Department Initiatives② Ishinomaki Regional Center, Community Support DivisionIshinomaki Regional Center: A Year’s Worth of Initiatives
Ishinomaki Regional Center, Community Support Division
1. Introduction
On March 11, 2011, a magnitude 9.0 earthquake caused a massive tsunami to hit the Pacificcoast of Japan. The three prefectures of Miyagi, Fukushima, and Iwate sustained horrific damage.
Many of the individuals affected by this disaster experienced irreplaceable losses, including
family members, homes, jobs, and communities, and continue even now to live in pain. The
Ishinomaki Regional Center of the MDMHCC was established on April 1, 2012 in an effort toengage in support activities for these affected individuals.
Pursuant to this goal of disaster survivor support, the Ishinomaki Regional Center has, in aneffort to better understand the status of various disaster-affected regions, made use of a variety ofevents, including conferences, training workshops, and case study meetings, to build a transparent
relationship with administrative agencies, SWCs, Comprehensive Community Support Centers,
NPOs, and other bodies active in the Ishinomaki area. Further, it has developed and implemented
support programming to assist disaster survivors in recovering from the damage done that day.
Here, we report on the results of these activities over the past year.
2. Developing Support
As we became more involved with affiliated organizations, we conducted interviews for
temporary housing resident support staff and administrative personnel, continued providing
support for alcohol-related problems, and provided places for private chartered housing tenants
to meet and socialize, among other initiatives.
(1) Support for Supporters
At the requests of administrative agencies and SWCs, we held “listening lectures” and group
work sessions for temporary housing visitation support staff and Comprehensive Community
Support Center staff, who frequently met directly with disaster survivors.
Further, at the request of administrative agencies, we conducted training workshops for andindividual interviews with health promotion staff and administrative personnel. Part-time
physicians from the MDMHCC served as lecturers. For individual interviews, we received
assistance from registered members of the MDMHCC Supporters’ Club. The details of our events
are as follows.
Targets
Onagawa Town SWC Temporary
Housing Support Staff
Training Workshop
Ishinomaki City SWC Temporary
Housing Support Staff
Training Workshop
Ishinomaki Jurisdiction
Comprehensive Support Center
Staff Training Workshop
Ishinomaki Jurisdiction Health
Promotion Staff Training
Higashimatsushima Nursing
Facility Staff Training
Ishinomaki Jurisdiction Nursing
Staff Training
Miyagi Prefecture Disaster Survivors’ Support Members Training

Details
Lecture: “Listening”
Group work

2

Participants
28

Lecture: “Listening”
Group work

9138

Lecture: “Self-Care”
Group work

1

68

Lecture: “Self-Care”

1254

Lecture: “Self-Care”

142

Lecture: “Self-Care”

1

10

Lecture: “Self-Care”

3

168- 48 -

Number of
eventsIshinomaki Public Health Nurses
Training
Toubu Health and Welfare Office
Jurisdiction Training*Ishinomaki Area Public Health
Nurse/Nurse Comprehensive
Support Center Staff Training

Lecture: “Self-Care”

1

18

Lecture: “Self-Care”

1

115

Lecture: “About Dementia”
Tokyo Metropolitan GeriatricMedical Center Physician

160Interview
Interview
Interviews
Interviews
Interviews

Target
Count
37
65
121
3
68

*Hosted by the MDMHCC.
[Supporter Interviews]
Targets and Support Content
Onagawa Town SWC staff and temporary support staff
Onagawa Town administrative personnel
Ishinomaki City SWC temporary housing support staff
Ishinomaki city-wide area administrative personnel
Higashimatsushima jurisdiction nursing welfare staff(2) Community Resident Support
We received a request from the city of Ishinomaki to provide visitation/telephone counseling tohigh-risk private chartered housing and emergency temporary housing tenants as identified by K6
scores collected via a health survey, and worked to reduce their emotional and mental burden.
Individuals receiving counseling were served via both repeated home visitations and walk-ins. Whenthe need arose, these individuals were referred to the Comprehensive Community Support Center, orwere accompanied on their visits by nursing-related staff, public health nurses, or nurses.
Further, we attended temporary housing district meetings and health counseling/case study
conferences, and also visited cases on an ad hoc basis after referrals from the Ishinomaki Jurisdiction
General Branch Office, Nursing Association, and Comprehensive Community Support Center.
The table below lists the number of visitations we were contracted for by the city of Ishinomaki
in FY 2012.
Targets

Number ofvisitations
Private chartered housing visitation targets
222
Emergency temporary housing visitation targets
96*We received assistance from the MDMHCC Supporters’ Club for private chartered housing visitations.
(3) Community Resident Support Projects(A space for art exhibitions and socializing for private chartered housing tenants, and the Koko
Farm Project, a survivor social initiative.)
We were often told by private chartered housing tenants that “temporary housing areas have art
exhibitions and places to socialize, but private chartered housing areas do not.” As several private
chartered housing tenants pursued art as a hobby, we established an artwork exhibition area, provided
them with a place to socialize, and hosted an “art exhibition and social” in an effort to help themregain their mental and physical health.
Works were exhibited in the Ishinomaki Joint Government Building Annex hall for two days: 1–
3 PM on Thursday, March 7, 2013 and 10 AM–3 PM on Friday, March 8. A great variety of works
were on display, including chigiri-e (torn paper collage), ceramics, wickerwork, knitwork, andJapanese papercrafts. In order to allow attendees to socialize, we had a café corner, hand massage,
and various do-it-yourself craft stations.
A total of 105 attendees visited on both days of the exhibition, and several asked the artists about
the creation of their works; socialization was in full swing. Attendees told us that they were “gladthat they got to talk to people who had lived here before the disaster” and that they “would like [us]- 49 -

to host the session once more” and to “host it in other areas.” We believe that this exhibition andsocial event contributed to the mental and physical health of private chartered housing tenants. We
hope to provide more such opportunities in the future.
With the cooperation of Higashimatsushima farm managers, we planned the Koko Farm Project,which would allow survivors to experience farming and fieldwork, and in FY 2012, we prepared
for this project by requesting affiliated organizations for their cooperation.
In FY 2013, we plan to implement the Koko Farm Project at full scale between April and October(half the year); we plan for the project to involve two hours of fieldwork and opportunities tosocialize twice a month in the mornings.
In the Infant Health Survey, we were requested by the city to provide “mother-child mental healthcare.” Our achievements in that respect in FY 2012 include holding related programming in the
Kahoku and Oshika areas of Ishinomaki 12 and six times in the last year, respectively. We plan tocontinue to provide this support in FY 2013 as well.
(4) Public Awareness and Support for Supporters Projects
Hosting the FY 2012 “Earthquake Mental Health Exchange Meeting in Ishinomaki” event
In an effort to foster collaboration between organizations active in the mental health care space
and to leverage these connections into effective disaster survivor support, we hosted the Earthquake
Mental Health Exchange Meeting, Miyagi in Ishinomaki” event. This social event was co-hosted
by the Disaster Mental Health Care Network Miyagi: Karakoro Station Foundation.
The event was based on the theme of “Current State of Survivor Support,” and at each of thesubcommittee meetings on the topics of “the elderly,” “people with disabilities,” and “children,”there were lively discussions regarding current tasks and future problems. During the general social
portion of the event, all attendees gathered in one room and were able to build face-to-facerelationships via the exchange of business cards and so on. We believe that this event wasmeaningful to those who participated.

Date and Time
March 1, 2013
(Fri).
3–7:30 PM
Ishinomaki
Grand Hotel

Details
Participants
1) Subcommittee Meetings:
104
a. Speak about the Current State of Elderly Support
b. Speak about the Current State of Disabled Support
c. Speak about the Current State of Child Support
2) Lecture: “Survivor Support from Here” – Hiroko Honma,
Niigata Disaster Mental Health Care Center3) General Social
We plan to continue to host such meetings to foster collaboration between affiliated organizations and to work toward the improvement of mental health and welfare in the region and beyond.
3. Ishinomaki Center: All-Hands Training Workshop
We of the Ishinomaki Regional Center hosted an all-hands conference and training session for allaffiliated staff, including transfer personnel, where we considered the status of support and our duties
in the area, and discussed issues and future directions. In particular, because we expect alcohol-related
problems to increase in the coming years, we conducted a four-part training workshop. The details ofthese meetings are listed below.

- 50 -

Part 1
Part 2
Part 3
Part 4
Supplementary
Training

Details
Lecture: “About Alcoholism (by a Physician),” group work
Case study, group work
Lecture: “Alcohol Problems as seen by the Ishinomaki Police Department,”group work
Case study, group work
Alcohol-related issues training report and group work

At the request of administrative agencies, the Nursing Association, and the Comprehensive
Community Support Center, we carried out support for alcohol-related cases.
Here, we would like to introduce an alcohol-related case that we worked with affiliatedorganizations to provide support for. We have received consent from this individual to publish thecase details here, but modifications have been made to remove any identifying information.
(1) Client: Mr. A, male, 60s, lives alone in temporary housing, single
Alcoholism, care level 1 (uses day service/helper)(2) Case Progress
Following a request from the care manager of the Comprehensive Community Support Centerin November 20XX, we had been providing support for Mr. A at the MDMHCC.
After the disaster, Mr. A had been living alone with the aid of a nursing service. He would
often begin drinking in the morning, subsequently becoming sleepy and lying down. This was his
daily routine. His eating was irregular, he had lost nearly all his energy, and his right arm andlower limbs showed signs of edema. At times, in his drunkenness, he shouted obscenities at thetemporary support staff and helpers who came to visit him.
City public health nurses, welfare staff, Comprehensive Community Support Center staff, caremanagers, helpers, day service staff, civilian welfare officers, and many other service personnel
were involved in Mr. A’s case. Unfortunately, these individuals’ work was not coordinated, andno one had any specific ideas on what to do for Mr. A. Exhaustion among his supporters was also
becoming a salient issue.
In February 20XX+1, an “alcohol-related problems study session,” organized by theComprehensive Community Support Center with Hospital B alcohol specialist staff (part-time
MDMHCC workers) as advisors was held. At this event, involved persons came together,achieving a greater understanding of Mr. A’s case. The care manager, who had the longest andbest relationship with Mr. A, was determined to be the point of contact moving forward, It was
decided on that meeting/that the care manager would be the contact point for support for Mr.A andcoordinate among the organizations involved in the support.
Mr. A had complained of high blood pressure, and after being recommended to see an internal
medicine specialist, consented. The care manager arranged for this, and in mid-March 20XX+1,
an MDMHCC staff member accompanied Mr. A as he visited an internal medicine clinic. We hadalready explained to this internal medicine physician that Mr. A had alcohol-related problems. Theinternal medicine specialist did as we asked and referred Mr. A for a psychiatric examination. At
this point, Mr. A himself had reached some level of understanding regarding his condition, and heasked the internal medicine specialist to write him a referral letter. In late March 20XX+1, Mr. A
visited an outpatient psychiatric clinic. The psychiatrist explained that based on descriptions of his
alcohol habits and his test results, hospitalization was necessary. The care manager madearrangements with Mr. A’s family, and in early April 20XX+1, Mr. A’s family admitted him to a
psychiatric hospital.
Two weeks after being admitted to the facility, Mr. A was able to walk with the aid of a caneor other mobility assistance device and his gait had become much steadier. The edema in his rightarm and lower limbs had disappeared, the color had returned to his face, and his expressions hadbrightened. He had slowly recovered his physical energy and was now even able to use the toilet
on his own. Mr. A himself, his family, and his care manager collectively decided that they would
consider admitting him to a long-term facility in the future.

- 51 -

(3) Case Wrap-Up
While a variety of support organizations were involved in Mr. A’s case, the supporters fromthese agencies did not share information with one another, and the point of contact was not clear.
Mr. A’s supporters were involved in his case in a disorganized manner and were growing
exhausted. Thus, we worked with the prefecture and other public health nurses to emphasize thefollowing two points in our collaborative support with other organizations.
①. In order to further their mutual understanding of Mr. A’s case, the supporters involved in his
care would implement a case study session or an alcohol-related problems study session.
②. The care manager, whom Mr. A trusted, would become a point of contact for Mr. A’s case andmediate the involvement of other organizations.
In this case, information exchange and proper collaboration between involved persons was
finally achieved following the study session. Further, the care manager, trusted by Mr. A, became
the one who would deal with affiliated organizations, and interactions with his family became
quite smooth.
This case reminded us of the importance of collaboration and information sharing between
supporters.
4. Looking Back on One Year of Activity
We have developed our activities over the past year in collaboration with affiliatedorganizations throughout the region. Our collaborative relationships with these organizations haveallowed us to provide advice enabling more effective support of counselees by deepening ourmutual understanding of the roles and characteristics of each organization. Further, through casestudy sessions and conferences, we have aimed to deepen understanding between supporters,
confirm the content of our support, and move toward more effective support.
Further, we believe that continued collaboration between affiliated organizations willcontribute greatly to the improvement of mental health and welfare throughout the region.
In the future, as we continue to develop our work, we hope to take the aforementioned lessons
to heart, and in our correspondence with disaster survivors and support organization personnel,
keep in mind the following creed: “Listen closely to people’s stories, empathize with, and respect
their feelings, and think alongside them.” We hope to work as closely as possible with thoseaffected by the disaster to continuously improve the quality and scope of our support endeavors.

- 52 -

Insomnia Among Tenants of Temporary Housing and its Causes
Ishinomaki Regional Center, Ishinomaki City Transfer
Occupational Therapist – Miyoko Kubota
1. Introduction
Two years and two months have passed since the Great East Japan earthquake, which occurredon March 11, 2011. Ishinomaki suffered enormous damage in the disaster, and over 10,000 people
still live in emergency temporary housing. At the Ishinomaki City Health Promotion Division, where
I was transferred, we have developed a variety of projects aimed at maintaining the physical andmental health of emergency temporary housing tenants (hereafter “temporary housing tenants”), but
at our counseling sessions and so on, there seems to be an endless supply of tenants complaining of
insomnia. In this manuscript, as part of the Disuse Syndrome Prevention Project (the “Yuikko
Project”), we will survey the daily activity levels of tenants, explore possible causes of insomnia, andreport our results.
2. Subjects
Our subjects were 102 (26.4%) of the 387 tenants who complained of insomnia, surveyed
between March and July 2012 as part of the Yuikko Project. Twenty-one of these individuals weremen and 81 were women, with a mean age of around 69.4±8.3 years. All subjects exhibited symptoms
of insomnia: 56 (54.9%) had difficulty falling asleep, 22 (21.6%) experienced nighttime awakening,two (2.0%) experienced early morning awakening, and 22 (21.6%) had difficulty achieving deep sleep.
Thirty-eight (37.3%) individuals were using hypnotics.
3. Results(1) Daily Activity Levels
While the most common response among tenants was that they “frequently worked outside”(40.2%), responses indicating low activity levels, including “sedentary” (26.5%), “frequently workat home” (24.5%), and “sometimes lie down” (5.9%), made up more than half of all answers,
indicating that tenants complaining of insomnia have reduced activity levels (Fig. 1).
Usually lying

Sometimes
down
Sometimes
lie lie
down
5.9%
5.9%

Usuallylying
down 1.0%
down 1.0%

No response
2.0%
No
response

2.0 ％Frequently
Frequently
work
work
outsideoutside
40.0%
40.2%

Sedentary
Sedentary
26.5%

26.5%

41
25
Frequently
work
at homework
Frequently
at 24.5%
home 24.5%

Fig. 1: Daily activity levels among temporary hous-

Fig. 1:Dialy activity levels amongtemporary
housing tenants
complaining of insomnia
ing tenants
complainingof insomnia- 53 -

(2) Frequency of Going Out (for 30 Minutes or More)
While those who went out “nearly every day” (48.0%) and “more than three times per week”(23.5%) accounted for more than 70% of all responses, the results indicate that nearly 30% of
tenants complaining of insomnia showed a tendency toward shut-in habits, stating they went out“around once per week” (20.6%), “around once per month” (3.9%), and “almost never” (2.9%)(Fig. 2).
Around once
per month
Around once 3.9%
per week
20.6%

Nearly never
2.9%

No response
1.0%
Nearlyevery day48.0%

Around 3
times per
week
23.5%

Fig. 2: Frequency of going out (for 30 minutes or more) amongtemporary housing tenants complaining of insomnia(3) Causes of Insomnia
Causes of insomnia that tenants were subjectively aware of included physical factors, suchas “frequent use of the toilet at night” (8.8%) and “joint and/or muscle pain” (2.9%),
psychological factors, such as “anticipatory anxiety or other anxiety symptoms” (5.9%) and“mental illness” (2.9%), and environmental factors, such as “being woken by noises and/or
snoring” (2.9%) (Fig. 3). However, 73 individuals (71.6%) did not provide answers identifying
any specific causes of insomnia.

Frequent use of the toilet at night
Anxiety symptoms (anticipatory
anxiety, etc.)
Joint and/or muscle pain
Woken by noises and/or snoring
Mental illness
Wake after not getting enough exercise
Cannot sleep when too tired
Cannot sleep because hands and feet
are too cold

Male

Dreamful sleep

Fig. 3: Causes of insomnia among temporary housing tenants
complaining of insomnia- 54 -

Female4. Discussion
Our results suggest that reduced daily activity levels and low frequency of going out wereaffecting the sleep habits of temporary housing tenants. Epidemiological surveys in Japan haveidentified three independent factors related to insomnia: stress, lack of exercise, andunemployment 1). Further, in the wake of the 2004 Niigata Chuetsu earthquake, the role of disuse
syndrome and the importance of treating attendant losses of functionality in activities of dailyliving were emphasized 2). In addition to evaluating the daily life functions of individuals
complaining of insomnia, it is important that we increase their opportunities to participate in
exercise and physical activity and heighten their daily activity levels.
The causes of insomnia among tenants complaining of insomnia were divided into three
categories: physical, mental, and environmental factors. In the case of physical/bodily factors, werecommend that individuals be referred to a specialist and that they receive treatment for theunderlying causes. However, in this study, in more than 70% of the tenants who complained ofinsomnia, the cause could not be identified. One important outstanding issue is the building of adiagnosis and treatment system that allows individuals immediate access to care after insomnia
onset 3). We must identify the effects of insomnia causes and insomnia itself on the body via
counseling sessions and so on, and quickly move to collaborate with medical organizations.
5. Conclusion
We determined that reduced daily activity levels were one cause of insomnia. In an effort toensure that countermeasures against disuse syndrome among temporary housing tenants lead to
improvements in sleeping habits, we plan to continue to support projects that seek to maintaintheir physical and mental health.
References
1) Konno, M., Kameyama M., Uchiyama M.: Anxiety Disorders and Sleep, Psychiatric Therapy,
313; 1139–1145, 2012, Hoshiwa Publishing.
2) Cabinet Office: Recommendations of a Study Group on Regional Disaster Prevention Measuresin Areas Scattered in Villages Such as Mountainous Areas.
3) Ozone, M., Hirabayashi, M., Kuroda A., Itou, Y.: Understanding and Working with Insomnia
Symptoms, Psychiatric Therapy, 312; 999–1005, 2012. Hoshiwa Publishing.

- 55 -Higashimatsushima Activity Report
Ishinomaki Regional Center, Higashimatsushima Transfer
Psychiatric Social Worker – Yuko Arai, Shizuka Oguchi
I was transferred to the city of Higashimatsushima after it was decided by the JAPSW that with
their assistance, there would be one or two psychiatric social workers rotating through on a daily basis
beginning in January, after which in April, Shizuka Oguchi and myself would be permanently stationed in Higashimatsushima. I was placed in the Welfare Division of City Hall and put to work on
post-disaster mental health care with two public health nurses from the Disability Welfare team.
Our primary work is to provide individual support via telephone/visitation to high-risk individuals
as identified from the results of health surveys conducted by the prefecture or city, or as listed in
Support Center or Comprehensive Community Support Center data. Insomnia, depressive affect, andbinge drinking are common among these individuals, and background factors include loss of a loved
one, family issues, loss of employment, anxiety regarding the post-disaster rebuilding of their lives,and bottled-up emotions following the disaster. By listening to them speak, we help put them at ease,and can, if needed, refer them to other societal resources. When doing so, our paramount concern is
to “respect the needs and pace of the individual.”
In addition, regarding individuals targeted via health surveys, we provide counseling to direct
walk-ins. While there are times when the counseling an individual is seeking appears to have no
relation to the disaster, we often uncover surprising, distant relationships between the two. We also
continue to provide this service as a way of supporting local supporters.
Nearly all local supporters in this area were affected by the disaster. They continue to workwithout time to rest their minds and bodies, and with their own myriad emotions and circumstances
set aside. As we think of the feelings and circumstances that drove them to such lengths, we reaffirm
the unforgettability of their sacrifices, and resolve to continue to work alongside them.
The foundation of our activities has been, since the beginning and till date, the ideal of local
public health nurses: “We do not want to lose even one more person.” Post-disaster mental healthcare is a long-term undertaking, and our transfer appointment is a short-term posting. Thus, one ofour goals is to build relationships between community residents and City Hall. We hope to be able tospread seeds of awareness among residents, such that they will think to turn to the city if they needcounseling or realize that it is okay for them to approach the city with questions regarding alcoholrelated problems. (Written by Yuko Arai.)
I was dispatched as a transfer employee to the Higashimatsushima City Department of Healthand Welfare, Welfare Division, Disability Welfare Team alongside Yuko Arai in April 2012.
The first thing we were told by the public health nurses we worked with was the following passionate statement: “I don’t want anyone else to lose their lives to this disaster. These people havesurvived; I want them to keep on living.” Through these words, I realized just how important the duty
that had been entrusted to us was, and I remember deciding that we had come to our posts to realize
this dream.
As I began to wonder what exactly I could do in my new position, I thought about living up to
the expectations of the public nurses we worked with, and decided to make “putting a smile on thenurses’ faces” my goal.”
These public health nurses are very busy and do not even have time to eat lunch in peace. I resolved not to get in their way, to adjust myself to the local atmosphere, and to keep calm and smilingat all times.
As I started becoming involved in actual work, I was surprised at how easy it was to get alongwith everyone. This was because the workplace environment was wonderful. I cared for my colleagues and for myself, thought of the residents as my family, and was truly moved at how wonderfula place Higashimatsushima was. I also feel that we were given a job that plays to our strengths, enabling us to build a mutually beneficial relationship and function as part of a team.
Thanks to this fortunate environment, I feel I was able to put my all into working for the benefitof the residents of the city. In this past year, I have met and talked over the phone with so many
- 56 -

different people. All the residents of this city are our targets, and I have realized quite deeply that
their pain is unrelated to the degree to which they were affected by the disaster, and that very few
individuals will, of their own volition, say that they are in pain. At the same time, I have remained
aware of the need to build a good relationship between these individuals and the city itself, so thatthey can rely on it as necessary.
Would a city resident, if asked, say “I’m glad she came to Higashimatsushima”? Have I reallymanaged to put a smile on the public health nurses’ faces? As I ask myself these questions, I lookforward to my second year of work in this position.
(Written by Shizuka Oguchi.)- 57 -

Looking Back on FY 2012 Mental Health Care Activities in Onagawa
Ishinomaki Regional Center, Onagawa Transfer
Psychiatric Social Worker – Tomoko Arashi
All governmental buildings in Onagawa were damaged during the disaster, and a large amountof data stored inside the government office was lost. Furthermore, all administrative personnel wereaffected by the disaster. Staff members who had lost a wife, child, or parent to the tsunami were notuncommon. At the same time, if we look at the designated temporary housing and individual cases
outside of welfare households (and I believe this is something that could probably be said for otherregions as well), a great many cases of alcohol-related problems can be observed. Onagawa has always had a very lively fishing industry, and many cases involve individuals who worked on fishingboats in their youth. It was not rare for these fishermen to be in on-board environments where alcohol
use was a given. For this reason, individuals who were forced to give up fishing owing to the disaster(or perhaps prior to it) found it rather difficult to escape from years of training oneself to wake up
early in the morning and go to sleep early at night, and ultimately found themselves with very little
to do during the day. For this reason, many turned to drinking. Further, while many individuals who
had retired prior to the disaster led similar lives, at that time, such habits were explainable as those of
one who merely “enjoys his drink.” However, after being placed in temporary housing, in close proximity to other residents, trouble was far closer at hand, and these individuals began to be viewed as“troublesome drunkards.”
In light of these circumstances, we of course provided individual follow-ups to town residents,
and also directed our efforts toward support for the Town Hall staff. Specifically, we disseminatedinformation on staff mental health, established a staff counseling counter, and provided counseling
via email as necessary. We named our information exchange letter the “Heart Tsushin,” and collecteda variety of facts on mental and physical health, enabled individuals to read the letter from theirborrowed computers, and are currently adding new issues every other week. The counseling counterfor the staff was named the “Heart Salon,” and is currently being held in a room inside the governmentbuilding every second and fourth Wednesday. Initially, we held the salon from 1:30 to 4 PM, but
despite the fact that the Director of the General Affairs Division had given employees leave toparticipate in the salon during business hours, most staff did not feel comfortable leaving their desks
in the middle of work. Thus, we consulted with the Town Hall, and from FY 2013 onwards, changed
the time slot to 4 to 6 PM, allowing personnel the chance to make use of the service after work. As
we plan to change the timing of the salon in April, which is very soon, there are still only a few
individuals making use of the service, but after the change, we plan to implement a variety ofmeasures to increase participation. Further, in terms of my duties as an MDMHCC employee, one
unique responsibility I have relative to staff in other regions is that I am also in charge of providing
back-to-work support to administrative personnel. As mentioned earlier, these individuals were allaffected by the disaster and had also been functioning as supporters for quite some time; thus, in thecase of many of these individuals, their mental and physical health was destroyed, and they wereforced to take leave of absence. I conducted multiple one-on-one interviews with these individuals,
worked with their attending physicians at Health Care Centers as needed, and helped them movetoward recovery. At present, the individuals whom I have had the pleasure of working with havereturned to work and are contributing meaningfully to their departments. I plan to continue to watch
over their progress in their early days of re-employment.
In terms of resident support, I began first with private visitations to tenants of private charteredhousing who were determined, via a health survey, to need follow-up. At the same time, I took overthe cases that public health nurses had been supporting through visitations and the like, and continue
to be in charge of them. Finally, in December 2012, I moved my desk from the Public Health Center
to the Welfare Section of the Health and Welfare Division at City Hall and became involved in the
support of welfare households that also have issues with mental illness.
As I think of individuals who will continue to live in temporary and reconstructed housing, I feel
my next goal should be to set up a Danshukai in Onagawa. In any case, I hope to continue to provide
long-lasting support to the people of this town.
- 58 -

FY 2012 Activities in Review
Ishinomaki Regional Center, Tobu Health and Welfare Office Transfer
Certified Expert Psychiatric Nurse – Tomoko Uchida
The Tobu Health and Welfare Office predicted that in the wake of the disaster, counseling cases
related to mental health issues, including alcohol-related problems, would increase. Thus, in an effort
to support work with individuals with alcohol-related problems or mental illness, I began providing
professional support as part of the Mother-Child Disorders team in April 2012. As I had been working
for private medical institutions for so long, when initially faced with the difficulty of mental healthand welfare tasks in the region, I found it problematic to situate myself, and floundered for some time.
However, the leader of the Mother-Child Disorders team and my fellow public health nurses gave me
invaluable advice, and I was able to work through this past year. My main duties during this time aresummarized below.
①. Support for Individual Cases(1) Visitation/interview support for individuals with alcohol-related problems or their families.
(2) Individualized support for individuals/families with mental illness who are experiencing
worsening symptoms or need help arranging medical services.
(3) Counseling support for individuals who need mental health care because of the disaster.
(4) Lifestyle and care support via outreach to enable individuals to continue to lead stable lives
after retirement.
②. Public Health Center Professional Support(1) Management and case support for alcohol-related special counseling, and creation ofmaterials and management support for alcohol-related problem family seminars(Document 1).
(2) Planning and management support for training workshops on alcohol-related problems.
(3) Management of specialist counseling and case support for adolescent shut-ins.
(4) Management support for developmental counseling (specialist counseling by pediatricians
for children with delayed motor development and for their parents).
(5) Professional support for checkup support provided by the Public Health Center for municipal
infant checkups.
After being involved in these duties for one year, I have realized one thing above all: the sheer
number of individuals throughout the region who had been living in horrible conditions even before
the disaster, who were exposed to a variety of significant stressors afterward, and who continue to go
about their daily lives with alcohol-related problems or various mental issues. I have also realized thesheer necessity of the activities of public health nurses and medical professionals, who work daily toensure that these individuals’ lives are at least somewhat supported. In order to construct a communitythat will enable individuals with some sort of mental illness to live out their lives, I believe that further
and farther outreach activities are necessary. As medical workers, to ensure that our activities in thecommunity can be conducted as smoothly as possible, close collaboration with Public Health Centers(and other administrative agencies) that carry out mental health activities in the region are vital, andfurther network building between medical, community, and administrative entities is essential.
As a nurse who has moved her arena of practice from the clinical domain to the community, I plan
to continue to share information and collaborate with affiliated organizations, make full use of my
specialist knowledge and communication skills in psychiatry, and attend to my duties, all in an effort
to build a community in which individuals with mental issues can more easily live out their daily
lives.

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Rules for participationin this seminar

Alcohol Seminar

Please do not repeat details sharedby another participant anywhere
else.

Ishinomaki Public Health Center

Please only listen to what other participants have to say. Do not offer critiques or criticisms.

What Alcohol Does

What happens to alcohol inside my body?

Cheers you up
Relieves anxiety
Lifts your moodGets broken down
Eventually
in your liver
even reaches
your brain
Gets absorbed inyour gut and small
intestine

Can lift depression
Removes your inhibitions
Can help you sleep(But drinking too much
has the opposite effect)

Problems caused by excessive
drinking~ Health problems ~ Malnutrition (loss of nutrients/dehydration)
Liver disease (fatty liver/cirrhosis)
Pancreatitis, high blood pressure,cancer, dementia, depression~ Domestic & social problems ~Drinking and driving, accidents
Strife at home, violence, divorce
Unemployment and otherfinancial troubles

Travels throughout yourbody via blood

The effects of drinking on the body
Esophagus• Esophagitis, • esophageal cancer, • esophageal
varices
Liver

Mind, brain, and nerves• Acute alcohol poisoning• loss of memory• hypobulia dementia (cerebral atrophy)• neuritis • TPO disorders• autonomic dysfunction• Fatty liver • liver fibrosis• alcoholic • hepatitis• cirrhosis• Cardiac hypertrophy, • arrhythmia, • hyperemia• Diarrhea, colonic cancer• Acute gastritis, • gastric ulcers• erosive hemorrhagic gastric ulcers• Pancreas

Small intestine

Cardiovascular system
Stomach/duodenum

Pancreas• Digestive malabsorption• Acute/chronic pancreatitis, • cholelithiasis• diabetes

Gonads/genitals• Men: testicular atrophy, • impotency• Women: • Amenorrhea, miscarriage,• Peripheral neuritis, anemia, gout
• osteoporosis, • femoral head necrosis

premature delivery, fetal alcohol syndrome- 60 -

Peripheral nerves, bones, blood

How much should you drink in a day?
Middle-aged mens

Women/elderly individuals

Pure alcohol: 20g
Beer (5%): 500 ml

Pure alcohol: 10g
Beer (5%): 250 ml
Sake (15%): less than 1/2 bottle
Choshu (25%): 50 ml

Sake (15%): less than 1 bottle
Choshu (25%): 100 ml

Overdrinking
Equivalent of more than 60 g of pure alcohol
Pure alcohol conversion (gram): volume drank * alcohol concentration * 0.8
Beer, 5%: 1500 ml (3 500 ml cans)
Sake, 15%: 500 ml (slightly less than 3 bottles)
Choshu, 25%: 300 ml
Chu-hai (7%): 1050 ml (3 350 ml cans)Wine, 12%: ~625 ml (4/5 of a bottle)
Whiskey, 43%: 180 ml (3 doubles)

Chu-hai (7%): ~350 ml
Chu-hai (7%): ~175 ml
Wine (12%): ~200 ml
Wine (12%): ~100 ml
Whiskey (43%): 60 ml (one double) Whiskey (43%): 30 ml (one single)

Appropriate amount of alcohol: 20 g of pure alcohol
Women and elderly individuals are more susceptible
to the effects of alcohol, and should only drink half that.

Individuals who overdrink regularly have thepotential of becoming alcoholics.

Let's look at how much alcohol we drink:
Use the handout given to you.

Some individuals that habitually

Screening A

drink or overdrink eventually

Men: 5+ points, Women: 4+ points

progress into full-blown
alcoholism!

Screening B

Men/women: 19 or fewer points

You should try to reduce the amount
you drink.
Men/women: 20 points
or moreYou are at a very high risk for alcoholism.
You should consider being seen by a medical
professional.

Characteristics of alcoholism

Diagnostic criteria for alcoholism
①.
②.
③.
④.
⑤.
⑥.

Not at ease unless there's some alcohol at home.
Ends up wanting to drink it even if it's hidden.
(Strong need for alcohol, compulsion)
Cannot control the amount of time spent
drinking or the quantity of alcohol consumed(loss of control)
Once the alcohol at home runs out, starts tremblingor grows annoyed (withdrawal symptoms)
Requires more to get drunk (tolerance)
Alcohol becomes more of a priority thanwork or home life
Physical illness, worsening of depression,
troubles at work or at home (adverse events)

It is a disease involving a lack of control in drinking.
When an alcoholic's alcohol runs out, they exhibit withdrawal symptoms.
It is a chronic, progressive, fatal disease.
It causes mental, physical, and social complications.
The only real path to recovery is to completely stop alcohol intake.
Alcohol cannot be quit alone.
This disease involves ignoring one's own
problems.
It has nothing to do with one's personality.

*If three or more of the above apply to you, you might
have alcoholism.

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The vicious cycle at home
In an effort to do something,a family member puts theirown issues aside and cleansup after the drinker.
Try to look for areasonBegin to hide things
and feel alone• They do not realize it
is a problem...
• They think they are
not being trusted...
• Theycontinue to only think that•things are bad deep down...
• The drinking willcontinue.
Constantly overwhelmed by unending problems

Responsibilities become unclear• I drink because you'realways pestering me!
• What's the big deal if I
drink on my own dime?!
• - Just let me drink anddie in peace!
• Alcohol doesn't eventaste good anymore!

Denial/loss of emotions, begin to reactreflexively to situations without any
thought

Changing the vicious cycle
They'll move towards a life that respects their own
needs!

The family's attitude

If a problem occurs,
make sure the drinker
knows it's their responsibility

I can't deal with all ofthese by myself! The
drinker will then become
open about their problems
and seek advice

A variety of problems
and worries will surface• If only they'd just stop
drinking...
• I've got to take care ofthem...
• • - I'd have divorced them long
ago if we didn't have
• They keep telling me
I'm the one at fault...
• I'm just so tired...

▪ Do 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 thedrinker when they are sober.
▪ Participate in seminars and counseling sessions to give yourself a chance to have yourstory be heard.
▪ - The family should engage in fun
activities together.
▪ - Don't try to deal with allof this alone.

The drinker will
begin to experience
the fact that they're
unable to control theirdrinking habits

The drinker will realize that they can't
just keep drinking
like this.

If you try to quit by yourself...

A self-help group is...
A group of individuals and families that are
grappling with alcoholism.

• The strong need to drink, mood swings, insomnia,
and other symptoms can cause you a lot of trouble.

AA: Hebita Community Center, Tuesdays, 2-3:30 PM
Danshukai: Medical Association Hall, Saturdays, 7-8 PM• You might start arguing or fightingwith your family and friends.

If you would like to be seen by aprofessional...

Why not try participating
in a self-help group or
getting seen by aprofessional?

Talk to your doctor, a municipal
public health nurse, or go in to
your public health center.

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- 63 -