Initiatives over the 4 years of the Miyagi Disaster Mental HealthCare Center ― Project analysis based on activity statistics―
Miyagi Disaster Mental Health Care Center (MDMHCC) Coordination Division,
Planning and Coordination Department *1, Planning and Coordination Department *2
Clinical Psychologist

Moe Seto *1, Psychiatric Social Worker Takao Tanno *1

Psychiatric Social Worker Miyuki Tenma *1, Secretary Hiromi Abiko *1,
Psychiatric Social Worker Yuichi Watanabe *2
１． Introduction
Miyagi Disaster Mental Health Care Center (henceforth, “Center”) was established in December 2011 as an
institution to manage support in the mental health fields following the Great East Japan Earthquake. Following
the Stem Center, the Ishinomaki and Kesennuma regional centers were established in April 2012, after which
support projects began in earnest. Based on the six project criteria of resident support, care worker support, raisingpublic awareness, human resource development, research, and support for various activities, we provided support
based on a multidisciplinary team.
Following the Hyogo Mental Health Care Center established after the Great Hanshin-Awaji Earthquake and the
Niigata Prefecture Mental Health Care Center after the Niigata Chuetsu Earthquake, disaster mental health carecenters were established in Iwate, Miyagi, and Fukushima prefectures after the Great East Japan Earthquake but
a distinct characteristic of the center in Miyagi prefecture is that it has conducted support projects primarily using
personnel from the Department of Health and Welfare from each municipality, or those of victim support, fromthe start of its establishment. Five years since the Great East Japan Earthquake and four years since work has
begun at the center in earnest, support activities requested of the center from each municipality or associatedorganization has changed alongside changes in the current situation. In this paper, we reflect on activity results ofthe past four years; investigate the characteristic roles of the center, which has provided mid- and long-term
psychosocial support following the Great East Japan Earthquake; and contribute to how we should think of the
future activities of our center and mid- to long-term support following large-scale disasters.
２．Methods
We at the center have developed an activity statistical system based on the disaster mental health information
support system (DMHISS) and are collecting activity data. We were not able to collect detailed data in FY 2012
but we were able to collect numerical data on activity content from FY 2013 onwards. This paper uses FY 2012activity report data, as well activity statistical system data in the three years from FY 2013 to FY 2015, andinvestigated activity performance of four out of the six project criteria (resident support, care worker support, raisingpublic awareness, and human resource development). Activities that were handled by multiple staff members weretreated as a single data entry.
３． Results（１） Summary （Figure 1）
Direct support to residents in the region was tabulated as the total number of times support was given.
In FY 2012, which was the first year when the center began work in earnest, this number exceeded 6000,
which subsequently increased annually, with 7589 cases in FY 2015. For care worker support, a single
case was tabulated in the form of individual advice to care workers or support for their various activities,
and this remained at around 1800 cases since FY 2013. Raising public awareness for the general publicand human resource development targeted for care workers are activities that primarily focus on thecreation and distribution of materials for raising awareness, providing opportunities for communication－ 120 －

and the implementation of various lectures or training programs and each hosted event or completed item
was counted as a single data point. Annually, there were approximately 300-400 cases for raising publicawareness and approximately 160-170 cases for human resource development.
Support for
supporters

Support forresidents

Human resource
development

Raising publicawareness

8,000
7,000
6,000
5,000
4,000
3,000
2,000
1,000
0
FY 2012FY 2013

FY 2014

FY 2015

Figure 1 Changes in the number of activities（２） Results of each project① Resident support
The number of cases for resident support has increased annually (Figure 1). Increasing tendencies can beobserved in the number of cases throughout the year when FY 2013 is compared to FY 2014, but significant
increases in the number of support cases are observed in the latter half of FY 2015 (Figure 2).
FY 2013

FY 2014

FY 2015

1,000

800

600

400

200

0
Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Figure 2 Monthly changes in the number of cases for resident support according to year

－ 121 －

A． Support methods
Visit-based support has been consistently high since FY 2012, with approximately 3300, 3800, 4300, and4400 cases in FY 2012, FY 2013, FY 2014, and FY 2015, respectively. Walk-in visitor support in eachmunicipality, support organization, or center ranged between 800-1200 cases each year and phone-based
support for supported patients and anonymous telephone consultations ranged between 1300 and 1900 cases.
Consultations at group activities (e.g., salon events) numbered at around 80 cases in FY 2013 but increased toover 180 and 220 cases in FY 2014 and 2015, respectively. Case conferences where the victims receiving
support themselves attended numbered around 30 annually from FY 2014 onwards. Additionally,
accompanied visits by doctors numbered 70-130 cases, where they promoted ongoing consultations andtreatment.
Table 1 Total number of cases according to support method for resident support

FY 2012FY 2013

FY 2014

FY 2015

6,437

6,236

7,135

7,589

total number of support

Support

Visit

3,302

3,807

4,309

4,465

Home-visit

1,190

880

855

1,078

Phone

1,945

1,310

1,566

1,668

-

87

188

228

Case conference (patients attending） -Consultation at group activities

12

30

31

Accompanied visit by a doctor

115

134

73

Other
Letter-based approach

（*2）

-

25

53

46

‐

155

238

91

* 1 Only the three classifications of visits, home-visits, and telephone were tabulated for FY 2012
* 2 Total number of cases does not include cases supported by letter■ FY 2012
8,000
7,000
6,000
5,000
4,000
3,000
2,000
1,000
0
Other

Accompanied
visit by doctor

Case conference(patients
attending)

Consultations
at group
activities

TelephoneHome-visit

Visit

Figure 3 Changes according to support method

B. Breakdown of new and ongoing consultations
The annual breakdown of new and ongoing consultations is shown in Table 2. Patients were notgiven individual ID numbers in FY 2013 and FY 2014, so there are cases where a single individual
has received multiple consultations but are counted as new consultation cases. Patients were issued
ID numbers from FY 2015 to determine consultation status and progress, so the new consultation
patient numbers reflect actual values with no duplicates. For this reason, the new consultation number
cannot be simply compared across three years. The number of ongoing consultation cases is the total
number for all three years and this number has increased with each year.

－ 122 －

Table 2

Support status
FY 2013

FY 2014

FY 2015

2,725

2,798

2,265

3,511

4,337

5,324

6,236

7,135

7,589

New（ Actual number ） includes referrals from*another hospital）
Ongoing（ Total number）
Total* Duplicates included in actual number for FY 2013 and 2014

C． Patient characteristics
a． Gender, Age, Employment Demographics
There have been slightly more women when viewed across all three years but no significant
differences were observed. More patients were observed as age increased (Figures 4 and 5).
Additionally, the employment demographics showed that there were many unemployedindividuals (Table 3). The percentage of individuals over 60 among all patients receiving support
was around 50%, and the percentage of unemployed individuals ranged between approximately
71-75%.
1,200
1,000
800
600
400
200
0
Age unknown

Over age 70

60s

50s

40s

30s

20s

Below age 20

Figure 4 Changes in patients receiving support according to male age group

1,200

1,069
1,059
1,021

1,000

749
746

800

679
492

600
417
401
340

400
200

4245 77589
2

590
511492208
1801 0
3

123

13
5

102

Age unknown

Over age 70

60s

50s

40s

30s

20s

Below age 20

049

Figure 5 Changes in patients receiving support according to female age group－ 123 －

Changes in employment demographics （ total number ）Table 3

FY 2013

FY 2014

FY 2015

Employed, self-employed(including those on leave)
unemployed

1,571

1,561

1,763

4,443

5,351

5,577

Student

64

112

100

unknown

158

111

149

Total

6,236

7,135

7,589

b． Earthquake damage situation
The percentage of patients receiving support who have suffered housing damage was at highlevels of around 80%. Additionally, many individuals were severely impacted by the earthquake,with the percentage of individuals who experienced or observed a potentially life-threatening
situation at approximately 33-45%, individuals who suffered environmental losses at 50-57%, andindividuals who suffered bereavement at approximately 18-20% (Table 4).
Table 4 Earthquake damage situation（ Total number ）FY 2013
Bereavement

FY 20141,257

FY 2015

1,402

1,370

The person injured

189

158

88

Housing damage

5,066

5,592

5,778

Life-threatening risks and

2,814

3,132

2,547

3,281

4,103

3,742

witnessing of them
Environmental lossc． Housing status
The percentage of victims receiving support who were residents of disaster public housing
increased from 0.1%, 3.7%, and 19.1%, between FY 2013-2015. Alongside this, residents incontainer type temporary housing decreased from 34.3%, 33.9%, and 25.0%, while those in
privately rented temporary housing decreased from 24.3%, 16.9%, and 12.3% (Figure 6).
Individuals living in container type temporary housing and non-governmental organizationbased privately rented temporary housing need ongoing support, but so too was it shown that
individuals who moved into permanent housing also required support.
3,500
3,000
2,500
2,000
1,500
1,000
500
0

Changes in the living environment－ 124 －

Other, unknown

Disaster public
housing

Privately-rented
temporary housing

Container type
temporary housing

Residence

Figure 6

d． Household situation
The
percentage
ofindividuals
livingalone
increased slightly, with valuesof 31.3%, 33.2%, and 35.5% in
FY 2013, 2014, and 2015,
respectively (Figure 7). Healthsurveys of individuals living in
temporary housing in Miyagi
Prefecture showed that thepercentage of individuals living
alone has increased1) 2), and our
results show similar trends.

Unknown and other
Living with non-family members
Living with family members
Living alone

Figure 7 Changes in the presence orabsence of a roommatee． Instigating factors for consultation requests
Support for high-risk individuals based on health survey results conducted on residents in container type
temporary housing and privately-rented temporary housing in Miyagi Prefecture and all home-visits
conducted in certain regions for residents in container type temporary housing and privately-rented temporary
housing was the primary instigating factors for the start of support. Requests from administrative agencies
have also increased annually.
Table 5 Route of referral （ Total number ： Multiple answers allowed ）FY 2013

FY 2014

FY 2015

818
362
47
56
2,964
1,204
615

1,121
615
31
90
2,970
1,933
744

1,253
337
37
120
3,310
2,459
805

151
526
0
93

221
165
3
149

198
308
3
236

From individual
From a family member
From a neighbor
From work
Health survey / home-visit
From administrative agency
From support center / temporary
facility support staff
From medical institution
From welfare institution
Unknown
Other

50%
40%
30%
20%
10%
0%

－ 125 －

Other

Unknown

From welfare
institution

From medical
institution

From support center /temporary facility
support staff

From administrative
agencyHealth survey / home-visit

From
work

From aneighbor

From a family
memberFrom individual

Figure 8 Changes in Route of referral (percentages of all patients)

f． Background of consultation requests
The primary background of consultations since FY 2013 has consistently changed in the living
environment, family problems, psychological disorders, health problems, and addiction disorders
Consultations relating to psychological disorders, health problems, and family problems inparticular increased annually.
Table 6

Background of Consultation requests （ Total number ： Multiple answers allowed ）FY 2013

FY 2014

FY 2015

the loss of close relationships

740

606

587

changes in living environment

1,648

1,479

1,436

1,084

852

837

203

275

403

financial difficulties related toreconstructionsocial resources
Unemployment issues

442

379

524

human relations

617

619

510

1,170

1,228

1,832

244

201

273

31

25

8

558

520

593

family problems
Education/child rearing/transfer
radioactivity
anxiety about the futureWork-related problems
psychological disorders
Aging-related problems

139

202

348

1,621

2,011

2,457

429

425

406

health problems

1,649

1,752

2,504

addiction disorders

1,062

1,549

1,454

other/unknown

197

172

188

None

235

96

216

40%

30%

20%

10%

0%
None

Other,
unknown

Addiction problems

Health problems

Aging-related
problems

PsychologicaldisordersWork-related
problems
Anxiety about
the futureRadioactivity

Education / childrearing, transfer

Familybl

Humanrelations

Unemployment
issuesSocial resources

Financial difficulties
related to reconstruction

Changes in living
environment

Loss of close
relationships

Figure 9 Background of Consultation requests Changes in (percentage of all patients)

g． Psychological disorders
The percentage of individuals with mental illness symptoms were consistently at around 56% since
FY 20134. Additionally, the percentage of individuals with mood or emotion-related symptoms was thehighest, followed but those with sleep problems and physical problems. Anxiety and addiction problems
were ongoing as well.
－ 126 －

Table 7 psychological disorders （ Total number ： Multiple answers allowed ）FY 2013
Has psychological disorders

FY 2014

FY 2015

3,500

3,958

4,255

physical symptoms

1,537

1,000

1,354

sleep problems

1,595

1,398

1,422

Psychologicaldisorderanxiety

871

802

1,025

mood and emotion-related symptoms

3,375

2,074

2,337

dissociation and conversion symptoms

8

9

13

obsessive-compulsive symptoms

107

56

53

Delusions, hallucinations

550

373

295

behavioral problems

195

214

129

epileptic seizures

5

7

19

disturbance of consciousness

5

23

4

child-specific symptoms

10

6

9

addiction disorders

584

707

836

other symptoms

95

64

91

60%
50%
40%
30%
20%
10%
0%
Other
symptoms

Addiction disordersChild-specificsymptoms

Disturbance of
consciousness

Epileptic
seizures

Behavioral problems

Delusions,hallucinations

Obsessive-compulsive
symptoms

Dissociationand conversion
symptoms

Mood- andemotion-related
symptoms

Anxiety

Sleep problems

Physical symptoms

Figure 10 Breakdown of changes in psychological disorders (percentages of all patients)

h． Psychiatric illness history, disease name, onset time
The percentage of individuals with a history of psychiatric illness has consistently been around 30-40%
since FY 2013 and we have conducted support not only for those with a medical history associated with the
Department of Psychiatry but also for those with no connection to the Department of Psychiatry services(Figure 11). When looking at the onset time of individuals with a history of psychiatric illness and whose
diseases are named, many individuals who have had their illness since before the earthquake received support,
and individuals whose illnesses occurred after the earthquake has received support in regions as well (Figure12). When classified by illness, there were many with schizophrenia/schizotypal disorder/delusional disorder(ICD Code F2), mood disorders (F3), and mental/behavioral disorders due to psychoactive substance use(F1) (Figure 13). The F1 and F2 categories which greatly increased in FY 2014 have decreased in FY 2015,
whereas F3 and neurotic disorder/stress-related disorders/somatoform disorders (F4) have tended to increaseover time, with the same level of onset before and after the earthquake. These data indicate that the influenceof earthquake-related stresses, including that of PTSD, has increased over time. Intellectual disabilities (F7)and psychological development disorders (F8) have also sharply increased since FY 2015. Lifestyleproblems in temporary housing have not surfaced until now, but these individuals are thought to havedifficulties in the communication and procedures necessary for adopting to future lifestyles during therebuilding of lifestyles in the region and this indicates that these individuals have demanded more support
during these times.
－ 127 －

8,000
7,000
6,000
5,000

■ Unknown history of psychiatric illness

4,000■ No psychiatric consultation

3,000■ History of psychiatric illness

2,000
1,000
0
FY 2013

FY 2014

FY 2015

Figure 11 Changes in the presence of
psychiatric illness history

3,000
2,500
2,000
■ unknown

1,500■ after the earthquake■ Before the earthquake

1,000
500
0
FY 2013

FY 2014

FY 2015

Figure 12 Onset time of individuals with named disease out of those with a history of psychiatricillness
Present since
beforeearthquake

After
earthquake

unknown

800
700
600
500
400
300
200
100
0
FY 2015
FY 2014
FY 2013

FY 2015
FY 2014
FY 2013

FY 2015
FY 2014
FY 2013

FY 2015
FY 2014
FY 2013

FY 2015
FY 2014
FY 2013

FY 2015
FY 2014
FY 2013

FY 2015
FY 2014
FY 2013

FY 2015
FY 2014
FY 2013

FY 2015
FY 2014
FY 2013

F2

F3

F4

F5

F6

F7

F8

F9

G4

FY 2015
FY 2014
FY 2013

FY 2015
FY 2014
FY 2013F1

FY 2015
FY 2014
FY 2013

FY 2015
FY 2014
FY 2013F0

No disease Unknown
name

Figure 13 Number of patients according to disease classification and onset time

－ 128 －

D． Support content
Consultations from the client comprise over half of the cases, but there were also support cases
where consultations came from family members or care workers (Table 8).
Table 8Changes in counselees（ Total number ）FY 2013

FY 2014

FY 2015

client

5,414

6,144

6,734

Family and relatives

770

888

798

Residents in neighborhood,acquaintances, friends,
workplace
supporters

22

43

25

29

57

29

Other

1

3

3

Total

6,236

7,135

7,589

We have conducted resident support with a priority on coordination with other institutions fromthe onset, but one form of coordination was to conduct accompanied visits with municipalities,
support centers, and medical institutions (Table 9, Figures 14 and 15). This reflects the fact that there
are regions that have conducted accompanied visits with medical institutions, which have been
entrusted with victim support by municipalities and support cases with medical institution affiliations
are present have increased annually.
Table 9Changes in the (total) number of cases with other organization affiliations
FY 2013

FY 2014

FY 2015

1,596

1,714

1,6

4,640

5,421

5,9

municipalities

609

781

761

With otherinstitutions

05

Without other

With other aorganizations

institutions

84
Health care center

127

92

56

medical institutions

41

128

226

Welfare-related

130

166

120

Support center

561

468

424

Other

212

192

103

7,000
6,000

With other institutions
With other institutions

5,000
4,000
3,000
2,000
1,000
0

Figure 14 Presence of other organization affiliations－ 129 －

FY 2013

FY 2014

FY 2015

20%

10%

0%

Municipalitie Health carecentermedical Welfare-related Support center
institutions

Other

Figure 15 Breakdown of other organization affiliations

E． Conditions at the end of support
Many outcomes at the end of support were either case where conditions improved or where no support
was deemed necessary. Additionally, this reflects the characteristic role of the center is acting as a pointof contact for municipal managers for providing spot triage for support and cases referred to otherinstitutions were mostly succeeded by municipally managed divisions, followed by referrals to medical
institutions such as psychiatric/neurological departments and psychiatric care.
Table 10

Conditions at the end of support

Referral site
breakdown

FY 2013
Improved situation / No support needed 1,680
Denial of support
75
Referred from another institution
184
Department of Psychiatry, Department of
44
Neurology, psychiatric care
Other than the above medical institutions 12municipalities
72
Judicial
3
Elderly welfare
22
Welfare for Persons with Disabilities 14
Child welfare
8
Employment center
6
Other

22

FY 2014
1,448
44
144
16

FY 2015
1,675
70
142
24

3
62
2
24
20
1
4

4
75
1
8
7
2
0

20

27

2,500

2,000
Referred from another institution

1,500

Denial of support
Improved situation /No support needed

1,000

500

0
FY 2013

Figure 16

FY 2014

FY 2015

Conditions at the end of support－ 130 －

② Care worker support
The number of activities for care worker support and the number of patients decreased in FY 2015
(Figure 17). Government officials comprised the majority of patients (Figure 18). Besides this, support
was provided for support staff of institutions or temporary housing set up for victim support after theearthquake and regional care workers who have been present since before the earthquake (health careproviders, school officials, etc.).
■(cases)2,500

Number of care
worker support cases

Number of patients

2,000
1,500
1,000
500

（people）
8,000
7,000
6,000
5,000
4,000
3,000
2,000
1,000
0

0
FY 2013

Figure 17

FY 2014

FY 2015

Changes in care worker support

4,000
3,500
3,000
2,500
2,000
1,500
1,000
500
Other

Volunteers

Senior welfare

Child welfare

Disability welfare

Social Welfare Council

Professional organization

Private organization

Public organization

Corporations

Fire brigade

Fire department

PoliceSelf Defense Force

Legal or judicial officials

Regional general support
centerSchool officials

Health care provider

Administrative official

Temporary housing
support staff

Support center

Officials from other regions

Health advocate

Municipal official

Welfare commissioners

Self-help group

0

Figure 18 Changes in care worker support patients

The number of professional guidance and advice and the number of cases both decreased in FY 2015
(Figure 19). Breaking down professional guidance and advice (Figure 20), there was initially a highnumber of guidance/advice requests regarding depression, but this gradually decreased. Needs for
Alcohol-related problems remain high. Guidance and advice for abuse problems have also increased.
“Other” categories include cases with schizophrenia, dementia, and developmental problems, as wellas advice on general support and advisors in study groups.
Administrative support was expected to decrease with time, but the quality of administrative support
has changed with not only requests for direct support but also data analysis relating to victim support
and collaboration with all forms of mental health welfare activities. Office work, including data analysis
and activity operations, has increased, reflected this trend.
The establishment of mental health consultation desks for care workers has been ongoing as well,and support needs for the mental health of the care worker themselves have increased alongside
workplace mental care even years after the earthquake－ 131 －

700

261 270226300

221237

182

20018930

OtherWork duty support

Regional issues

Changes in each care worker support activity
Establishment of
mental healthconsultation desks
Case conference(patient absent)

Workplace mental care

Post-visit / interview
report

Other

Abuse

Complicatedgrieving

Depression

DrugbGambling

Alcohol-relatedbl－ 132 －

Ｐ
Ｔ
Ｓ
Ｄ

503
474

500

54
30
56 68 5838 45

108 110
1
7
59
75
75

100

391
387

400

Medicalexamination
supportProfessional
guidance / advice

Figure 19
0

616
585

600

1,200

1,000

800

600

400

200

0

Figure 20 Changes in broken-down professional guidance and advice

Until now, a total of 16 individuals have been dispatched to 6 cities, 2 towns, and one health welfare office, andas of the end of FY 2015, eight individuals were dispatched to 5 cities and 2 towns. Dispatched staff members
responded to the needs of each administrative agency and coordinated with mental health activities, as well as
responding to activity support needs.

Kesennuma City
Ongoing
Ongoing
Ongoing

Minamisanriku Town
Ishinomaki City
Eastern health welfare officeOngoing
Higashimatsushima
City

OngoingOnagawa Town
Shiogama City
OngoingNatori City
Ongoing
Iwanuma City
Psychiatric Social Worker

Clinical Psychologist

Occupational Therapist

Nurse

Figure 21 Deployment of dispatched staff members③ Raising public awarenessThe number of public awareness activities for the general public increased by over 100 cases fromFY 2014 to FY 2015 (Figure 22). Simultaneously, the number of patients also increased byapproximately 1000.

（Cases）

Number of people who
participated in ta publicawareness campaign

Number of
educational
workshops

450
400
350
300
250
200
150
100
50
0

（People）
7,000
6,000
5,000
4,000
3,000
2,000
1,000
0

■

FY 2013

FY 2014

FY 2015

Figure 22 Changes in raising public－ 133 －

Conducting and cooperating with salon activities as well as educational workshops were the focus of
public awareness activities. Salon events that have achieved their objectives of communication
promotion were continued, but from FY 2015, salons targeted to specific regional issues, such as sobriety,dementia, and isolation prevention for individuals under the age of 60, were established. Additionally,in FY 2015, several salons were ended due to the withdrawal of institutions that hosted them or the endof victim support projects and there are salons that the center wishes to succeed and continue hosting.
There are initiatives related to alcohol-related problems that involved coordination with the Medical
Corporation Tohokukai Tohokukai Hospital, the Miyagi Prefectural Danshukai, and other associatedorganizations. The number of regions that have been involved in the study group or sobriety meetings
that include stakeholders to launch Danshukai in their area has gradually increased with time.
Stakeholder participation in alcohol-related initiatives is an ongoing struggle, but we sought to stabilize
this as a local resource by continuing to work with regional care workers. We hosted a training session
relating to the basics of cognitive-behavioral therapy (mental training workshops) with the Tohoku
University Department of Preventative Psychiatry. Additionally, upon request of the Miyagi branch of
the Japan Health Insurance Association, we conducted lectures on workplace mental health incorporations until FY 2014, but in FY 2015, we established a contract with the association to conduct“mental health promotion delivered lectures” at 9 offices. There were over 770 participants in total, andit was an opportunity to raise public awareness to groups that work during the day and have difficulty
connecting with support through individual home visits.
200
180
160
140
120
100
80
60
40
20
0
Other

Salon
activities

Public awarenesstraining

Establishment of
mental healthconsultation desks

Presentations atconferences andprofessionalorganizations

Web page management /updates / information
sharing

Media-based publicawareness activities

News agency
responses

Inspection
supportDistribution of publicawareness materials

Figure 23 Changes in public awareness activities
Number of participants
45

0

100

Figure 24

Breakdown of educational workshops－ 134 －On the status of the disasterarea and center activities

200
On workplace mental
health300

5On physical health

400

10

On stress, mental care,and self-care

500

15

The effects of theearthquake on children

600

20

On addiction problems

700

25

Pointers for handlingindividuals with stress

800

30

About psychologicalillnesses

900

35

Post-disaster mental
reaction

400

④ Human resource development
No major changes in the number of human resource development cases or patients were observed(Figure 25). Events were conducted for a wide range of professions, including welfare commissioners
and school officials, and were centered around administrative officials (Figure 26). The number of
temporary housing care support staff participants decreased, which corresponded to the decrease incontainer type temporary housing and the increased skills of these support staff. We also continued toprovide support for the human resource needs of the general public, including gatekeepers and dementia
supporters.
（Cases）

Number of humanresource■ development needs

Number of students inhuman resource
development（People）

200
6,000
4,000

100

2,000
0

0
FY 2013

Figure 25

FY 2014

FY 2015

Changes in human resource development

1,400
1,200
1,000
800
600
400
200
0
Other

Volunteers

Senior welfare

Child welfare

Disability welfare

Social WelfareC
ilProfessional
i i
Private organizations

Public organizations

Corporations

Fire Brigade

Fire Department

PoliceSelf Defense ForceRegional general support

Legal and judicial
officials
School officials

Health care providers

Administrative officials

Temporary housing
ff
Support centers

Other regionalorganizations
Health advocates

Municipal
officials
Welfarecommissioners
Self-help
groupsGeneralbli

ーFigure 26 Changes in human resource development candidates

Workshops on addiction problems and support skills were the focus of human resource development
care worker training content (Figure 27). Additionally, there was increased support for training needs
relating to mental health in children. When broken down by support skill workshop, support for training
needs relating to listening skills was consistently conducted since FY 2013 (Figure 28). Besides this, awide range of content was implemented for the needs of each region, including psychological first aid(PFA).

－ 135 －

60
50
40

3234
26

30
20

11
10

333

12

15

10
8
6

121

108

7118

8 9 999

5

19

12
76

108

111
Other

Case study

Disaster affected area
situation and center activities

Workplace mental
health training

Training about
mental disorderSupport skill training

Supporter mental healthtraining

Media conferenceChildren mental healthtraining

Suicide measure related
problem training

Elderly mental healthtraining

Addiction-related problem

Disaster mental care exchange
meeting

Figure 27 Changes in each human resource development
ti it

30
25
20
15
10
5
Other

Psychologicalrecovery skills

Cognitive behavioral
therapy

Responding tosurvivors

On stress, mental care,and self-care

On listening

Figure 28

Breakdown of support skill workshops

The first mental health care meeting for disaster victims in Miyagi was sponsored by the Natural
Disaster mental health care network Miyagi in FY 2011 for information sharing and network-building
among care workers, and the second meeting was co-hosted with the center. They have been conductedin three locations within the prefecture every year and the meetings included timely themes, lectures,group work, and information exchange sessions. The number of participants has tended to decrease(Table 11), but we intend to continue these meetings in the future as they not only deepen collaborative
efforts and provide the support that fits the actual conditions of each region, but so too do they provide
mutual support among care workers involved in victim support.

－ 136 －

Table 11 Implementation status of mental health care meetings for disaster victims in Miyagi (FY 2012 onwards)
Hosting time / location

Theme

Session 3 （ Sendai City ）FY 2012
Session 4（Ishinomaki

Number of participants

1 year and 8 months since the earthquake ~current status of the disaster area and challenges)

60

Discussing the present and future of victim support

83

Reflecting on post-earthquake activities ~trying to build better relationships~

80

Connecting the future, making the future

60

City）
Session 5（Kesennuma

Session 6（Ishinomaki

City）
FY 2013

City）
Session 7（Sendai City）

Making support connections a circle

81

Session 8（Minamisanriku

Support heading into the future73

Session 9（Sendai City）

Making support connections a circle

49

Session 10 （Ishinomaki City）

The people and forces heading into the future33

Session 11 （Ishinomaki City）

Making support connections a circle

27

Anybody can support anybody ~ the resources of this city are “people” and48“connections with people”~

63

Town）
FY 2014

FY 2015

S e s s i o n 1 2 （Kesennuma City）
Sessi
o n 1 3 （Ishinomaki City）

Five years since the earthquake – discussing the present and future* the Natural Disaster Mental Health Care Network Miyagi sponsored the first meeting, and the center was a co-host from the second meeting onwards(first and second meetings were conducted in FY 2011).

４． Discussion（１） Resident support
Resident support provided by the center is an outreach activity for high-risk individuals based on healthsurveys primarily conducted on residents in container type temporary housing and privately rented
temporary housing. For these reasons, this area a high percentage of patients who have suffered housing
losses due to the earthquake witnessed or experienced life-threatening situations, environmental losses,
and bereavement. As a result, these individuals needed a variety of psychological and psychosocial
support. We collaborated with each organization to respond to individual cases and it was often the casethat we would connect individuals to care workers who supported regional lifestyles, such as municipal
managing division or temporary housing support staff. There were times where we also conductedcasework that connected to diagnoses from appropriate medical institutions or accompanied visits by adoctor.
The fact that many victims receiving support at the center are senior citizens or unemployed individuals
reflects the emphasis of initiatives on these demographic groups, which have previously been indicatedas high risk. Meanwhile, this may also reflect the restrictive nature of the support system, which isconcentrated during the day during weekdays. There are regions where we conduct visits on the weekends
upon request of municipalities, and future challenges include how to approach groups that are difficult to
encounter during the daytime hours of the weekday.
When the center was first established, there was a lot of support provided for individuals suffering fromschizophrenia or mood disorders who’d suffered before the disaster, and increases were observed overtime in the support for alcohol-related problems, as well as mood and stress disorders that began after thedisaster. Furthermore, increased relocation to disaster public housing and the home reconstruction resulted
in increased responses to individuals who have problems with self-sufficiency, various procedures, andcommunication, such as those with mild intellectual disabilities or those who have developmental
problems. Additionally, when looking at the background of consultations, we can see that many responses
included support for health for the mind and body, particularly sleep problems, mood and emotion-related－ 137 －

symptoms, anxiety, addiction disorders, and family problems. The number of consultations for addiction
disorders has slightly decreased, but this may be a result of our efforts in care worker support and humanresource development relating to alcohol problems, as well as the increased response capabilities ofregional care workers. However, we believe that initiatives for alcohol-related problems require ongoing
work, and the progress of such initiatives needs to be carefully monitored.
There are various victims receiving support at the center, ranging from healthy individuals to those withmental illness. Since the establishment of the center, our ongoing policy for regional resident support
activities has been to continue detailed outreach activities and accompany victims, and to connect themto regional resources as needed in coordination with associated institutions. Future investigations on how
staff members responded to various problems affecting regional residents and what approaches wereeffective will be necessary.

（２） Care worker support

Care worker support can be considered in terms of the two following points. The first point is the quality
and quantity of victim support. We conducted support relating to the fields of mental health by providing
professional advice and guidance (i.e., supervising, case conferences) and meanwhile, we also continued
administrative support as well as outreach based on government request and sought to reduce workloads.
The center has conducted support in all regions of the prefecture except for Sendai city and the advantage
within the center is that information in each region can be shared and initiatives in other regions can betaken back as a reference. In particular, the introduction of the dispatch system is thought to be effectivelyfunctioning in both the “quality and quantity” of support.
The second point is the support provided for the mental health of the care workers themselves in disasterareas and we are involved in initiatives such as providing support for workplace mental health and theestablishment of mental wellness consultation booths for care workers. Many care workers have been
overworked since immediately after the disaster, and they are victims. Perhaps the organizational support
for line care and the opening of mental wellness consultation booths as a consultation source aredemanded by the center to handle the fatigue of these care workers.
In this context, the number of cases where guidance and advice are given from professionals has
decreased in FY 2015. This may indicate improved mental health-related support capabilities of regionalcare workers but ensuring a system that continues to provide effective care worker support while
incorporating the changing needs of care worker support as the regional situation changes will be an
important future issue.
（３） Raising public awarenessWith regards to raising public awareness in the general public, the need for addition and self-care skills,
particularly the basics of cognitive-behavioral therapy (mental training workshops), has increased year by
year. Even salon activities have become more restrictive in their audience, shifting from communication
promotion to sobriety, dementia, and the prevention of isolation in relatively young demographics. Thisis likely a change from training and salon sessions that address a wide range of health issues relating to
the mind and body to more specific needs corresponding to the issues of each region. Concerning salons,
coordination with regional care workers needs to be strengthened and support needs to become
autonomous to ensure that salons are established and continued as a regional resource.
（４） Human resource development
There is an ongoing need for training relating to listening skills in workshops for care workers. It isthought care workers are being advised through individual cases in supervisions and case conferenceswith regards to individual support skills. These skills contribute not only to workshops for specialists but
also for the development of gatekeepers and dementia supporters and will likely be connected to the
expansion of human resources that manage regional mental health issues.
Increasing the communication of regional care workers and establishing smooth cooperation are also
important roles of the center. Support organizations will withdraw from the area with time, but it isprecisely for this reason that venues where care workers can gather and share current activities and issues,－ 138 －

such as the mental health care meetings for disaster victims, are thought to be important.
５． Conclusions
Reflecting on the past four years of activities since the establishment of the center, we can see that wehave conducted activities alongside regional care workers, which include administrative public healthnurses, in care worker support, raising public awareness, and human resource development, with a focus
on resident support based on outreach. Kato (2016)3) has mentioned that the fundamental aspect of mental
health countermeasures in recovery periods are “the activation of regional health networks and its
reinforcement”. The center has also engaged in various projects, setting the coordination and collaboration
with regional health networks as an important goal. It is thought that this aspect is reflected some extent
in the present results as well. Additionally, the present results reinforce the fact that the activities of ourcenter have addressed issues from multiple layers and angles and have responded to needs that have varied
by region and period. In the future, we need to reflect on these initiatives to date and extract issues, further
strengthen coordination with regional care workers, and conduct effective support that incorporates
regional needs and situations.
This paper analyzed the results of center activities based primarily on the activity statistical system data,
so we cannot discuss the characteristics of specific initiatives and their effects. Even initiatives that seem
identical at first glance may vary in content depending on the region and period, so it is thought that weneed to evaluate future changes, including qualitative investigations of the activities conducted.
Acknowledgments
We would like to thank Professor Hiroaki Tomita of the International Research Institute of Disaster
Science at the Tohoku University Department of Disaster Psychiatry for his advice in writing this paper.
References

１） Results of the FY 2015 Miyagi Prefecture privately-rented temporary housing health survey for residents
http://www.pref.miyagi.jp/uploaded/attachment/359976.pdf（June 10th, 2016）
２） Results of the FY 2015 Miyagi Prefecture temporary emergency housing （ Container type temporary
housing ）health survey for residents http://www.pref.miyagi.jp/uploaded/attachment/341278.pdf（June10th, 2016）３）Kato, H. （2016）,Chapter 7: Medium and long-term support ：General remarks. Sakai, A., Niwa, S., Matsuoka,
H. (Supervisors), Otsuka, K., Kato, H., Kin, Y., Matsumoto, K. (Editors), Mental health in disaster situations,Igaku-Shoin, 171－ 139 －