Stem Center Community Support Division Activity Report

Stem Center Community Support Division
Activity Report
Miyagi Disaster Mental Health Care Center
Stem Center, Community Support Division
Manager, Public Health Nurse – Yukie Oba
Assistant Manager, Nurse – Ikuko Moriya

Introduction
Miyagi Prefecture’s restoration plan encompassed 10 years and comprised three stages: recovery, regeneration, and development. In 2018, we entered the development stage—the last phase of the plan.
The Community Support Division of the Stem Center of the Miyagi Disaster Mental Health Care Center(hereinafter our division) has also carried out its work this year, fully aware of the amount of time that the
MDMHCC has left as an organization. In this document, we will report on—and briefly discuss—the content
and nature of our activities in FY 2018.
1．Activities
Our division’s jurisdiction covers the coast of Miyagi Prefecture, except for the Kesennuma and Ishinomaki
regions, and includes four cities—Shiogama, Tagajo, Natori, and Iwanuma; and four towns—Matsushima, Shichigahama, Watari, and Yamamoto. In the first part of FY 2018, our division had 11 employees, and in thelatter half, it had 10. We transferred 2 people to Natori (only 1 remained in the latter half of the year) and 1 to
Shiogama.
Table 1 lists our FY 2018 support teams for each municipality and the support programming they implemented.
Table 1: Support Team Structure and Programming by Municipality

Municipality

Support team structure

Support programming

Matsushima

2 employees dispatched 2-3
times a month* Case support* Home visit support for health surveys of high-risk individuals (apartmenttype only)* Helping with training workshops

Shiogama

2-3 employees dispatched 1
day per week
1 transfer* Case support* Home visit support for health surveys of high-risk individuals* Helping with training workshops* Overseeing “Mental Health Support Development Course” (Transfer)* Carrying out technical support for city public health nurse for temperance/responsible alcohol consumption, led to temperance support interviews during
special health examinations by the city

Shichigahama

2 employees dispatched twicea week between February andMarch* Home visit support for health surveys of high-risk individuals* Attendance at Suicide Countermeasures Network Conference

Tagajo2-4 employees dispatchedonce every week

* Case support* Home visit support for health surveys of high-risk individuals (apartmenttype only)* Co-sponsoring “Physical Health Salon” (planning, implementation)* Helping with presentations at academic conferences

Natori

The first half of the year: 2-4
employees dispatched once
every week
The latter half of the year: 1-4
employees dispatched 3 days
per week
Transfer: 2 (1 in the latter
half)* Case support* Home visit support for health surveys of high-risk individuals* Organizing a “health salon”* Participated in formulating suicide countermeasures plan (Transfer)* Supervision of case management (Transfer)－ 66 －

FY 2018 Bulletin, Issue 7

Iwanuma

1-3 employees dispatched one
day per week

Watari2 employees dispatched oncea weekYamamoto

2 employees dispatched oncea week* Case support* Home visit support for health surveys of high-risk individuals* Participated in regular case review* Interviews with Supporters* After receiving a request for postvention, we visited the residents involved
and conducted group work for Supporters* Case support* Assisted in hosting and regularizing periodic residents’ conferences (motherchildren to elderly)* Case support* Home visit support for health surveys of high-risk individuals* Assisted in public awareness projects for residents* Assisted in hosting study conference for difficult cases* Participated in formulating suicide countermeasures plan
* Mental health counseling for SWC members* Assisted in summarizing academic conference presentations (cases) and disaster home visit activities

The Miyagi Disaster Mental Health Care Center works in six focus areas: resident support, Support for Supporters,
raising public awareness, human resource development, research, and support for various activities.
Figures 1 and 2 show how the total work time at this division and the percentage of time allotted to each work
category has changed over the past four years, from FY 2015 to FY 2018. We have spent the lion’s share of our timeon resident support, followed by Support for Supporters. Resident support also enjoys the highest share of total
activity time each year, followed by Support for Supporters. Although minimal, the time spent on human resource
development training and raising public awareness has been increasing.
0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

FY 2013■ Conference liaison, etc.
■ Support for various activities■ Support for Supporters■ Human resource development training■ Resident support■ Raising public awareness

FY 2014
FY 2015
FY 2016
FY 2017
FY 2018
Figure 1. Change in Community Support Division activity time
0%

20%

40%

60%

80%

100%

FY 2013■ Conference liaison, etc.
■ Support for various activities■ Support for Supporters■ Human resource development training■ Resident support■ Raising public awareness

FY 2014
FY 2015
FY 2016
FY 2017
FY 2018
Figure 2. Percentage of Each Activity Type－ 67 －Stem Center Community Support Division Activity Report

Next, we will summarize our work in FY 2018 according to the focus area.
(1) Resident support
Figure 3 shows the total number of resident support cases handled by the Stem Center by the primary cause.
Request from the person requiring assistanceFamily and relatives
Neighboring residents
Workplace
Health survey
Administrative agencies
Support center, temporary support staff, etc.
Medical institutions
Welfare institutions
Unknown
Other
0

100

200

300

400

500

600

700

800

900

Figure 3. Stem Center Total Cases in Jurisdiction by Primary Cause in FY 2018

The most common reason for counseling was a request from administrative agencies, followed by a “healthsurvey.” Requests from administrative agencies included cases involving alcohol-related problems, mothers having trouble with parenting, and elderly people having delusions. We also accompanied municipal
public health nurses on home visits and were present at walk-in visits, interviews, etc.
Immediately after the disaster, our health survey work called for surveying people in apartment-type temporary housing or emergency prefabricated temporary housing. It now involves surveys of disaster public
housing tenants or residents of their own homes. This division has overseen the provision of home visit
support to high-risk individuals flagged by both kinds of surveys. The criteria for determining high-risk
individuals from health survey results vary slightly between municipalities: some have a “K6 score of 13+,”
while others demonstrate behaviors that include “drinking from morning or midday,” “excessive drinking,”“difficulty sleeping,” “lack of someone to confide in,” “very poor health,” and “history of psychiatric illness.” Health survey-prompted cases were more commonly resolved after the first home visit; cases requiring sustained support were much less common. In FY 2018, we received requests from seven municipalities (except Watari) for post-survey home visit support; we responded to all of them.
＜Discussion＞
High-risk, disaster-affected individuals flagged by health surveys shared their feelings with us, including
statements like this: “I’m finally able to talk about the painful things that happened during the disaster,”and “Before, I didn’t even feel like opening the health survey forms I’d receive, but now I feel like fillingthem out.” any individuals have only just become capable of expressing their feelings, eight years later.
We feel it is vital that we continue to pay close attention to these individuals’ feelings and listen attentively
to what they have to say.
Individuals who needed sustained support often had the following issues—suspected PTSD; grief; hikikomori; and multi-problem households. We feel that we need to slowly help these individuals face what
they are going through.
For such individuals, we are their only source of support. We realize that we must give them opportunities to share their problems with regional authorities, which will enable them to live peaceful lives.
－ 68 －

FY 2018 Bulletin, Issue 7(2) Support for Supporters
In our Support for Supporters work, we aimed to share information on the state of the municipality
and to work alongside supervising health nurses while keeping in mind the fact that we were still in thereconstruction phase. We were involved in specific activities such as joint home visits, post-interview
information sharing, hosting of case study conferences, and technical support. Regular case reviews andcase study conferences were held in Natori, Iwanuma, Shiogama, Watari, and Yamamoto, and even public health nurses from outside the supervising division attended. In FY 2018, after receiving a request for
postvention from Iwanuma, we conducted group work and individual interviews with those involved.
Table 2 is a list of training workshops for supporters. At the beginning of the year, we met with amunicipal disaster survivor support departments to identify their needs and dispatched our employees
accordingly.
Table 2. Training Workshops
for SupportersMunicipali-

Support content and topic

Targets

Participantsties

Shiogama

TagajoNatori

Iwanuma
Yamamoto
MisatoUpskilling Counseling Staff“The Fundamentals of Alcohol Addiction and How to Treat it”
Training for Supporters Working with Alcohol-Related Issues

Administrative officials

30

Administrative officials

27

Mental Health Supporter Course Practicum“Early Interventions for Excessive Drinkers:
Tips and Tricks for Succeeding at Temperance”
Training for New Shiogama City Mental Health Workers“How to Communicate Effortlessly with Families”“The Attitude Necessary for Mental Health Work”

District welfare officials

11

Administrative officials

10Administrative officials

24

SWC members

200

Regional comprehensive
support center employees
Administrative officials
Administrative officials
Administrative officials

16

Administrative officials

30

Mental Health Care Study Meeting“The Effects of the Great East Japan Earthquake on Children and
Future Care”
44th Meeting of the Natori Social Welfare Association“Let’s Learn About and Protect Mental Health: What Welfare
Workers Need to Know to Implement Regional Initiatives”
Lecture at 6th Regional Comprehensive Support Center Liaison
Conference
Alcohol Issues Study Group
Alcohol Issues Training Workshop
Temperance Support Follow-Up Training “Tips for Temperance
Support”
Training to Respond to Alcohol-Related Issues in the Elderly

Listening to Volunteers’ Course “How to Listen” and “About Self- volunteer
Care”

11
17
18

23

＜Discussion＞
We sought to inform municipal authorities of the importance of having regular case reviews and casestudy conferences, which would allow regional public health nurses to work together when responding
to cases. We then worked with the same authorities to organize these events. We participated in study
conferences, etc., and although we made progress in terms of assessments and management, transferred
employees—who had had more opportunities to work alongside city public health nurses as part of their
daily routine—were likely to provide more specific assistance to supporters on the ground. In addition
to public health nurses, the employees of this division include psychiatric social workers, clinical psychologists, and nurses. Municipalities overseeing these activities shared the following thoughts with us:“Case study conferences with psychiatric social workers and clinical psychologists, etc., allowed us tolearn things from many different fields, and helped us look at support in a more multifaceted way,” and“These events were valuable opportunities for us to receive experiential knowledge from division employees.” We believe that many people thought that analyzing cases with professionals from many different backgrounds, was a very good thing. Other divisions and health centers, apart from the ones overseeing the process, participating in these case study conferences. The cases examined involved a rangeof subjects, from mothers and children to the elderly, allowing them to become a regular event.
Since our Center has a deadline by which it will close its doors, the issues that the employees of ourdivision understand and deal with will one day have to be passed on to community authorities. We must
continue to work with health care center staff and municipality officials to address regional issues andsummarize the achievements of our efforts.
－ 69 －Stem Center Community Support Division Activity Report(3) Raising public awarenessThis division is involved in a range of public raising awareness initiatives, including projects thatstage social events—like salons—that target community residents. Table 3 lists the specific social
events for community residents that we participated in.
Table 3. Social Events for Community Residents (Salons)

Activity
name

Involvement

Targets

Description

Frequency

Iwanuma

Utsukushi
ma Salon

Host

Individuals
who movedfrom Fukushima
toIwanumaOncemonthly

NatoriNatori
HealthSalon

Co-sponsoredwith the cityMenattempting toquit drinking

TagajoTagajoBody
HealthSalon

Assisted city
in hosting

Residents
of disasterpublichousing

Determined salon topics along with the participants. We made Namie Yakisoba and otherFukushima foods andencouraged them totalk about their lives
back home. Nineteen
individuals were registered.
Fifth-year: In themorning, we exercisedand had cooking classes, and in the afternoon, we used “drinking journals” to lookback on how far they’dcome.
Everyone filled out
their drinking journals;
nearly all of them wereable to reduce theamount they drank, approaching responsibleamounts. Thirteen individuals were registered.

Shiogama

Shiogama
Relief Salon

Watari

IwanumaWatariMen’s ClubOB Club

Salon Inside Reconstructed
Housing

Assisted city
in hosting

Area residents

Implemented
alongsidetown

Men under
70 livingalone

Worked withorganizations
hired by thecity

Residentsof reconstructedhousing

Based on the results of
the Tagajo disaster survivor’s health survey,
we held this event infour different reconstructed housing areas.
Held salons in two administrative districts
that sent in requests.
Relaxation was themain goal. We also provided counseling on
mental health.
We hosted this event in
FY 2016.
Afterward, it was held
only at the request of
Supporters, and it became an event whereparticipants
would
converse with eachother while eating
lunch. Initially, we targeted men under 60,
but to increase participation rates, we raised
the cutoff age to 70.
The smile support center manages this event,which is a social
meetup for residents ofreconstructed housing
projects, who were relocated as a group.
Our division provides
counseling for participants.

－ 70 －

Number oftimes held in
FY 2018

Cumulative
number of participantsOncemonthly

11

121

Once
yearly4

69

Onceyearly2

20

Onceevery 34 month4

10

Our division provides
counseling forparticipants.

8

77

12

164

FY 2018 Bulletin, Issue 7＜Discussion＞

The Tagajo “Body Health Salon” is a public raising awareness event meant to increase awareness of
self-care and to serve as a preventative measure that obviates the need for long-term support. We cosponsored it with the city, and targeted individuals based on the results of the disaster survivors’ healthsurvey (those with more than one of the following: “sleep issues,” “depression,” “easily fatigued,”“drinking”). Our division oversaw an alcohol patch test corner. We served an appropriate amount of
alcohol; many family members were surprised to see how much their loved ones drank, and we think
this measure helped raised public awareness around this issue.
As for the “health salon” and the “Utsukushima Salon,” we had high participation rates and were able
to see how members were using these events to improve their own lives. The “Watari Men’s Club” wastemporarily shut down in FY 2017, but following requests from participants, we reopened it in FY 2018as the “OB Club.” Previously, we had hosted the event ourselves, but the new “OB club” was nearly
entirely run by participants: they chose the dates and venues, and planned the itinerary.
We might be approaching a time when we will have to decide whether our division will continue toorganize these activities, and how these activities will be managed.
Public awareness projects targeting residents are listed in Table 4.
Table 4. Public Awareness Training Projects Targeting Residents

Municipalities

Training topic and title

Participants

Matsushima Mental Health Supporter Development Course Follow-Up Training (Part 1)

23

Mental Health Supporter Development Course Follow-Up Training (Part 2）

36

Mental Health Supporter Course: Protecting Precious Lives (1)36

Mental Health Supporter Course: Protecting Precious Lives (2)29

Mental Health Supporter Follow-Up Course Ⅰ“Increasing Communication Skills:
Learning How to Express Yourself Assertively”

9

Mental Health Supporter Follow-Up Course Ⅱ“Group Work: How I Can Reduce Stress,” and “An Aromatherapy Yoga Experience”

6

Shiogama

Watari
Yamamoto

Health and Nutrition Workshop“Tricks for Destressing: Mental Health Care Tips You Can Start Using Today”

1

Dementia Supporter Leader Development Course: “How to listen”

18

Mental Health Promotion Classroom “About Stress” (held in 5 locations)

106＜Discussion＞
In terms of our public awareness initiatives targeting residents, we received a lot of requests to assist
with the “Mental Health Supporter Development Course” training. We also received requests from othermunicipalities, perhaps because many of them had formulated suicide countermeasure plants in FY
2018, and we anticipated receiving a large number of requests to assist with these development courses
in 2019. In the future, we will respond to the needs of the communities we serve and assist them inproviding support wherever we can.
(4) Human resource development
We held training workshops aimed at disseminating knowledge on topics that wererequested by municipalities. We primarily carried out temperance-related training in
FY 2018, and we have listed these workshops in Table 5.

－ 71 －Stem Center Community Support Division Activity Report
Table 5. Temperance Support Training

Date

Location

2018
August 7

Sendai

August 8

Osaki

Content
FY 2018 Temperance Support Technical Training“Temperance Support Activities You Can Do in
10 Minutes”
Lecturer: Dr. Takahiro Fukuda, National Hospital
Organization Hizen Psychiatric Medical Center
FY 2018 Temperance Support Follow-Up Training“Tips for Temperance Support”

November
16
2019
February
15

Iwanuma

Shiogama

Participants

Collaborating organizations

74
49

Miyagi Prefecture
Mental Health andWelfare Center

17

MiyagiPrefecture
Shiogama
Health carecenter
Iwanumabranch24

Miyagi Prefecture Shiogama Health care center

Reviewing Tips for Temperance Support and Discussing How to
Implement Them
Lecturer: Dr. Takahiro Fukuda, National Hospital
Organization Hizen Psychiatric Medical Center
FY 2018 Alcohol-Related Issues, Supporter
Training“Early Interventions for Excessive Drinkers: Tips
and Tricks for Temperance Support”
Lecturer: Dr. Takahiro Fukuda, National Hospital Organization Hizen
Psychiatric Medical Center＜Discussion＞
Our division has strived to disseminate knowledge about “temperance support” since FY 2017.
In FY 2018, we held follow-up training for individuals who had taken our “FY 2017 Temperance
Support Training” program. Seventeen people participated, both temperance support practitioners alongwith people who were considering becoming practitioners. In our group work sessions, participants
shared their opinions and were able to learn a lot. Dr. Fukuda, the lecturer, commented that because theattendees were all people that had taken the course before, he was able to go even deeper this timearound.
Aside from follow-up training, we held temperance support training for Supporters, with the intentionof “enabling attendees to carry out temperance support” twice outside the Miyagi Prefecture Mental
Health and Welfare Center, and once outside the Miyagi Prefecture Shiogama Health care center. Participants shared the following opinions with us on a post-training questionnaire: “I had heard of temperance support, but I’d never been trained in it”; “I can use this in my health guidance work” and “Thisis the first time I’ve heard of the ‘drink’ unit.” Eighty-percent of the participants indicated that they
were “satisfied,” and the remaining 20% indicated they were “slightly satisfied or neutral,” indicatingthat the initiative was well-received overall.
The concept of “temperance support” could be found in the “Miyagi Prefecture Alcohol DisorderCountermeasure Promotion Plan.” Future training workshops will be held primarily by the Miyagi Prefecture Mental Health and Welfare Center. The role of this division will therefore transition to raisingpublic awareness of temperance alongside supporters among community residents.

－ 72 －

FY 2018 Bulletin, Issue 7(5) Research
The two research initiatives that our division participated in FY 2018 have been listed in Table 6.
Research title

Table 6 Research

Description

What we have learned from our
support of victims of the Great
East Japan Earthquake

We carried out health surveys of disaster-affected people between FY 2012 and FY 2016. We carried out outreach-type support with many different professionals for individuals needing
follow-up. We summarized the characteristic features of the support we extended in FY 2016.

What we have learned from our
support of a hikikomori

Regular home visits to people we had encountered while conducting
the disaster health survey, helped them improve.
We summarized that relationship.

Collaborating municipality
TagajoYamamoto

2．SummaryIn FY 2018, municipalities began contemplating the switch from disaster victim support to daily life support.
We carried out our community support work this year with the awareness that our division had a closure deadline. While some disaster survivors are only now discovering the ability to speak of the pain they endured solong ago, we also met some who were unable to acclimate to their new surroundings and had closeted themselvesaway in their houses. To move past the effects of this disaster, we must draw closer to the members of ourcommunity, and that will take time. While a close relationship with community members is of course important,sharing information with Supporters and creating opportunities for them to approach us for advice is also one of
our responsibilities.
We held many “temperance support” training workshops, and we were able to tell that the supporters werequite interested in the topic. In the future, we will pass the torch for these initiatives to the Miyagi Prefecture
Mental Health and Welfare Center, and we will endeavor to expand the scope of our practice while focusing on
health care centers. We might say that our goal in early FY 2017, to spread the idea of temperance throughout
the prefecture, has been achieved for the time being. Going forward, we plan to channel this achievement into
our temperance support work to reduce the number of residents and families that struggle with alcohol abuse
disorders.

－ 73 －