Department Initiatives
Kesennuma Regional Center, Community
Support DivisionKesennuma Regional Center Initiatives
Kesennuma Regional Center, Community Support Division
Psychiatric Social Worker – Takao Tanno
1. Introduction
Three years have passed since the Great East Japan Earthquake. Removal and processing of
rubble has come a long way, and the ground level in flooded urban areas has been raised and leveled.
In addition, the construction Table 1: Emergency Temporary Housing Tenant Numbersof seawalls and riverTotalembankments and the Munici- Emergency Temporary Private
pality of Housing
chartereddevelopmentof As
Com Tenant Occupie Tenant
Occupi Tenant Occupitransportation
networks 3/31/201 plexe sseddshousinged
such as the Sanriku 4Kesennuma s 93
6,631 units
2,974 2,731 units
1,017 9,362 units
3,991
Expressway
isalso Minamisanriku
58
5,245 1,980
120
35
5,365 2,100
underway. However, city
406 42,310 18,596 40,182 16,417 83,122 35,013
construction plans envision Miyagi
separate residential and Pref.
*Created using data from Miyagi Prefecture website: Emergency
commercial/industrial areas temporary housing (container-type) provision and relocation status,and leave little room for the and relocation status of emergency temporary housing (private
imagination of a new charteredtownscapeor bylivelihoods.
In oftheproperties
Kesennuma
area
housing)municipal location(as of March(Kesennuma/Minamisanriku), approximately
15,000people
still
have
no
choice
but
to
live
in
31, 2014).
container-type temporary housing and similar accommodation. Public disaster housing construction
has only just begun, and it appears that it will take several years before the last few tenants are able
to move into those units. The fishing and seafood processing industries are only halfway rebuilt,
and stable employment is still a rare commodity. Jobs and housing are simply not available inabundance, and a stable life remains a dream for many.
2. Looking Back at Our FY 2013 Activities
The Kesennuma Regional Center (hereafter, “Center”) has, in its work, focused on providing
cooperation and advice to supporters. Therefore, our first-year efforts focused on building
relationships with people involved in support. Subsequently, in our second year, our goal was tocarefully continue our progress while increasing our opportunities to collaborate with cities andtowns. The Center’s activities for the second year are described below.
(1) Raising Public AwarenessWe published a column called “the Sanriku Heart Tsushin” in the Sanriku Shimpo newspaper(July 2013–February 2014). Beyond the direct issues of anxiety, fear, and other mood
disturbances caused by individuals’ disaster experiences, we wrote articles on a broad array of
topics related to mental and physical health, alternating authorship with the Kesennuma Public
Health Center. The goal of this column was to provide information to community residents andto let them know about counseling counters and points of contact near them. As a local
newspaper, the Sanriku Shimpo holds considerable influence, and our column led to individual
counseling cases and requests for training.
Further, we used a blog to spread local information and details about our activities in the
Kesennuma area. In response to requests from affiliated organizations, we dispatched lecturers
to training workshops and lecture sessions and arranged lectures on mental health topics. We
also created and distributed pamphlets on disaster mental health and self-care for working
persons to the affiliated organizations. These and other activities made up our public awarenessefforts.
(2) Community Resident Support
Support for local residents was overwhelmingly requested by local public health nurses andsupport groups, but there were quite a few cases of direct visits to our Center and consultations
over the phone. The characteristics of the cities and towns were as follows.
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① Kesennuma
Based on the results of the Private Chartered Housing Tenants Health Survey (December
2012–January 2013) and the Emergency Temporary Housing (Container-Type) Tenants
Health Survey (September–October 2013) conducted by Kesennuma City and Miyagi
Prefecture, we provided follow-up support, including working with high-risk individuals andproviding caregiver counseling during infant health checkups. In addition, we confirmed thestatus of and provided continued support to cases whose progress after the involvement of
mental health care teams was unclear.
② Minamisanriku
Our primary work consisted of responses to cases requested by public health nurses, andwhile the number of cases we worked with was low, several required continued visitation.
In terms of follow-ups for private chartered housing/container-type temporary housing
tenants, we primarily worked with disaster-affected town staff or individuals for whom avariety of factors made the involvement of town public nurses difficult.
(3) Human Resource Development① Earthquake Mental Health Care Exchange Meeting Miyagi
The “5th Earthquake Mental Health Care Exchange Meeting Miyagi in Kesennuma” washeld for the purpose of sharing information, exchanging opinions, creating networks, andfostering fellowship among supporters working in Kesennuma City and Minamisanriku
Town. There were 80 participants, and the responses to the questionnaire (44 people) showedthat attendees were highly satisfied with the lectures and subcommittees.
② Supporter Training
In response to requests from supporters, training was conducted on various themes suchas alcohol-related problems, mental health of supporters, and suicide prevention.
(4) Support for Supporters① Kesennuma
a. Placement of Specialists in Municipalities (Transfer)
Psychiatric social workers and clinical psychologists were dispatched to the Health
Promotion Division of Kesennuma City. By taking on part of the city’s business, including
visitation support to high-risk individuals identified via resident health surveys conductedin private chartered and container-type temporary housing, mental health counseling via
walk-ins and over the phone, caregiver counseling during infant health checkups, statusconfirmation for children who had failed to receive checkups, support for foreigners andmothers who had divorced their husbands owing to domestic violence, and hosting of the“Koko Café” (Exchange Salon Project), they aimed to lighten the burden placed on publichealth nurses.
b. Project Assistance[Resident Health Survey Follow-Ups]
Follow-up support provided on the basis of the results of surveys of private charteredhousing/container-type temporary housing tenants was split between the Kesennuma City
Health Promotion Division, Kesennuma Public Health Center, and this Center. High-risk
individuals were those with K6 scores ≥13 points (corresponding to severe mental illness),
those who “began drinking during the day,” those with “terminated medical care,” and“elderly individuals living alone.” This Center was placed in charge of follow-ups for 29
tenants of private chartered housing and 25 tenants of container-type temporary housing,
and we confirmed these individuals’ status via phone calls and visitations. Afterward, wewere tasked with providing continued support for seven tenants of private chartered housing
and five of container-type temporary housing.
Additionally, we continued to provide follow-up support for three individuals identified
in the FY 2011 Private Chartered Housing Health Survey, for whom the impact of theearthquake appears to be long-term.
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[Caregiver Counseling During Infant Health Checkups]
Until 2012, a clinical psychologist was assigned to handle three-year-old child medical
checkups as a prefectural project. However, this placement was no longer in effect startingin 2013; thus, we provided consultations to caregivers regarding the growth anddevelopment of children. The content of these counseling sessions was diverse, and included
family relationships, financial problems, marital relationships, and child discipline; in manycases, several problems were combined. If a single consultation was not enough, we
responded in cooperation with the Health Center. There are many items tested during healthcheckups of three-year-old children, and as these tests needed to proceed safely andsmoothly, the free participation of Center staff allowed us to keep an eye on the movementof children in the waiting room as a group, to watch individual mother-child relationships,
and to observe maternal facial expressions, enabling us to reduce the number of cases ofconcern that went overlooked. We were able to provide on-the-spot consultation to parents
who requested it, which we believe led to the enhancement of the medical examinations.
In addition, we participated in individual conferences after the event and provided advice
to medical examination staff regarding understanding children’s behavior and support
parents. The placement of clinical psychologists at this Center has increased the sense of
security of the public health nurses in charge, and as the practice of post-checkup
conferences continues, it seems that the skills of the medical examination staff have
improved.
[Koko Café (exchange salon project) Assistance]
The Koko Cafe was implemented by Kesennuma City as a part of the Exchange Salon
Project for residents of private chartered housing, who are harder to reach than residents ofcontainer-type temporary housing. With the cooperation of Mitsumine Hospital, this Centerand the Kesennuma City SWC (volunteer center) co-sponsored the project with the aim offacilitating resident interaction. At each event, we held a program (health lecture, relaxation,
handicrafts, cooking, etc.) that utilized the instructor’s expertise, and then held a discussion.
The hands-on program, in which participants could create something they could then takehome as a souvenir, was particularly popular. What was important in this was the time
participants spent casually drinking tea together, which facilitated communication. Someparticipants confided their daily worries to the staff, and sometimes we responded to theseneeds individually. Many people continued to participate, and it was felt that participants
expanded their social circle and deepened social relationships through the Koko Cafe.
[Assistance in Health Festival]
We helped with the Health Festival held by Kesennuma City. We operated the “Koko Cafe
Corner” for the purpose of maintaining and improving physical and mental health and toprovide a place where local residents could relax. Alongside tea and coffee, we distributed
pocket tissues and pamphlets as educational goods with the message of “depression
prevention.”[Work with Mental Health Care Team Subjects]
Of the residents with whom mental health care teams were involved immediately after theearthquake, we visited 17 people whose progress and current situation were unknown andconfirmed their current living and health conditions (starting November 2013). As a resultof examining all subject data after visitations, in five cases follow-up was considered
unnecessary, six cases were judged to require continuous support, and six cases wereuntraceable because of address changes. Our Center was put in charge of the six cases that
required continuous support, and we reviewed these every month and examined support
policies in place therein with the city’s Health Promotion Division.
c. Mental Health Support for Kesennuma City Staff
We discussed staff health measures with the Tohoku University Graduate School of
Medicine, Endowed Department of Preventive Psychiatry (the “Endowed Department”), theMiyagi University School of Nursing, and the Kesennuma Health Center, and provided staff
health support as a part of “disaster response.” Our Center conducted staff health surveys
and follow-up interviews in collaboration with the Endowed Department in accordance with- 25 -

guidelines put in place in 2012. In addition, PR pamphlets were provided to Kesennuma
City staff (including dispatched staff) at the time of the health survey (1,500 copies). These
provided information on stress check and stress coping methods, self-care, communication,and skill improvement. Doctors, nurses, and psychiatric social workers conducted interviews
for those who desired them (nine people).
In addition, a regular health counseling room was opened in collaboration with Miyagi
University. There were two consultation locations (inside the main government building andlocal agency), and the center was opened regularly on the third Wednesday of every monthfrom June 2013. Miyagi University hosted the counseling room once per month. Operating
hours were between 10:00 AM and 4:00 PM, and clinical psychologists and psychiatricsocial workers were on hand to take turns to accommodate up to five people. Although only
a few individuals made use of this health counseling service, it continued to be used after
September, by both city staff and staff dispatched from outside the prefecture. Owing to thesmall number of users, it was not possible to clarify the characteristics of the consultation
content, but we were able to regularly carry out mental health consultations for staff, anelement that had not been set up within the city organization.
② Minamisanriku
a. Project Assistance[Support to Affiliated Persons via Individual Support]
In response to requests from public health nurses in the Minamisanriku Town Health andWelfare Division, we attended supporter meetings, assisted with interview counseling andvisitation support, carried out visitation accompaniment, attended case study conferences,and so on with the Public Health Center as needed for health survey follow-ups. Additionally,
we accompanied public health nurses on visitations to a container-type temporary housingdevelopment where a suicide had had a great effect on the community, and offered analysis
and advice regarding necessary support.
b. Mental Health Support for Minamisanriku Staff
Health measures for Minamisanriku staff and many dispatched staff were discussed atmeetings held eight times in 2012. At the first such meeting for 2013, it was confirmed thata series of staff health measures (managerial and staff training, health surveys, interviews)
implemented in 2012 would continue, but after that, regular meetings were unable to be held.
The second meeting was held in March 2014, and we discussed the direction for FY 2014
regarding mental health measures for employees. Our Center also attended the meeting,examined necessary measures, and provided advice.
In addition, a health counseling room was opened for Minamisanriku staff and dispatchedstaff, and starting in July 2013, individual counseling was conducted on the fourth Tuesdayof every month. To make it easier for staff to consult during lunch breaks and outsidebusiness hours, the consultation time was changed to 12:00–6:00 PM, and the name of theconsultation room was changed from the “Health Counseling Counter” to “Staff
Consultation Room Octopus” to help staff feel more comfortable. Since July 2013, we havemade efforts to inform the staff about the monthly consultation day in advance, and thenumber of users has increased slightly.

③ Support Organizations
a. Assistance in Support Organization Activities
We maintained the following relationships with organizations conducting support
activities for residents of container-type temporary housing.
[Kesennuma Area Support Center]○ Assistance with Kesennuma District Support Center Health Counseling
Health consultations for container-type temporary housing residents conducted by the
Kesennuma District Support Center, operated by the Kesennuma City SWC, are held once

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a month in the Niitsuki and Shishiori districts. Since they also provide counseling on mental
issues, our Center has cooperated since June 2012.
In Niitsuki, these counseling sessions were held once per month at the trailer houses built
on the Goemongahara baseball grounds, and we assisted to the consultation on physical,
mental, and living conditions provided by Support Center nurses. Most counselors aim tocheck vital signs such as blood pressure and measure weight, but in some cases, theymentioned mental health problems during the interview. Thus, by attending the meeting, ourCenter staff was able to respond smoothly to each individual. The number of users was 25
per year, of which four were individually supported.
Health counseling in the Shishiori area was carried out in the “Genki Class” as in 2012.
The Genki Class is a comprehensive health counseling initiative conducted jointly by
Miyagi University, University of Hyogo, Kesennuma District Support Center, Northern
Area Comprehensive Support Center, City Health Promotion Division, and our Center. After
conducting measurements, gymnastics, and health consultations, we also set up events
where residents could interact over a cup of tea. Twenty to 25 residents participated eachtime, and the average number of counselors conducting the mental counseling our Center
was in charge of was one to two.
○ Involvement in Supporter Meetings
By participating in supporter meetings in Kesennuma, Niitsuki, Oshima, Shishiori, Omose,
Matsuiwa, and Hashikami districts, we responded to requests for accompanying visits andprovided advice on how to deal with cases. Under these circumstances, we also responded
to consultations regarding the mental health of the supporters themselves.
[Karakuwa District Support Center]We participated in monthly supporters’ meetings and provided information, advice on
how to respond, and visitation accompaniment. In difficult cases, we got involved as casemanagers and shared information. Subsequently, a request for “skill improvement training
for supporters” was made, which led to the implementation of a training workshop. Whensupporters felt uneasy owing to lack of experience or professional qualifications and had
difficulty dealing with residents, we provided consultation and advice. This led to a sense of
security and skill improvement for supporters.
[Ichinoseki District Support Center]
We received a request to work with container-type temporary housing residents who weredifficult to respond to, and we provided continuous support. While this was made difficult
by the absence of a consistent point of contact at the Support Center, we have continued tomake regular visits and our relationship is gradually becoming stable.
[Motoyoshi District Support Center]In an effort to ascertain psychological symptoms, accordingly develop support plans, andlighten the burden of Support Center staff, we worked alongside them to alternately conduct
visitations to individuals with sustained mental disturbances in container-type temporary
housing. We shared the results of these visits with the Support Center counselors at
Motoyoshi district meetings and other occasions.
[Kesennuma Reconstruction Association (KRA)]
We accompanied KRA staff on their activities to ensure they proceeded smoothly, while
also providing assistance and receiving consultations from the residents. In addition, we
talked about things that the KRA staff were worried about, such as problems with work, andgave advice. Many of the KRA staff were unemployed owing to the disaster, and they often
had no experience in interpersonal support; thus, as part of our support work for supporters,
we continued to build relationships with them and maintained an environment where it waseasy to provide counseling and advice. After that, we received a request for skill
improvement training, which led to the implementation of training workshops.
[Minamisanriku Survivor Lifestyle Support Center]
The Survivor Life Support Center operated by the Minamisanriku Town SWC employs
local residents, and many of them have no prior experience and provide support to survivors
while shouldering the burden of their own disaster experiences. In 2013, organizational- 27 -

restructurings and staff changes increased, including the integration of six satellite centers
into four locations; thus, more detailed support was required.
○ Individual Interviews/Consultation with Supporters
We provided counseling on mental health in the workplace, including direct counselingwith the clients and consultations with senior staff and managers. With the continuous support from last year, we were able to establish a relationship where we could consult andrespond in a timely manner.
○ Senior Meetings“Senior meetings” were held to provide a place for senior lifestyle support staff to discuss matters. The events were held flexibly according to the needs of senior staff and division heads. In 2012, events were held bimonthly (three times in total), but in 2013, thesemeetings were held almost every month (11 times in total). After the group meeting, individual follow-up was also conducted. In this way, senior staff were given opportunities toshare their feelings and solve problems in accordance with changes across the organization.
○ Support for Minamikata Satellite Center
Since 2012, we have been visiting the Minamikata Satellite Center once or twice amonth. We provide a wide range of support, such as visiting with support staff with regard
to residents to whom it is difficult to respond, giving advice on how to interact with residents,
and responding to individual consultations with support staff.
b. Mental Health Support for Support Organization Staff Involved in Support Activities[Kesennuma City SWC (including Kesennuma District Support Center Staff)]
A health survey was conducted by the Endowed Department in December 2013 (for 227
people), and in March 2014, the Endowed Department and our Center staff interviewed applicants and high-risk people (12 people).
[Minamisanriku Town SWC (including Survivor Lifestyle Support Center Staff)]
We provided feedback on the overall results of the health survey conducted by the staff ofthe Minamisanriku SWC in June 2013. After that, a health survey was conducted by theEndowed Department in November 2013 (for 118 people), and in January 2014, theEndowed Department and our Center staff interviewed applicants and high-risk people (11people).
(5) Support for Various Activities
The “Wakachiai no Kai,” sponsored by the Kesennuma City Health Promotion Division, isbeing held by the Sendai Grief Care Study Group. As a place where people who have experienced
similar losses can gather, there were times when it took the form of a salon to enable participants
to relax without having to talk about their loss experiences. Although the numbers of both newand continuing participants were small, we introduced the Wakachiai no Kai to residents who
were in mourning while continuing to respond to changes in participating residents’ situations.
One Center staff member also participated each time, providing background support to theorganizer and supporters involved.
3. Toward Next YearIn the second year, one of our goals was to increase opportunities to collaborate on support withcities and towns. The Koko Café, a joint project with Kesennuma City, is now held once or twice amonth. Although it was initially a one-off event, we have also continued to provide assistance for the
Health Festival. In addition to these relationships, there was a new request for “caregiver consultation
in infant health checkups” this year, and public health nurses and clinical psychologists began toprovide some support for mother-child consultation once or twice a month. Here, it was more
important for us to be present when public health nurses were reflecting on medical examination
situations and individual consultations. This consultation-like involvement was an opportunity forother organizations to understand what we and our staff can do, and for us to do the same for them.
In addition, all the staff of this Center took turns participating in the Koko Café multiple times.
Collaborations with multiple organizations have deepened our trustful relationships. It is probable- 28 -

that such involvement led to the expansion of support such as “correspondence with mental healthcare team subjects,” as well as the multiple requests for training project help that we received. Our
relationship with Minamisanriku was largely the same as last year, but the frequency ofaccompanying interviews and visits increased, both in terms of town-conducted visits and those
conducted by the Survivor Lifestyle Support Center. Accompaniment support allowed us to achieve
a common understanding of the issues faced by the residents.
Our collaborative work with municipalities has definitely deepened, and we believe we were able
to carefully continue individual projects and responses.
In this way, our efforts in this second year of operation generally achieved our goals in that wewere able to collaborate with municipalities and support groups, but some issues remained. Our goalfor our third year is to tackle these issues.
4. Issues and Directions(1) Sharing Problems Associated with Support① Supporter Mental Health
Reconstruction projects are being carried out throughout Kesennuma, and it is expectedthat the peak work volume will be around 2014–2015. The same is true for Minamisanriku,
where the workload of municipal staff is expected to increase further. Thus, there areconcerns about chronic fatigue and the accumulation of stress. As part of our efforts in 2013,
we were able to create a system in which each employee pays attention to his or her own
health condition and, if desired, can be referred for mental health consultation. However, thenumber of staff counseling users is small, and even if they have troubles, they are not often
referred to counseling. Only now, three years after the earthquake, many people are finallybecoming able to talk about that time. There is a need for a more accessible system that allows
people in need to receive timely consultation and support. It will be necessary to discuss
health measures looking ahead for several years, taking into account the intentions of local
municipalities. In addition, there are concerns about not only the mental health of municipal
employees but also that of supporters of residents living in private chartered and containertype temporary housing. Many supporters are emergency employees, and the longevity of
their employment period is uncertain. We have dealt with confusion, worries, and anxieties
as needed during our visits, but it seems necessary to consider new mental health measures
for supporters and support groups.
② Resident Isolation and Suicide
Some of the topics that were discussed in the supporter meetings were the issues facedby communities, such as those formed in container-type temporary housing developments.
Differences in the management of the residents’ association, conspicuous vacancies incontainer-type temporary housing, and uneven involvement of events staff and volunteers
were brought up, among other things. Differences among residents are already appearing
everywhere, and it is difficult to welcome a new life when many are moving base from private
chartered and container-type temporary housing to public disaster housing. We expect that
residents’ feelings of being “left behind” will increase. Container-type temporary housing
will inevitably be consolidated and reduced, and people in these communities will become
even less likely to notice worries and problems that have become apparent. Likewise, inprivate chartered housing, interaction between residents will reduce further, and it will bedifficult to accurately grasp their living situations.
The increase in the number of suicides at the beginning of 2013 is a cause of concern,and when considering the situation of future disaster survivors, isolation and suicide areproblems that cannot be overlooked. It seems that it is time to grasp the current situation,
propose concrete countermeasures, and work toward them. Efforts to expand foundational“lookout” programs and services, such as health promotion training for residents, gatekeeper
training, resident medical examinations, and provision of information in workplace healthmeasures are being considered. The development of “salons” where residents can interact
must not be limited only to private chartered housing; rather, these initiatives should also be
deployed in areas with conspicuously vacant container-type temporary housing, elderly- 29 -

individuals, individuals living alone, and people with illnesses or disabilities. It is unlikelythat measures directly linked to suicide prevention countermeasures can be easily
implemented, but we would like to do what we can.
In addition, so far, we have dealt with confusion, turmoil, and feelings of self-blame
experienced by the supporters and neighboring residents of suicide survivors. We haveworked with residents alongside public health nurses. Another thing we can do is to think
about the issue of suicide with affiliated organizations. We must protect the dignity of thedeceased and deal with these incidents carefully, with utmost consideration for the bereaved
family. To that end, it is important to clarify the nature and scope of what we can do when
we come into contact with situations related to suicide.
③ Supporter Networks
In the context of supporting local residents, opportunities for us to engage with residents
with complex problems are increasing. We have had chances to engage with residents who
experienced prolonged grief and who showed problems with continuous drinking(loudness/ranting), verbosity, overactivity, and repeated fluctuating moods. In the context ofchildren, there often seems to be a combination of several issues. The support period also
varies, from those who calm down after several interviews and visits to those who need todeal with the probability of long-term support. The continuation of individual support isrequired, but in the future, it will be necessary to consider at what stage people will be referred
to local mental health services and to consider smooth transitions in support provision.
(2) Issues with this Center’s Support Systems
In our second year of operation, we have conducted our activities while increasing ouropportunities to collaborate with cities and towns, but we were not able to establish relationships
with all regions. When thinking about how to tackle regional issues, we must reconsider the natureof effective support systems at this Center, including how transfer employees and Regional
Center staff share issues, and how to collaborate with cooperating institutions such as theEndowed Department and Tohokukai Hospital.

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