Section I
Miyagi Disaster Mental HealthCare Center
Activities

１． FY 2018 Report
２． Department Initiatives
３． Collaborative Initiatives

1. FY 2018 Report

FY 2018 Project Activity Status
FY 2018 Miyagi Mental Health Care Forum Report
Child Mental Health Care Community Center Project

FY 2018 Activity Status by Project

FY 2018 Activity Status by Project
Director, Psychiatric Social Worker – Yuichi Watanabe
Manager, Psychiatric Social Worker – Tetsuro Higuchi

Introduction
According to the “Basic Guidelines for Reconstruction after the Great East Japan Earthquake,” the recovery
and reconstruction period was slated to end in 10 years, in 2020; there are now but two years left of this period.
Based on where we are with regards to the restoration of infrastructure necessary for daily life, the outfitting
and preparation of permanent residences, the revival of industry and commerce, and declining air dose one
might say that we are in the “wrapping up” phase of our recovery and reconstruction efforts.
Founded in December 2011, the Miyagi Disaster Mental Health Care Center has now been active for eight
whole years. Progress in the reconstruction of damaged residences has helped accelerate efforts to move community members out of temporary accommodation; as a result, the landscape of disaster-affected areas and thelives of the people that call these areas home, have been transformed. In response to broader trends, this center’s
activities, too, have changed.
We will use business statistics to examine this center’s initiatives and projects in FY 2018; the current stateof affairs; and the varied issues facing disaster-affected areas. We will also focus on and describe previoustransitions and changes that have manifested in disaster-affected areas since the earthquake first occurred.
1. 2018 Achievements by Totals
Table 1 summarizes the results and achievements of our projects by the department.
As for resident support, we saw a decline in the number of support cases we handled—a total of 6,451 in FY
2018 as opposed to 7,237 cases in FY 2017 (FY 2016 6,752). Despite the year-on-year decrease in the numberof cases handled by the Stem Support Division (FY 2016 1,727; FY 2017 1,602), the caseloads at the Kesennuma Regional Center（FY 2016 1,235; FY 2017 2,100; FY 2018 2,235) and the Ishinomaki Regional Center(FY 2016 1,341; FY 2017 918; FY 2018 1,229) have fluctuated around their previous values. If we examine
case totals by support method (Table 2), the yearly decrease in the number of “visitation counseling” cases
becomes apparent. For example. last year’s figure for total walk-in counseling cases was 1,805, a slight increase
as compared to two years prior (FY 2016 1,211; FY 2017 1,700).
Regional Community Support Divisions
Planning Division
Kesen- Ishinomaki Stem
Municipality
numa
Transfers
Resident support
2,235
1,229
1,099
1,767
33
Support for supporters
63
260
325
605
0
Public awareness
168
44
51
44
52
Human resource devel8
15
21
17
24
opmentSupport for various ac600
50tivities
Research
102
02

Stem C Part-time/ Supporters,
Mgmt
ContractetTotals

35
85
31
38

3
4
13
9

50
48
2
4

6,451
1,390
405
136

1

0

0

12

11

0

0

16

Conference liaison

48

0

2

1,940

533

363

279

556

－5－

159

FY 2018 Bulletin, Issue 7

The number of cases handled by transfers was 2,333 in FY 2016; 2,471 in FY 2017; and 1,767 in FY 2018,indicating the beginning of a downward trend. One possible factor driving this pattern may be the fact that atransferring employee left in the past year. In FY 2018, despite a noticeable decline in cases of support for
supporters and a slight increase in public awareness and research activities, no remarkable yearly or centerbased trends were observed.
Increases in the number of Resident Support, and Support for Supporters cases handled by the Supporters’
Club and others, are believed to be the result of their cooperation with child cohort studies, etc.
2. Project-Specific Changes
This center’s activities are organized around six project focus areas. Below, we lay out the results of our workin each of these areas.
(1) Resident Support① Target Demographics
a．Total Number of Support Cases and a Comparison of Response Methods

Table 2 provides a breakdown of the total number of Resident Support cases, according to support
method. Previous trends included overwhelmingly large numbers of visitation counseling cases and multiple outreach support cases as well. However, these numbers have decreased in recent years (from 3,068
in FY 2016 to 2,913 in FY 2017); at the same time, there has been an increase in walk-ins (from 1,211 in
FY 2016 to 1,700 in FY 2017) and telephone counseling cases (from 1,843 in FY 2016 to 2,131 in FY2017). The proportion of these cases to our case totals has seen a yearly increase and is now close to thenumber of visitation cases we handle. If we look at the breakdown of walk-in counseling cases by thecenter (Figure 1), Kesennuma Regional Center’s share of walk-in cases is far and away from the largest;
it is readily apparent that this method of support has replaced visitation and telephone cases.
Table 2: Total Cases by support method (excluding mail correspondence, N = 6,366)

Support Method
Home visit
Walk-in visit (at counseling help desks, etc.)
Telephone counselingGroup activity counseling
Case conference (when target supporters are present)
Accompanied doctor’s visit
Other
Total
0

1,000

Cases
2,162
1,805
1,947
313
19
75
45
6,366

2,000

3,000
■ Home visit

Kesennuma C Support Division■ Walk-in visit

Ishinomaki C Support Division■ Telephone counseling■ Group activity counseling

Stem C Support Division■ Case conference (when target supporters are present)■ Accompanied doctor’s visit

Transfer■ Other

Planning Department
Stem C Management
Part-Time / Contract
Supporters Club, etc.

Figure 1: Cases according to division andsupport method (total cases; N = 6,366)－6－

FY 2018 Activity Status by Project
Table 3: First-time visit referral sources(multiple answers; N = 1,005)b.

Referral source

Cases

Health survey/door-to-door visit

490

Administrative agency

170

No referral

178

Family member

135

Physician/welfare center

7

Support center/temporary support staff

61

Other (neighbor, workplace, unknown, etc.)

71

Gender, Age, and Employment Demographics (Figure 2)
Overall, no large differences were observed between the number of men and women served. Both figures
were roughly equal. However, in the under-20s, the 40s-50s, and the 70s-and-older age groups, womenconstituted a greater proportion of those served than did men. The proportion of female clients in the 70sand-older age groups remained consistent from year to year. The increase in the proportion of female clients
under 20 began with the establishment of a counseling desk at the Kesennuma Regional Center near anursing school. As for the high proportion of female clients in the 40s-50s age group, it has been attributed
to the fact that many mothers attend our mother-child counseling sessions. It is evident that the breakdownof the individuals we see changes in response to our initiatives.
1,500
Women

Men

Working/Self-employed (including on leave)

1,000

Student
Unemployed500

Unknown

0

< 20s

20-30

30-40

40-50

50-60

60-70

> 70s

Figure 2: Support clients by gender and age group (total cases; N = 6,366)c

Disaster Survivors’ Current Status
While there has been a decrease in the total number of cases since FY 2017, the ratios of support targets
by bereavement status (Figures 3, 4), disaster-related injury (Figures 5, 6), and housing damage (Figures 7,8) have largely remained the same. There was no significant change in the rate of bereaved individuals,
except for a slight decrease in the number of respondents who indicated “children.”Bereaved
Bereaved
970
15％
15％
Unknown
3,263
Unknown
51％
3,263

51％

Parent0

SpouseChild

Not bereaved
2,133
Not bereaved
34％
2,133
34％

SiblingGrandparent
Grandchild
Other relatives
FriendNeighbor

Figure 3: Bereavement status(total cases; N = 6,366)

Figure 4: Bereavement details (total cases, multiple answers; N = 970)

－7－

FY 2018 Bulletin, Issue 7
Self

0

100

200

300

400

SpouseInjured
112

Child
SiblingGrandparent

No injury
2,788

Grandchild
Relative other than the above
Friend/neighbor

Figure 6: Injury details (total cases, multiple answers; N = 112)

Figure 5: Injury to self or close relative(total cases; N = 6,366)

0

2,000

4,000

Completely
damagedUnknown

Half damaged

1,458

Partly damaged23%
No damagedamage1,490
23％

Housing
Housing

Forced evacuation

damageddamaged
3,416
3,416
54％

Voluntary evacuation
Unknown

Figure 8: Housing damage details (total cases; N = 3,418)

Figure 7: Housing damage(Total Cases; N = 6,366)

d．Housing Status (Table 4)

A decrease in the number of cases assigned to container-type temporary housing and apartment-type
temporary housing, as well as an increase in the number of individuals living in their own homes orreconstructed housing, clearly indicate that efforts to rebuild and move residents back into their homes
are proceeding smoothly.
If we look at the current housing situation by division (Figure 9), at the Kesennuma Regional Center,
there are numerous cases of individuals living in their own reconstructed homes, while at the Ishinomaki
Regional Center, disaster public housing cases are most numerous. Characteristic differences in the
proportions of these types exist.
A disaggregation of individuals living independently in their own reconstructed homes (Figure 10),shows that it is still very uncommon, whereas a breakdown of those living in disaster public housingshows that lone individuals make up nearly half of all residents.
Table 4: Current housing situation (total cases; N = 6,366)

Housing TypeOwn home

Cases
3,682

Container-type temporary housing

66

Apartment-type temporary housing

153

Disaster public housing

2,272

Other/unknown

193

－8－

FY 2018 Activity Status by Project

0

1,000

2,000

3,000

Kesennuma C Support Division■ Own home
■ Container-type temporary housing■ Apartment-type temporary housing■ Disaster public housing■ Other/Unknown

Ishinomaki C Support Division
Stem C Support Division
Transfer
Planning Department
Stem C Management
Part-time/Contract
Supporters’ club members, etc.

Figure 9: Current Housing Situation by Division (Total Cases; N = 6,366)
0

1,000

2,000

3,000

4,000

Own home■ Living alone■ Living with others■ Other/unknown

Container-type temporary housing
Apartment-type temporary housing
Disaster public housing
Other/unknown

Figure 10: Housing situation by household status (total cases; N = 6,366)

e. Counseling Topics
The proportions of topics like mental health concerns, family and household concerns, healthissues, and addiction were nearly unchanged. Compared to how often they were cited in FY 2017,
there was a slight decrease in references to “lifestyle changes” and “financial concerns”, suggesting that the outfitting and preparation of living spaces had made satisfactory progress (Figure 11).
0.0%
Mental health concerns

20.0%

40.0%

60.0%

Family/household concerns
Health issues
Addiction
Interpersonal issues
Future anxiety
Social resources
Unemployment
Lifestyle changes
Financial concerns
Education and childcare
Work-related troubles
Aging-related issues
Loss of a loved one
Radioactivity
Other/unknown
Nothing in particular

Figure 11: Percentage of valid responses for each counseling topic (total cases, multiple answers; N = 6,366)－9－

FY 2018 Bulletin, Issue 7

f．Mental health concerns
Compared to FY 2017, there was a decrease in sleep problems and an increase in problems
with addiction, but other figures did not change much (Figure 12).
General mood-related
Sleep problems
Physiological symptoms
Anxiety
Delusions, hallucinations
Addiction problems
Behavioral problems
Obsessive-compulsivenessDissociation
Epileptic seizures
Child-specific concerns
Disturbed consciousness
Other symptoms
No symptoms

Figure 12: Breakdown of valid responses to the question of mental health concerns(total cases, multiple answers; N = 6,366)

g．Medical History, Illness Period, and Treatment History (Table 5 and Figure 13)

In comparison to FY 2017, there were no major differences in the number of total cases—thepercentage of individuals with previous medical history remaining unchanged at 46.6% (FY 201744.1%, FY 2018 46.8%). In terms of the breakdown, F2 and F3, the most commonly diagnosed
conditions in FY 2017, reversed positions in FY 2018 with F3 becoming the more frequently diagnosed condition, as was the case in FY 2016. Characteristically, F2 cases were much more prevalent
before the disaster, whereas F3 cases became more commonplace after.
In 2017, the number of F1 cases that appeared after the disaster was less than 30%. Although
this number has continued to rise every year, that trend may have finally been broken this year.
Perhaps, as a result, F7 case totals were higher this year than they were in FY 2017.
Table 5: Medical history and current treatment plans(total cases; N = 6,366)

Psychiatric medical history

Cases

Existing medical (Currently in treatment)
history(Treatment ended)

2,160(Treatment interrupted)

582(Untreated)

20(Treatment status unknown)

41

166

No medical history

2,476

Unknown medical history

921

0

200

400

600

800

1,000

F0 Organic, Including Symptomatic, Mental Disorders
F1 Mental and Behavioral Disorders due to Psychoactive Substance Use
F2 Schizophrenia, Schizotypal, and Delusional Disorders
F3 Mood (Affective) Disorders
F4 Neurotic, Stress-Related and Somatoform Disorders
F5 Behavioral Syndromes Associated with Physiological Disturbances and PhysicalFactors
F6 Disorders of Adult Personality and Behavior
F7 Mental Retardation

Pre-disaster onset
Post-disaster onset
Unknown onset

F8 Disorders of Psychological Development
F9 Behavioral and Emotional Disorders with Onset Usually Occurring in Childhood andAdolescence
G4 Epilepsy
No Disorder
Disorder Unknown

Figure 13: Cases by diagnosis for individuals with medical history (total cases, multiple answers; N = 2,969)－ 10 －

FY 2018 Activity Status by Project② Descriptions of Support Provided
a. Cases by Support Method and Division
Figure 14 provides a breakdown of support methods by the Community Support Division.
Whereas in FY 2017, the grand majority of cases were handled via transfer, in FY 2018, it was
Kesennuma Regional Center that processed the bulk of the caseload. From FY 2017 onwards,
walk-ins constituted a large percentage of Kesennuma Regional Center’s cases. Compared to FY
2017, there was a decrease in the total number of cases handled by the Stem Center Support Division; the number of cases handled by the Ishinomaki Regional Center in FY 2018, on the other
hand, exceeded that of the previous year.
0

1,000

2,000

Kesennuma C Support Division

3,000■ Home visit■ Walk-in visit■ Telephone counseling■ Group activity counseling■ Case conference (when target supporters arepresent)■ Accompanied doctor’s visit■ Other

Ishinomaki C Support Division
Stem C Support Division
Transfer
Planning Department
Stem C Management
Part-time/contract
Supporters’ club members, etc.

Figure 14: Cases by support method and division (total cases; N = 6,366)

b. Breakdown of Support Targets (Figure 15)

Overall, in contrast to FY 2017, no large changes were observed in the percentages of individuals
interested in counseling. Most individuals pursuing counseling were doing so for themselves, followed by those who were doing it for their family members. These two groups constituted the
majority of all counseling cases. In the past, requests from “other support workers” were relatively
common, but in FY 2018, their numbers were less than half of what they had been in FY 2017.
0Self
Family, Relative
Neighbor
Friend, Acquaintance
Workplace
Administrative agency
Temporary support worker
District welfare official
Other support workers
Other

Figure 15: Support targets (N = 6,366)

c. Affiliated Organizations (Figure 16)

The percentage of municipal affiliates has grown since FY 2014, to as much as 71.0% in FY 2018;indicating that their proportions continue to remain quite high (65.7% in FY 2016, 72.8% in FY2017). On the other hand, in addition to switching the order in which “medical institutions” and“welfare institutions,” appear the percentage of health care centers fell considerably—from 10.1%
in FY 2016 to 9.2% in FY 2017 to 3.6% in FY 2018. If we look at the divisional breakdown (Figure17), we see that not only were there no health centers at the Ishinomaki Regional Center, the presenceof medical and welfare institutions at the Stem Support Division was quite minimal, with municipal
matters comprising the better part of their affairs. Each center has its own set of support activity
trends.

－ 11 －

FY 2018 Bulletin, Issue 7
0.0%

50.0%

100.0%

Municipality
Welfare institution
Medical institution
Health care center
Support center
Other

Figure 16: Percentage of valid responses for affiliated organizations (total cases, Multiple Answers; N = 1,128)
0

200

400

600

800
■ Municipality■ Welfare institutions■ Medical institutions■ Health care center■ Support center/Temporary support staff■ Other

Kesennuma C Support Division
Ishinomaki C Support Division
Stem C Support Division
Transfer
Planning Department
Stem C Management
Part-time/Contract
Supporters’ club members, etc.

Figure 17: Breakdown of affiliated organizations by division (total cases, multiple answers; N = 1,128)③ Support Case Termination
Table 6 provides a breakdown of outcomes at the time of the case response. Most cases are ongoing. Among them, the number of “fixed-term” cases decreased by about 500 when compared tolast year, although no significant changes in cases being attended to on a “continuing basis” wereobserved. The number of cases closed either due to improved circumstances or denial of support also
decreased, but there was no significant change in the number of cases closed due to referral to anotherorganization.
In terms of a breakdown of the organizations that cases were referred to (Figure 18), there was anincrease in the number of cases sent to municipalities relative to FY 2017 (43.2% in FY 2017 to56.8% in FY 2018).
Table 6: Outcomes (N = 6,366)

Continuing

StatusCases

Municipality

Fixed-term

3,137

Welfareinstitutions

Continuing basis

2,321

Medicalinstitutions

0

Legal orjudicial centers

Situation improved

798

Employment
centers

Referral to another
org.

95

Denial of support

15

Other

Closed

Other

0.0%

20.0%

40.0%
56.8%

16 8%
1 .8%
1.1%
0.0%
11.6%

Figure 18: Valid responses forreferrals to other organizations0－ 12 －

60.0%

FY 2018 Activity Status by Project④ Miscellaneous Resident Support
In addition to individual counseling, we also provided resident support by establishing gathering
places and conducting social events in different areas.
At the Ishinomaki Regional Center, we set up a “Koko Farm” vegetable cultivation event to provide
residents with a chance to socialize, while at the Stem Center, we set up an “Utsukushima Salon” forindividuals who had moved down from Fukushima Prefecture. While we plan to continue such initiatives into FY 2019, the “Heart Café” gatherings in Kesennuma will conclude in FY 2018; we intend
to hold a class reunion in FY 2019. Furthermore, attendance at social gatherings and other such events
have been included in the totals for (3) raising public awareness.
⑤ Summary

The total number of cases handled over the last three years went from 6,752 in FY 2016, to 7,237
in FY 2017, to 6,451 in FY 2018; the numbers remain quite high into this year as well. While cases
handled by the Stem Support Division and via transfer, fell, there was an increase in the number ofcases handled by the Kesennuma Regional Center and Ishinomaki Regional Center. Differences inregional characteristics and center-specific initiatives affect the number of people served and the total
number of cases handled, among other things.
A characteristic of recent years has been the continuing decrease in the number of cases involving
home visits, coupled with an increase in the number of walk-in visits. Upon examining a breakdownof referral sources for first-time visitors (Table 3), we see how the number of cases originating fromhealth surveys and door-to-door visits has decreased every year, leading to fewer home visit cases. The
following factors may be contributing to this increase in walk-in counseling sessions: an awareness ofregional centers and the services they offer in each community; regional public raising awareness activities and other measures that have helped residents take a proactive approach to counsel, after which
they continue to attend follow-up visits.
With regards to our support clients’ living situations, percentages-wise, we have seen an increase in
the number of people living in their own homes and disaster public housing and a decrease in thenumber of people living in container-type and apartment-type temporary housing. This is proof thatreconstruction efforts are making progress. Furthermore, unlike those whose homes have been reconstructed, it appears that individuals who move into disaster public housing predominantly live alone.
The fact that elderly residents make up a disproportionately large fraction of disaster public housing
residents has already been pointed out; we must develop measures that prevent elderly individuals
from having to live alone, as well as strategies to build more interconnected communities.

(2) Support for Supporters
In addition to implementing training sessions and counseling meetings for individuals who provide
support to those affected by the disaster, the same supporters were also allowed to attend case conferenceswhere they received advice and guidance from professionals. We also dispatched specialists to various
municipalities.
① Targets of Staff Support
A look at the status of support provided to supporters (Table 7) shows that a total of 1,390 cases werehandled and that that number has fallen every year; from 1,549 in FY 2017 to 1,492 in FY 2018. Whileadministrative officials continue to play a prominent role, the number of cases involving temporary
support staff, volunteers, and others who are deeply invested in disaster relief efforts has decreased
even further this year (Figure 19).
While the number of support cases involving “professional guidance and advice,” “case conferences,” and “support in official duties” has remained high, there has been a yearly-decrease in figures
for “professional guidance and advice” and “support in official duties”. On the other hand, “case conferences” have increased, as have “community issues” and “workplace mental care.”A breakdown of professional guidance/advice topics shows that while cases involving abuse andalcohol-related problems were most common, the total number of cases decreased when compared tolast year (Table 8).
If we examine the division-wise breakdown of support for supporters (Figure 20), we can see thatwhile the total number of cases has decreased, the number of cases at the Ishinomaki Regional Center
alone has more than doubled relative to FY 2017. If we look at the breakdown of each center, we see－ 13 －

FY 2018 Bulletin, Issue 7

that transfers handle the vast majority of cases of support for official duties, and that case conferencescomprise the majority of this work at the Stem Support Division, professional advice, and guidanceand checkup support comprise the majority at the Ishinomaki Regional Center, and setting up counseling help desks comprises the majority at the Kesennuma Regional Center. The initiatives of eachcenter have their characteristics.
As for the details of professional advice and guidance given at each division (Figure 21), the percentage of cases involving “abuse” was the highest at the Stem Support, Transfer, and Stem Management divisions, and alcohol-related problems were high at the Ishinomaki Regional Center and amongtransfers.
Further, the reason “Other” percentages are so high across the board is the presence of advice andguidance (save regarding abuse) in child mental health projects.
Table 8: Professional guidance/advice topics(total cases, multiple answers; N = 344)

Table 7: Status of support for
supporters

Cases

Targets

Post visit/interview report

81

119

Professional guidance/advice

344

1,259

Regional problems

47

365

Support case info

Workplace mental health

17

35Case conference (when target supporters were absent)

339

1,236

Setting up a counseling help desk

73

100

Health exam support

86

603

Administrative support
Other

340

579

63

295

Total

1,390

4,591

0

1,000

Topic
Alcohol-related problems
Gambling problems
Prescription drug abuse
Depression
Complicated grief
PTSD

1
3

Abuse
Other

2,000

59
258

3,000

4,000

Administrative officials
Educational institution officials
Child welfareNGO
Disability welfare
Healthcare workers
Regional comprehensive support center
Social welfare council
Neighborhood council officials
Senior welfare
Support center
District welfare officials
Health advocates
Professional organizations
Firefighters
PolicePublic organizations
Temporary support staff
Business enterprise
Volunteers
Officials from other regions
Fire brigade
Legal or judicial centers
Self-help groups
Self-defense force
Other

Figure 19: Support target information (total number of individuals; N = 4,591)－ 14 －

Cases
39
1
0
12

FY 2018 Activity Status by Project

0

100

200

300

400

500

600

700

Kesennuma C Support Division■ Post visit/interview report■ Professional guidance/advice■ Community issues■ Workplace mental health■ Case conference (when target supporters were absent)■ Establishing counseling help desks■ Health exam support■ Administrative support■ Other

Ishinomaki C Support Division
Stem C Support Division
Transfer
Planning Department
Stem C Management
Part-time/Contract
Supporters, etc.

Figure 20: Support for supporters by division (total cases, Multiple Answers; N = 1,390)
0100Ishinomaki C Support Division200■ Alcohol-related problem

Stem C Support Division■ Gambling problems■ Prescription drug abuse

Transfer■ Depression

Planning Department■ Complicated grief

Stem C Management■ PTSD

Kesennuma C Support Division■ AbusePart-time/Contract■ Other

Supporters, etc.
Figure 21: Professional advice and guidance topics by division(total cases, multiple answers; N = 344)

② Professional aid for municipalities
In FY 2017, we deployed eight employees to seven municipalities. We began FY 2018 with the samearrangement; however, after one of our clinical psychologists ended their deployment in the middleof the year, we were left with a total of seven employees in seven municipalities. In terms of theirprofessions, one was an occupational therapist, and the rest were psychiatric social workers.
③ Summary

Overall, while the number of cases of Support for Supporters has declined from year to year, theachievements of the Ishinomaki Regional Center have increased. As “professional advice and guidance,” “health exam support,” and “case conferences” comprise the majority of cases across all centers,
in FY 2018, there was a surge in “health exam checkups” which included 63 cases at Ishinomaki Regional Center. One mitigating factor is perhaps the growing need to respond to recipients of infant
medical examinations, which we can assume was an important service offered by the Support for Supporters umbrella project in FY 2018.
As for transfers, although one employee left midway through FY 2018, the transfer system itself
remained largely unchanged. Transfers were typically assigned several “official duties” that varied
considerably and required flexibility and versatility. This made it difficult for us to translate their essence into business statistics. As we reevaluate the work of this center in the future, we must determine,in collaboration with the agencies to which they will be deployed, what systems the transfers will
belong to and what manner of the work they will do.
－ 15 －

FY 2018 Bulletin, Issue 7(3) Raising public awareness① Producing and publishing public awareness materials

We took part in a variety of initiatives designed to deepen post-disaster understanding of mental
health and health care in general, including distributing pamphlets, working with news agencies, conducting educational workshops and running salons, etc. Issues 19 and 20 of our PR magazine were
published in August 2018 and January 2019, respectively (Table 9). In addition to reprinting our“MDMHCC pamphlet” and “Let’s Learn! How to Engage with Alcohol,” we developed and distributed a new “Self-Care for Children” pamphlet during our children-oriented events (Table 10).
Table 9: PR Magazine Issues

Table 10: Pamphlet Information

Issue

Month No. printed

Distribution area

Title and contents

Print type

Copiesprinted19
20

AugustJanuary

Prefecture-wide

MDMHCC Pamphlet
Let’s Learn! How to Engage with Alcohol
Self-Care for Children

Reprint
Reprint
New

1,000
4,000
3,000

2,000
1,900

② Public awareness training (Table 11)

We are asked every year to present on topics such as “stress, mental health care, and self-care,” aswell as “addiction problems (alcohol, etc.).” With regards to our “stress, mental health care, and selfcare” presentation, not only were we asked to plan community events by neighborhood councils, highschools, universities, and even daycares, for parents and guardians. Many more people have come toneed this training in recent years. We also held this workshop not only in coastal regions but throughout
the prefecture.
As for content related to “addiction problems (alcohol, etc.),” “Danshukai Meeting Experiences”
held regularly in certain towns and cities by nearly the same group of members comprised the bulk of
our work. The number of times we were able to hold public awareness programming decreased from84 last year to 75. One of the items that decreased most was “workplace mental health,” (FY 2017 13
times → FY 2018 3 times).
Table 11: Educational Workshop Topics (N = 75)

No. held
1

Emotional response to the earthquake

Total attendees
80

6
3

127
24

Earthquake's effect on children

26
3

144
170

Stress and mental health care, self-care

30

1,314

Physical health00Mental health at the workplace

3

97

Current status of affected areas and MDMHCC programming

3

94

Mental illness
Basic listening skills workshop (for bereaved families, etc.)
Addiction problems (including alcohol)

Table 12: Salon Activities (N = 125)

Center Division
Kesennuma

Ishinomaki
StemTransfer

Other

Total

MDMHCCheld or joint

34

18

28

0

13

93

Cooperation
with anotherorganization

2

5

9

16

0

32

－ 16 －

FY 2018 Activity Status by Project③ Salon activities (Table 12)

Salon activities organized individually or jointly by each center consist primarily of the following:
Male Life (support program aimed at residents at risk of social isolation, Kesennuma Regional Center);
Dementia Café: Kokoccha (Kesennuma Regional Center); Koko Farm (social exchange via fieldwork,
Ishinomaki Regional Center); “Natori Health Salon (temperance meeting, Stem Support Division),and Utsukushima Salon (exchange with refugees from Fukushima, Stem Support Division). Each had
its characteristics.
We also cooperated with other organizations that held multiple health counseling conferences andsocial events.

④ SummaryIn addition to the work described above, this year we also disseminated information via our website—we uploaded issues 5 and 6 of our bulletin—and a mail-in magazine. To communicate the work
this center does to a global audience, we are currently in the process of preparing English translationsof these issues as well. We also plan to develop an official activity record that summarizes our work
thus far.
As we approach the ninth anniversary of the disaster, however, some certain salons and events will
no longer be held, and certain activities and programs whose scale or frequency will be reduced. We
will carefully consider both the needs of our current participants and our administrative and organizational capabilities before determining whether to continue a program and how it will continue.
(4) Human Resource Development① Overall Project Status
We implemented a variety of training events aimed at developing both professional and supporter
human resources (Table 13).
While there has been a reduction in our total caseload since FY 2017, there has been an increase intraining programs related to child mental health and suicide prevention.
About addiction, in FY 2018, we conducted training workshops for municipal workers at different
medical institutions and held a skill-up alcohol abuse case study conference for individuals who had
already taken one of our courses.
We had support skills training in HR development activities (labeled “Other” in Table 13) including
workshops on cognitive behavioral therapy, “Exercise for Heart and Mind (13th and 14th),” “Psychological Skills Training, v. 1-3,” and Psychological First Aid (PFA) organized in collaboration with the
Tohoku University Graduate School of Medicine’s Department of Preventive Psychiatry. We also held
events to introduce medical welfare personnel to cognitive-behavioral approaches that they could use
in their daily support work or during medical examinations. PFA training workshops, held at the request of various groups, included the WHO PFA Workshop and PFA for Children. A PFA booster
course aimed at personnel who attended our Training of Trainers workshop in FY 2017, is also included in this total.
Concerning child mental health training, our primary efforts are in the areas of education, childwelfare, and medical personnel. We taught attendees how to interact with children following a disasterand their possible reactions, as well as how to interact with them regularly. The content of these events
varied considerably.

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FY 2018 Bulletin, Issue 7
Table 13: Human Resource Development Activities (N = 136)

Description
Earthquake relief conference

No.

Media conference00

Attendees
00Addiction problems

19

441

(Alcohol)

(19)

(441)

(Other addictions)

(0)

(0)

Support skill workshop

42

1,678

(Listening skills)

(2)

(63)

(Stress, mental health, and self-care)

(3)

(256)

(Other)(37)(1,359)2

205

Mental health workshop for Supporters
Workplace mental health workshop

7325

Children's mental health workshop

26

1,620

Seniors mental health workshop

1

18

Countering suicide workshop

19

661

Mental illness/disorder workshop

594

Affected areas and MDMHCC programming

4279

Case study

9

52

Other
Total

2

44

136

5,417

② SummaryIn FY2018 as well, the most commonly held training workshops were those related to temperance
and PFA. The workshop content demanded of our specialists also changes from year to year. Previously, demand was highest for content regarding “listening” or “stress,” but needs are changing, andPFA-specific content “which will be of use to attendees in the event of a new disaster”, or cognitive
behavioral therapy, which can be utilized in everyday support work, have both come to be highly
desired. We did not hold any media conferences or earthquake relief conferences in FY2018.
Amidst these changes, the demand for workshops on children, alcohol abuse, and suicide remained
high. Some reasons for this include the growing recognition that these topics reflect major issues
confronting several communities that have, in recent years, led to several cities and towns creating
advanced community suicide prevention plans; the implementation of the Basic Act on Measuresagainst Alcohol-Related Harm; and the drafting of other basic plans. These initiatives demonstratethat interest in these topics remains high.

(5) Research
To summarize this center’s achievements and communicate them to the outside world, we continue
to engage in a variety of outreach initiatives. In FY2018, we carried out 16 research presentations, issuepresentations, and lectures.
There were multiple presentations on disaster-affected cohort studies and child/PFA related topics.
We also put on joint presentations regarding hikikomori support and publicized various SST initiatives
through radio programs at the Kesennuma Regional Center, and summary activities in specific cities
and towns. A breakdown of the content disseminated through these publicity initiatives is given below.

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FY 2018 Activity Status by Project

Research Title

Year

Month

Presenter2019

February

Naru Fukuchi

What training programs were needed in Japanese communities after the Great East Japan Earthquake and Tsunami of 2011?

2019

February

Naru Fukuchi

Interviewing adoptive and foster parents who have children with developmental disabilities: preliminary interview to develop a special parent
training program

2019

February

Naru Fukuchi

What child psychologists can do in emergencies

February

Naru Fukuchi

Psychological education for parents and children in the wake of largescale disasters

2018

DecemberNaru Fukuchi

Community-based preparation for future disasters – The significance of training in Psychological First Aid (PFA) for Children

2018

DecemberNaru Fukuchi

The effect of large-scale disasters on communities and a discussion of
future preparations – Disaster mental health as a public health issue

November

Mitsuaki Katayanagi

The potential for SST via radio broadcasts in a disaster-affected regionof Eastern Japan

September

Yumi Suzuki

What we have learned from the Tagajo Disaster Survivors HealthSupport Project

2018

September

Reira Onuma

What we have learned from our support of a hikikomori

2018

September

Naru Fukuchi

Human support guidelines in emergencies – Focusing on Psychological First Aid for Children

2018

September

Naru Fukuchi

Creation of our FY 2017 Bulletin, Issue 6

2018

July

Naru FukuchiChild psychoeducation in the outdoor camps for children who wereaffected by the Great East Japan Earthquake

2018

June

Naru FukuchiChildren with developmental disorders and evacuation shelters

2018

June

Shusaku Chiba

Study of longitudinal support for children born after the disaster ②– The results of a health survey in Miyagi Prefecture of parents andguardians with children born after the disaster

2018

June

Naru Fukuchi

Study of longitudinal support for children born after the disaster ①– The results of a health survey in Miyagi Prefecture of children
born after the disaster

2018

June

Naru Fukuchi

The effects of the Great East Japan Earthquake on child mental healthand development – A cohort study of disaster-affected areas

2019

2018
2018

(6) Support for Various Activities
We cooperated with other support organizations in a variety of ways, including by backing their activities. The following are some of the key activities we contributed to.
・ Helped with interviews looking back on “Energetic Classrooms”
・ Participated in “Sharing Meetings” in a gesture of support for bereaved families
・ Helped manage a “Seagull Meeting” for individuals with higher brain dysfunction
・ Provided psychological care to disaster survivors in Malaysia
3.

Summary
Compared to the previous year, there was a decrease in the number of resident support cases handled by thecenter in FY 2018. A breakdown reveals a decline in the number of counseling cases, specifically in cases
involving home visits and health surveys or door-to-door visits. Progress in the construction of disaster public
housing and the reconstruction of private homes likely decreased the number of individuals needing such services, and the reduction in the number of municipalities participating in such programs no doubt also contributed to this pattern.
On the other hand, this year saw an increase in the number of walk-ins and group activity counseling cases.
Reasons might include an increase in the numbers of attendees seeking counseling at group events, and individuals seeking walk-in counseling following joint events with educational institutions and other affiliates.
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FY 2018 Bulletin, Issue 7

While counseling cases that were prompted by health surveys were once far and away from the most common
type of case, in the future, we can expect the kind of diversification of referral types that we saw this year, tocontinue. This will throw the differences in programming between the centers into greater relief.
In terms of Support for Supporters, a yearly increase in the percentage of cases accounted for by case conferences appears to be a characteristic pattern. As this center approaches eight years of service, local cases areshared with local divisions, and the tendency for multiple parties to work together to address a patient’s needs
grows ever stronger. Since many cases are the product of complicated circumstances, we believe it may benecessary from a care management perspective to prepare support systems consisting of multiple interdisciplinary teams.
As for our support skills training workshops, which are one of our many human resources development
initiatives, we have moved from themes of “listening” and “self-care” to events that deal with skills that would
prove valuable when responding to new disasters, such as PFA. Recently, many educational institutions haveexpressed their interest in participating in some of our workshops, and we must consider combining our customary approaches, with training on issues of interest to many communities, such as abuse and suicide, toprovide individuals with the opportunity to acquire tools that will prepare them for future disaster occurrences.
About raising public awareness, one of our biggest issues is determining how to continue to provide information to the public via our website. In FY 2018, we began to publicize English versions of our bulletins, andwhile we continue to evaluate others’ access to our material, we would also like to explore alternate avenues
for promulgating the achievements of this center and the tools that we have developed. From the perspectiveof preventive psychiatry, we expect our current and future public awareness efforts—which extend across various communities—to grow ever more valuable. We hope to make full use of the various techniques and approaches we have cultivated at this center to generate highly effective public awareness strategies.
Our research in FY 2018 culminated in reports on PFA, hikikomori, and high-risk support targets. We are also
carrying out a child cohort study in three prefectures, as well as research on our salon activities. Not only do we
expect the results of our salon study to help us decide whether or not to continue our salon activities, but we also
hope that by comparing the results of our salon work with that of other organizations, we will be able to gain
insights that can be used to effectively manage salon-type initiatives in the event of another disaster. It is quite
common for salon-type activities to serve as a form of support in the wake of a disaster. To better prepare for
future disasters, we believe it is important for us to review and analyze our previous achievements.
Eight years have passed since the earthquake. Though resident support and Support for Supporters cases
have largely trended downwards, the issues remaining in our communities are as complex as ever, and manyof the problems we face defy easy solutions. As we continue to conscientiously respond to these myriad challenges, we must examine the roles and functions of both this center and its affiliates as we explore the possibility of a new psychiatric welfare system for our communities.

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