The Significance of and Issues with Salon Activities in Disaster-Affected Areas: What We Have Learned
from the Progress of Salon Activities Targeting Evacuees from Fukushima Prefecture

Chapter II
Research Reports and Contributed Manuscripts
1. The Significance of and Issues with Salon Activities in Disaster-Affected Areas:
What We Have Learned from the Progress of Salon Activities Targeting
Evacuees from Fukushima Prefecture
2. Camp Project for Parents and Children in Disaster-Affected Areas
3. Symposium for Community Development Supporting the Raising ofChildren:
What We Have Learned from the Michinoku Children's Cohort – Practical Report

The Significance of and Issues with Salon Activities in Disaster-Affected Areas:
What We Have Learned from the Progress of Salon Activities Targeting Evacuees from Fukushima Prefecture

The Significance of and Issues with Salon Activities in Disaster-Affected Areas:
What We Have Learned from the Progress of Salon Activities Targeting Evacuees from Fukushima Prefecture

The Significance of and Issues with Salon Activities in Disaster-Affected Areas:
What We Have Learned from the Progress ofSalon Activities Targeting Evacuees from Fukushima Prefecture
Miyagi Disaster Mental Health Care Center
Stem Center, Planning and Research DivisionPsychiatric Social Worker – Yuichi Watanabe

1. Survey Objectives
The massive earthquake that struck on March 11, 2011 caused a tsunami on Japan's Pacific coast,
wreaking enormous damage, leaving 18,430 dead and missing. Additionally, the Fukushima Daiichi Nuclear Power Station accident occurred, forcing many Fukushima residents to evacuate to the neighboring
prefecture, Miyagi Prefecture. Regular salon activities for these people were started and support groups arecontinuing these activities.
The Miyagi Disaster Mental Health Care Center has cooperated with salon activities held by otherorganizations since FY 2014 and took over as host of these activities in FY 2017 (Slide 1). These activities
generally consist of seasonal events, such as cooking and tea talks, and sometimes participants even bringgifts. Overall, these activities take place in a peaceful atmosphere (Slide 2).
Eight years have passed since the earthquake, and the earthquake reconstruction plan presented by
Miyagi Prefecture is nearing its end. Furthermore, new questions about the expansion, withdrawal, andsignificance of these salon activities are being raised. In this study, we examined the relevance of this salonfrom questionnaire surveys and interviews with participants. We reported on the issues people faced in theparticular situation of evacuation outside the prefecture. The purpose was to provide suggestions for considering salon activities in a future disaster and to gain insight into future disaster support considerations.
2. Survey Content(1) Targets: 18 salon participants, aged 74.8±6.3 years (61-87),
7 male (38.9%), 11 female (61.1%).
(2) Implementation methods
Salon participants were surveyed using the following two methods (Slide 3):① We sent participants copies of the Health-Related Quality of Life (HRQOL) scale SF-8 and ourquestionnaire via postal mail and used these to conduct a survey. We asked about their living
conditions and health level and confirmed how they perceived salon activities.
② We conducted interviews with current participants and those involved in the operation of thesalon. Participants were interviewed mainly about their living conditions. We interviewed thepeople concerned about the background to establishing the salon and the operational issuesthussfar.

--103 -The Significance of and Issues with Salon Activities in Disaster-Affected Areas:
What We Have Learned from the Progress of Salon Activities Targeting Evacuees from Fukushima Prefecture
3. Results
The response rate was 100%, and there were no missing values. In terms of the SF-8, the scoring ratetended to be lower than the 2007 national standard value. However, the obtained values are not necessarily
low considering our participants' average age (slides 4, 5, 6).
From the answers to our questionnaire, we discovered that the salon offered participants an opportunity
to go out and expand their social circle (“Q. The salon provides me an opportunity to go out.” Stronglyagree/somewhat agree with responses = 83.3%) (“Q. My social circle has expanded.” Strongly agree/somewhat agree responses = 88.9%), and we found that many people wanted to continue their salon activities(“Q. About the future of the salon, I would like it to continue for as long as possible. I would like it tocontinue for a little while longer,” 77.8%) (slides 7, 8).
From the results of our interviews, it became clear that while many people wanted to continue the salon,
they believed it would be quite challenging to manage the salon entirely independently. Many participants
thought that some external support was needed. Moreover, we discovered that many participants did not
move to Miyagi Prefecture immediately after the nuclear accident but instead had repeatedly moved aroundthe country several times. Additionally, many of them experienced physical and mental disorders during
the process of evacuation and moving. It became clear that some people are still worried about securing
their basic livelihoods and planning for the future (Slide 9).
4. Discussion
From the salon participants' survey at this time, we inferred that many people are still living with “ambiguous loss” eight years after the earthquake. In the interviews, many respondents said they felt uncomfortable when asked questions such as “Did you receive significant compensation?” (or heard rumors thatsuch questions were asked) at evacuation sites. For those who were hurt at the evacuation site and repeatedly
moved, the salon was a valuable place to talk about the local area without hesitation and manage theirhardships after the earthquake.
We believe that the participants' age in this survey was why our SF-8 scores were lower than the standard values. In light of this, the low score obtained is not necessarily an indication that the health conditionof our participants is extremely low, but we did discover that some people had suffered heavy physical andmental burdens due to the evacuation and relocation thus far and were experiencing troubles in their current
daily lives. Furthermore, many were asked about compensation at the evacuation site and said they felt
uncomfortable (Slides 10 and 11). Currently, nearly all of the people who participate in multiple salonsparticipate in salons for evacuees from Fukushima Prefecture. It is thought that these experiences may haveinfluenced their choice of salons (Slide 12).
Additionally, we obtained many positive answers to the question of whether or not “Salons enable me
to talk about my hometown without hesitation.” Evacuees’ evacuation experiences have been an obstaclein their efforts to expand their friendships in their new homes. Thus, the need for a salon where evacuees
can talk about their hometown without hesitation has been raised since the earthquake. It is still considered
to be expensive even after eight years have passed.
Moreover, from the interview, it appears that the participants engaged with the salon for multiple reasons and their feelings about the salon were different. Further, each participant had various backgroundfactors, including the differences between those who voluntarily evacuated and those who evacuated dueto the nuclear accident. Furthermore, there are differences between the original municipality of residences
and the relationship with Tokyo Electric Power Company (TEPCO) before the earthquake. In the questionnaire, the salon's “ease of participation” and “program content” were not so highly evaluated, and evenwhen asked about “the topic of nuclear power plants,” there were relatively few answers that indicated thatit “was a big topic.” It is thought that the circumstances leading up to such participation, differences instanding position and background, and so forth, influenced participants’ evaluation of the salon and its
contents.

--104 -The Significance of and Issues with Salon Activities in Disaster-Affected Areas:
What We Have Learned from the Progress of Salon Activities Targeting Evacuees from Fukushima Prefecture

In these interviews, participants indicated that there were two other salons they visited. However, while
they decided to participate in those salons based on the program content (i.e., they did not participate inevery meeting), nearly all the same members participated in our salon every time. No large fluctuations in
the number of participants were observed. It is thought that our salon's character is not the attractiveness ofthe program content itself, but the “atmosphere” where participants can meet face to face and talk without
hesitation. Although each participant has a different background, everyone is cherished which contributes
to the pleasant atmosphere.
Further, from the interview, it was confirmed that many people are thinking about living in Fukushima
Prefecture and resuming business. Many feel that they cannot give up on their hometown. This is the socalled “ambiguous loss,” and it can be said that a deep attachment to the past life and emotion that values
the present life coexist. In this survey, we became acquainted with each other through the salon. It wasconfirmed that the participants exchanged information such as going to Fukushima prefecture and goingback and forth between each other's houses. Such exchanges are considered to be an essential factor in
activating one’s resilience. Also, for those who have conflicting feelings about the past and present, thepresent residence is the most convenient position for maintaining mental balance.
5. Wrap-Up
Some participants are gradually participating in club activities to expand their relationships in their newplace of residence. However, in this survey, there were still many requests for the salon to continue, and it
was found that there is still a significant need for a place where people can talk without hesitation. With thecompletion of the reconstruction plan, projects are being organized more and more. However, I think it isnecessary to contemplate continuing the nature of such a space to ensure that participants' needs are notignored. In future, I would like to study comparisons with other salons and surveys of the actual conditionsof evacuees in Fukushima Prefecture and consider opportunities for dissemination, all while remaining
respectful to the feelings of those who have evacuated.
(This paper is a compilation and addition of the content presented at the 55th Japan Mental HealthWelfare Association National Convention and the 18th Japan Mental Health Welfare Society AcademicMeeting.)--105 -The Significance of and Issues with Salon Activities in Disaster-Affected Areas:
What We Have Learned from the Progress of Salon Activities Targeting Evacuees from Fukushima PrefectureSalon Overview

FutabaOkuma
FukushimaTomioka

Regions that cannot
be returned to
Regions with restricted
residency

Fukushima
Daiichi Reactor

Kawamata

Fukushima

Namie

MiyagiMinamisoma

IitateRegions ordered toevacuate

Areas released on March
31/April 1, 2017

Questionnaire results, SF-8

Survey Overview

Answer• 18 salon participants• aged 74.8±6.3 years (61-87)• 7 male (38.9%), 11 female (61.1%).

1Targets

2 Implemented
methods:

In the past month, how much did physical health problems
limit your usual physical activities (walking, climbing the stairs, etc.)?

The following two methods were used(February 2019)

Survey type

Questionnaire

In the past month, how much difficulty did you have doing your daily
work, both at home and away from home, because of your physical health?

How much bodily pain have you had during the past month?

Content

During the past month, how much energy did you have?

① Health-Related Quality of Life Scale, SRF-8②Our own questionnaire

During the past month, how much did your physical health or emotional
problems limit your usual social activities with family or friends?

Confirm living status, health level, and opinions about the salon.

Interview survey

Mean value

items
Overall, how has your healthbeen over the past month?

About participants lifestyles and specificopinions about the salon.
* Salon managers were asked about their
history, issues, etc., with the salon.

During the past month, how much have you been bothered by emotional
problems (such as feeling anxious, depressed or irritable)?
During the past month, how much did personal or emotional problems
keep you from doing your usual work, school or other daily activities?
Shunichi Fukuhara, Yoshimi Suzukamo, SF-8 Japanese Manual: Specified Nonprofit Organization Health and Medical
Evaluation Research Organization, Kyoto, 2004(this citation appears on several slides)

Shunichi Fukuhara, Yoshimi Suzukamo, SF-8 Japanese Manual: Specified Nonprofit Organization Health and Medical
Evaluation Research Organization, Kyoto, 2004(this citation appears on several slides)

Slide 4

Slide 3

Questionnaire results, SF-8

Questionnaire results, SF-8
During the past month, how much have you been bothered by emotional problems (such as feeling anxious, depressed orirritable)?

Overall, how has your health been over the past month?
Excellent
Very good

Not at all
Slightly
Moderately
Quite a lot
Extremely

GoodFair
Poor

Very poor
Total

Total
During the past month, how much did your physical health oremotional problems limit your usualsocial activities with family
or friends?

In the past month, how much did physical health problems limit yourusual physical activities (walking, climbing the stairs, etc.)?
Not at all
Very little
Somewhat
Quite a lot
Could not do social activities
Total

Not at all
Very little
Somewhat
Quite a lot
Could not do social activitiesTotal

Shunichi Fukuhara, Yoshimi Suzukamo, SF-8 Japanese Manual: Specified Nonprofit Organization Health and Medical
Evaluation Research Organization, Kyoto, 2004(this citation appears on several slides)

Shunichi Fukuhara, Yoshimi Suzukamo, SF-8 Japanese Manual: Specified Nonprofit Organization Health and Medical
Evaluation Research Organization, Kyoto, 2004(this citation appears on several slides)

Slide 6

Slide 5--106 -The Significance of and Issues with Salon Activities in Disaster-Affected Areas:
What We Have Learned from the Progress of Salon Activities Targeting Evacuees from Fukushima PrefectureSurvey results, question items ①

Survey results, question items ②

Items with ~80% positive answers
The percentage of answers that indicated that the salon was “veryeasy to participate in” and program content was “very fun” wassmall.

“The salon is easy to participate in.”
“The salon has broadened my social circle.”With respect to a question asking if “the topic of the nuclear accident was raised,” we also observed a low rate of responses indicating that “it very much was,” and variance was high.

“I meet with salon participants outsidethe salon, too.”” can speak about my hometown with“Iout hesitation.”“I want the salon to continue.”

Finally, in response to the questions “Did salon participation
change your daily life?” and “I receive information about Fukushima and my place of residence,” the percentages of responses indicating “great change” and “I strongly agree,” respectively, werelow.

“I want to try attending other salons.”“The salon is an opportunity for me to go out.”

Slide 7

Slide 8From interviews
Number ofevacuations/relocations

Average of 7.2 times(4-14 times)

Number ofyears living inMiyagi

Average of 5.37 years(3-8 years)

Survey results, interviews“I used to work all day before, but I became unable to handle that mentally.”
It became clear that participants had been through a significant number of evacuations and relocations before coming
to live in Miyagi, which left them with considerable physical and mental burdens.
“I eat dinner at my eldest son’s house.”“I play with my grandchildren, who live in the same city.”
While many participants responded that their families had
been “reduced,” they maintained some degree of connection, and were not left isolated.
“I liked it better when it was smaller.”“I would like more people to participate.”
Participants’ desires for what they would like to see happen
to the program varied considerably. We believe these differences in opinion have to do with how these individuals
came to take part in the salon.

Number of
Average of 3.97 years
years participat- (1-6.5 years)
ing in the salon

Slide 9Slide 10

Survey results, interviews

From interviews
Salon participation“I take care to not appear as though I have money.”“When I tell people I relocated from Fukushima, they start asking me about my compensation money. I try to avoid telling
people I’m an evacuee.”multiple answers
possiblenot participating
in any 11%

Most participants had experienced negative emotions
due to unpleasant comments.

Participating
89%
Salons for Fukushima people“I’m not sure whether or not I should return home or just startworking here.”“While my family’s graves are back home, there’s nothing elsethere.”“I want to go back, but my children don’t.”

Salons in Miyagi

Now that more than eight years have passed since the disaster, participants feela variety of different ways about their current situation: some are optimistic andlooking forward to broadening their social circle, some are unable to decide what
to do, and some feel empty about their daily lives.

Salon A

Salon B

Salon C

Slide 12Slide 11--107 -

Salon D

Salon E