been selected for the
public disaster housing lottery, and there is no prospect of moving into the next public disasterhousing development) has become apparent. At times, I am asked by elderly individuals if they will
be forced to live out the rest of their lives in temporary housing. Even if we assume that thesethoughts are the product of emotional unease caused by confrontations with harsh truths, I want tobe the sort of supporter who can approach such feelings in earnest and walk alongside individuals
as they move toward finding their own answers, or at least something of the sort.

- 45 -

Looking Back on Our FY 2013 Activities in Higashimatsushima
Ishinomaki Regional Center, Higashimatsushima Transfer
Psychiatric Social Worker – Yuko Arai
1. About Higashimatsushima(1) Current Situation
In response to the needs of Higashimatsushima City, the MDMHCC has assigned staff here since
FY 2012. Before reporting my activities in Higashimatsushima, I would like to describe the city
itself. Table 1 shows data on the city, including its population and the damage it sustained in thedisaster.
Table 1: Higashimatsushima Population and Disaster-Related Damage Status
At the time of the
At present (3/1/2014)
disaster
Population
Households

43,142 people (3/1/11) 40,193 people (△ 2,949 people)
15,080 households
14,904 households (△ 176 households)
Totally destroyed: 5,514 homes (1,264 washedaway)
Nearly destroyed: 3,059 homes
Half destroyed: 2,500 homes
Partially damaged: 3,506 homes
Total: 14,579 homes (97% of households)
1,109 persons (65 of which are disaster-related
casualties)

Disaster damage

Casualties
Missing persons

25 persons

Container-type
temporary housing

29 locations
1,753 units

29 locations, 1,437 units (3,365 people), 82.0% occupancy rate

Privatehousing

1,312 units (11/4/11)

704 units (1,966 people)

charteredPublic disasterhousingGroup
relocation
promotion project

16 locations, 1,010 units planned
Can be moved into starting April 2014
5 locations, 254 units
7 complexes, 1,288 units(717 private housing units, 571 public disasterhousing units)*Created in accordance with data taken from the Higashimatsushima City website.
(Data on container-type/private chartered housing taken from Miyagi Prefecture website)- 46 -

(2) Main Disasters in Higashimatsushima
Higashimatsushima has experienced significant disaster damage over the years. Theseexperiences are put to use in post-disaster responses in the city, such as debris disposal. The main
disasters are shown below.
Table 2: Main Disasters in Higashimatsushima
Date
Name of disaster

Scale/Damage

June 12, 1978

Miyagi Offshore Earthquake

M7.4

July 26, 2003

Northern Miyagi Earthquake

M6.4

March 11, 2011

Great East Japan Earthquake

M9.0

Houses damaged: 8,602
Injured: 675*Total damage sustained by the former towns of Yamoto and Naruse.
The two were merged into Higashimatsushima City in 2005.
(3) Personnel Organization System in Higashimatsushima
The personnel organization system of the Higashimatsushima Health and Welfare Department
is as follows. Transferred staff are assigned to the Disability Welfare Team and take part in postdisaster mental health care alongside city public health nurses and staff dispatched by the Miyagi
Reconstruction Bureau.
Health and Welfare Department

Welfare Division
Parenting Support Division

Health Promotion Division

General Welfare Affairs Team
Disability Welfare Team
Lifestyle
Post-Disaster Mental
WelfareHealth Care Supervisors
Team
ElderlyCareTeam

3 Higashimatsushima
Transfers
1 Miyagi Reconstruction
Bureau Dispatch(4) Higashimatsushima Reconstruction Community-Building Plan (Formulated 12/2011)
Of the four basic policies of the Higashimatsushima Reconstruction Community-Building Plan,
health counseling and mental health care for disaster survivors is placed under item 2: “Town
development that facilitates support and allows people to live with peace of mind.”
2. Activities Undertaken this Year
(1) Community Resident Support① Individual Support
In FY 2013, we provided individual support for a total of 2,134 cases, including 1,079
telephone consultations, 173 walk-in consultations, and 882 visitation consultations (including
those overseen by transfer staff and individuals dispatched by the Miyagi Reconstruction Bureau).
The status of individual support this year is as follows.
a. Follow-Up Continuation for Post-Disaster Mental Health Care Cases from the Previous Year
We continued to provide individual support to cases that continued into FY 2013.
b. Health Survey Follow-Ups (Part of Higashimatsushima’s Suicide Prevention
Countermeasures Project)
In addition to health surveys for residents of container-type temporary housing and private
chartered housing, we conducted mental health questionnaire-based screening at specific medical
examinations in the city and followed up on those results (Tables 3 and 4).

- 47 -

Table 3: Health Survey Follow-Up Status
Treatment
Has lost 10
Distrib Collection
Insomnia +BeginsFollowsuspendedkg
ution (response
no hospitaldrinking
up targets K64)
owing toor more in(househrate)visits + no
duringmentalthe last yearolds) (households)
one to talk to
the dayillness
5)
1,672
655 (39.2%)
87
17
6
1
42
21

Container- FY
2012
type
temporary FY
1,498
405 (27.0%)
61
17
4
2
25
housing 1) 2013
Private chartered
945 675 (71.4%)
543)
14
2
4
17
housing 2)(FY 2012)
1) Container-type temporary housing resident health survey secondary follow-up (Miyagi
Prefecture “Health and Life Survey Form”).
2) Private chartered housing resident health survey secondary follow-up (Miyagi Prefecture“Health and Life Survey Form”).
3) Sixteen of them were requested to other municipalities by moving out.
4) Index for measuring anxiety/depressive symptoms.
5) For 2012, there was weight loss from before the earthquake.

13
17

Table 4: Follow-Up Status of Special Medical Examination Mental Health Questionnaire Screening
2+ items on
the CAGE
Individuals
Collection
Follow-up
scale orDistribution
K6
requesting(response rate)
targets
drinking tocounseling
get rid of
hangovers
Specific medical
examinations 6)~14,000 4,122 (29.4%)
356
44
127
185
(FY 2013)
6) Specific medical examination mental health questionnaire screening and secondary follow-up (Higashimatsushima City “Questionnaire on Mental Health”).
*A single individual can be included in multiple categories.
c. Other Cases We Worked With
In addition to the above, we worked with individuals with mental illness, shut-ins, and the elderly.
② Support Through Collaboration with Other Organizations
We collaborated with other organizations to participate in checkup accompaniment, case study
sessions, and case conferences, among other things.
(2) Support for Supporters (Assistance in Projects)① Strengthening Alcohol Countermeasures
a. Strengthening collaboration for preventive interventions: exploring individual support incollaboration with the Health Promotion Division.
b. Establishing a place to connect for recovery: preparation for the founding of a self-helpgroup.
c. Support preparation/ledger maintenance: creating risk criteria and developing support inaccordance with severity.

- 48 -

② Regular Meetings
In addition to alcohol countermeasures, we assisted with the consideration and implementationof projects in regular meetings held with city public health nurses.
(3) Other
We also assisted with data entry, recordkeeping, and other administrative business.
3. What I Have Realized Through Our Activities
Last year, our main task was post-disaster mental health care, and we functioned as auxiliaries tocity public health nurses. This year, our system changed because of changes in the city, and as the
Disability Welfare team was constantly being sent out to work, in addition to mental care after theearthquake, we played a role similar to that of city public health nurses, such as dealing with casesof mental disabilities and shut-ins. It may be said that the seconded staff who continued to enter
could act as a link at the time of transfer. On the contrary, the seconded staff felt that they lacked theability and flexibility to grasp the daily changing local conditions and needs.
By being involved in cases that are not limited to mental care after the earthquake, we have more
opportunities to collaborate with local psychiatric welfare initiatives and have come into contact
with local issues. Perhaps pre-earthquake issues have become more evident, such as scarce social
resources, insufficient isolation of persons and families with mental illness, inadequate networks ofrelated organizations, and lack of support for people who do not fit into existing services. It will benecessary to take this as an opportunity for intervention, by first raising a voice about the current
situation and then sharing it with the parties concerned.
Cases of suicide are increasing, and in a retrospective meeting with public health nurses,
commonalities between these cases were considered, including recovery-period depression, mental
isolation, financial problems, loss of roles and jobs, and the disproportionate involvement of theyounger generation.
Through follow-ups based on health survey results, we saw situations that clearly required
support, such as problem drinking. Some people were unable to call for aid by themselves, andhelping these individuals highlights the significance of the survey itself. In addition, although there
are a few people who were picked up multiple times as follow-up targets, most cases involved
different subjects each time, and I feel that regular implementation is effective. Furthermore, theimpact of the earthquake is not limited only to people living in container-type temporary housing
and private chartered housing, and it can be said that the mental health questionnaire at the time of
specific medical examinations was able to expand the target population, despite its limitations.
Health survey follow-ups often involved heavy drinkers. Those who were health conscious andwere able to go about their lives despite heavy drinking were provided information over the courseof a session or two. In addition, we tried to provide continuous support to those in concerning
physical or living conditions, and to those who wish to save drinking or stop drinking. Even if eachsession is short, I felt that if there was a system that allowed regular follow-ups through specificmedical examinations, it would motivate the affected person themselves, and supporters would not
run out of steam. Finally, some individuals were severe alcoholics. It is good that support began withthe survey, but there are many issues regarding support methods, and we must continue to reexamine them.
4. Toward Next YearI would like to continue the work done this year in the next FY. Health surveys will continue, andI would like to keep carefully following up on their results. Response rates to these surveys are
expected to continue to decline, and thus the matter of how to identify high-risk people becomes anissue.
In addition, we must keep in mind that the transition to public disaster housing will start in April
2014. We would like to assist other organizations to ensure that preparations for launching thealcohol self-help group, which started this year, and the care of bereaved families will continue, even
if they affect only a small group of people. I would like to continue to maintain records and caseledgers and to try to create a situation where support is not interrupted because of transfer
circumstances.
Finally, there are many issues, including support for working generations and supporter
exhaustion, that health surveys cannot accurately capture. While remaining abreast of the needs ofthe city, I would like to reconsider what it is that we, as external supporters, are uniquely positioned
to accomplish.
- 49 -

Looking Back on FY 2013 Activities
Ishinomaki Regional Center, Tobu Health and Welfare Office Transfer
Certified Psychiatric Nurse – Tomoko Uchida
1. Introduction
This is my second year as part of the Mother-Child and Disability Team at the Tobu Health andWelfare Office. In terms of my community mental health and welfare activities, I was often put incharge of home visits and consultation services normally handled by public health nurses. Further,
support for home visits has increased, and we have served not only affected individuals but also theirfamilies and coordinated with supporters of related organizations. At the workshop at the HealthCenter, we held a lecture for technical staff regarding a simple intervention program for heavy
drinkers to share information on mental health and welfare work. In addition, at the Japan PsychiatricNursing Academic Meeting, we exhibited a poster that functioned as an activity report of the
MDMHCC, helping us inform participants from all over the country about our daily work and thesituation in disaster areas (Fig. 1).
2. Individual Case Support

Counseling cases

TelephoneInterview

Home visit

Checkup
supportAccompaniment
duringfamily counseling

148

22

129

23

3

3. Support for Supporters(1) Specialist consultation and case support regarding management of alcohol-related problems,family classroom management support regarding alcohol use.
(2) Planning and management support for alcohol-related problem training.
(3) Creating a questionnaire for mental health and welfare consultation cases.
(4) Guidance to city public health nurses on health exercises for the elderly.
(5) Lecture at the in-house community health technical staff workshop.
4. Toward the FutureWork support at the Public Health Center is centered around assisting public health nurses in their
daily work, mainly for individual support for cases of mental disorders. However, as I work
alongside public health nurses on their daily support work as part of the mental health and welfare
activities in the region, I cannot help but notice that there are still a great many people who arestruggling to make it through each day because of the difficulty of their lives, and many who are
putting their bodies through horrible conditions in disaster areas as they try and fail to regain lost
livelihoods. In order to continue to provide support from within the community, it is of course
necessary to refer such individuals to treatment; however, I deeply feel that lifestyle support, whichenables these individuals to live peacefully in their chosen ways, is also quite necessary.
Coordination with related organizations and cooperation with supporters in the region has beensmoothly executed over the past year, and the fruits of our labor are beginning to grow. Nevertheless,still more time is needed to build effective networks.
As I move into my third year of work support via the transfer program, I aim to deepen mycollaborations with public health nurses and regional supporters while confirming and reconfirming
my own roles within the organization.

- 50 -

- 51 -• Management support for specialist counseling for alcohol-related problems.
• Management support for alcohol-related
problem family seminars.
• Planning and management support foralcohol-related training workshops.
• Management support for specialist counseling for puberty/shut-ins.
• Management support for mental healthand welfare counseling.
.

Implementing study sessions to deepen
awareness and understanding of dementia
among temporary housing residents and local community residents.

travel from the hospital out to local
communities, and get involved in a variety of post-disaster mental health careand welfare activities.

Figure 1: MDMHCC Activities

Raising Public AwarenessDo not concern yourself with whether or not the drinker
drinks.
- Do not clean up after them, and do not solve their problems.
- Distance yourself from their violence.
- Only have important conversations with the drinker when
they are sober.
- Participate in seminars and counseling sessions to giveyourself a chance to have your story beheard.
- The family should engage in
fun activities
together.
- Don’ t try to deal with allof this alone.

The family’ s
attitudeAt the Tobu Health and Welfare Office, we provide administrative support to individuals with alcohol-related problems and mental disabilities.

(As a certified psychiatric nurse, I

Liver disease (fatty liver/cirrhosis) Pancreatitis,high blood pressure,cancer,dementia,
depression

Malnutrition (loss of nutrients/dehydration)
Malnutrition (loss of nutrients/dehydration)~ Health problems ~Problems caused byexcessive drinking

Support for
Supporters

MDMHCC
Resident
Support<Ishinomaki Regional
Center Activities>• Social and Art Exhibition for residents of designated temporary hous• “ Koko
ing Farm,” a place where temporary housing and designatedtemporary housing residents can gather.

Resident Support/Provisionof Places for Healing• Counseling work with individuals who need disasterrelated mental health care.
• Counseling/visitations/interviews with alcohol abusers and theirfamilies.
• Individual support for individuals with mental disabilities whose
symptoms are worsening or who need connections to medical services, as well as with their families.
• Outreach lifestyle/medical support to enable individuals tolive stable lives after being discharged from a medical
facility.

Miyagi Branch, MDMHCC – Tomoko Uchida