***Document I

Second Operation Plan of the Miyagi
Disaster Mental Health Care Center(Summary version)
FY 2021–2025

Psychiatria et Neurologia Paediatrica Japonica 61(3): October, 2021

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Purpose of plan
The prefecture has indicated a policy of continuing mental health care even after FY 2021 and formulated the “Miyagi
Prefecture Mental Health Care Initiative Policy for FY 2021 Onwards” in August 2020. Based on this, the Center decided
to formulate a second operation plan to clarify the basic principles and policies of Center operation during the five-yearperiod from FY 2021 to FY 2025.

Initiatives and issues to date
Resident support
We offered victim support upon the request ofmunicipalities by sharing the role of supporting thoserequiring follow-up after health surveys with support center
support staff and others.
The number of requests for support for older adults
living alone and cases with multiple problems, such asalcohol-related problems, has increased, and we provided
support in cooperation with related organizations inmunicipalities and communities. These initiatives wereindispensable for the early detection and early support ofvarious issues.

We conducted salon activities for apartment-type rental
housing residents, who tended to be isolated, in collaboration
with municipalities and related organizations. These
initiatives were effective in preventing the isolation anddeterioration of physical and mental health.
Relocation to public housing has progressed, and thenumber of cases requiring support has decreased.
Collaboration and relationships of trust were established withmunicipalities and related organizations through theactivities, and there have been more requests for supervisingand accompanying visits for difficult cases, such as shut-ins.

Support for supporters
Projects, such as those tackling alcohol-related
problems and suicide prevention measures, have led to theeffective development of projects in line with community
mental health and welfare issues. These are outcomes ofcooperating with municipalities and health centers.
The Center adopted a secondment system from an earlystage to dispatch staff to municipalities upon their request.
These staff members responded to various issues that arosein disaster areas after the disaster, such as overseeing
mental health and welfare projects and difficult cases, andthey were highly regarded by the municipalities.
We established staff member counseling service boothswith the cooperation of the Department ofPreventive Psychiatry of the Graduate School of
Medicine at Tohoku University based on requests frommunicipalities, and we provided individual consultations. We
have seen promising results, such as increased awareness of
the importance of mental health measures in the workplace.
Danshukai held in each region immediately after theearthquake functioned as important venues for theparticipants to continue abstinence. In the future, it isnecessary to continue providing support for danshukai
activities in each region as well as for alcohol-related
problems according to each region while cooperating withmunicipalities.

Raising public awarenessWe cooperated in community residents’ workshops
held by municipalities. The use of picture-story shows andskits so that the topics feel more familiar to the residents
was effective in improving the mental health of theinhabitants.
We cooperated with municipalities and relatedorganizations to try to understand residents who tended to
be isolated, and we held salons and various classes.

These were effective for improving the interaction betweenresidents and for the physical and mental health of residents
who tended to be isolated after moving into public housing
or relocating.
We disseminated information, such as the Center’s
activity status and training, on the homepage andworkshops, which fostered the understanding of issues,
such as mental health and alcohol-related problems, amongresidents.

− 5453 －−－Children’s Mental Health Care Community Based Project

We responded to consultations from children and parents
through walk-ins and home visits. The number of handledcases increased every year, and the content tended to becomplicated.
For the professional dispatch project, which aimed toprovide professional advice to supporters, we provided Center
staff-based supervision upon the request of municipalities,
dispatched clinical psychologists and psychiatric socialworkers, conducted case studies with municipal managers andothers, and responded to consultations. This was anopportunity for municipal managers to recognize theusefulness of collaborating with external professionals.
We invited instructors from outside of the prefecture to
conduct training for educators and supporters. There was muchinterest from public health nurses, nursery teachers, school
teachers, and others, and there were many participants in eachsession.
We conducted the “Children’s Cohort Study” in threeprefectures in the Tohoku region (Iwate, Miyagi, Fukushima)
with the objective of evaluating the transformation of children
and families and clarifying support efficiency. This is expected
to provide valuable survey data, and ought to be continued.
Human resource development

We took up a wide range of themes in response to requests
from related organizations and supported the mental healthpromotion of victims. There were initially many requests forcooperation in earthquake-related lectures and training, such as
on stress and PTSD, following the earthquake. However, over
the years, the topics changed to alcohol-related problems,suicide prevention, and workplace mental health.
We have conducted on-the-job training for alcohol-relatedproblems since the opening of the Center after being entrusted
by Tohokukai Hospital. There have been many requests
received every year, and many community medicalorganization and local government officials have taken ourcourses. However, although the number of graduates isincreasing every year, it has been difficult to raise the level ofcommunity supporters owing to relocations at the affiliation
location. In the future, we think it is necessary to collaborate
with municipalities and health centers to encourage thecontinuous study of the training content.
ResearchThe Bulletin, published every year, and the official activity
record published in FY 2020 are also results of the detailed
summary of the activities in the Center.
The Miyagi Mental Health Care Forum, which was started
in FY 2017, was planned as a venue for sharing andunderstanding the situation of the disaster area as well as
investigating the reconstruction of community mental healthand welfare. As support organizations continue to withdraw
from the region every year, there have been fewer places forsupporters to gather and exchange ideas, and visitors have said
these types of plans are necessary.

− 5554 －−－Basic principle and basic policy

Basic principle

Improve community mental healthand welfare in disaster areas

Basic policy① Implement “seamless support for residents, fromchildren to adults.”② Resident support involves mental health care
activities centered on outreach, based on
accompanying visits with related organizations
and municipalities.
③ Support for supporters involves implementing
activities that contribute to the improvement of theskills of supporters through case studies andconsultations. It aims to offer support relating to
the mental health of supporters.
④ Raising public awareness involves activities
relating to the mental health of community
residents that prioritize preventive viewpoints todeepen understanding and interest in the mental
health of residents while cooperating withmunicipalities.
⑤ Activities are implemented with the perspective ofhanding down the experience cultivated in past
activities, such as by summarizing the ideal way ofsupport that can be utilized in the event of a futuredisaster. The activities that the Center has overseenoffer valuable knowledge on mental health care
activities in the event of a disaster.
⑥ Activities are conducted according to the actual
circumstancesofmunicipalities
while
collaborating and cooperating with relatedorganizations and municipalities, with the aim ofimproving community mental health and welfare
activities. The transition of various projects will besystemically implemented in anticipation of theconclusion of activities in FY 2025.

Project plan
Resident support◇

We will collaborate with related organizations to conduct consultation support activities for community
residents who require mental health care, such as those with psychological burdens after the disaster or those
who have become further isolated owing to changes in the community. We will seek to improve community
mental health.

Support for supporters

Plan◇

Supporters who oversee support activities in disaster areas will continue to be important players inreconstruction, and follow-ups on supporters are an important issue. We will supervise individual cases with aneye toward human resource development and provide technical support, such as accompanying them on visitswith an aim toward skill improvement. We will collaborate with health centers and mental health welfare
centers, depending on the local circumstances.
We will provide professional advice and accompanying visits for supporters to help supporters address a wide
range of mental health issues. We aim to further improve the skills and reduce the psychological burdens ofsupporters by providing opportunities for various professional training (including self-care).

Raising public awareness
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Plan

Central issues to be addressed in the next five years

Plan◇

There is a need to focus on older adults living alone, isolated individuals, infants/schoolchildren, alcohol-relatedproblems, and those who have other problems, such as being a shut-in.
Support for cases with multiple issues has been increasing. We will conduct visits and consultations withmunicipal and health center public health nurses to provide seamless support. Furthermore, there is a need tocooperate with medical and welfare-related organizations in the community and shift to community mental
health and welfare activities while responding by teams.

Activities for raising public awareness among residents with the aim of improving the mental health ofcommunity residents and preventing the aggravation of any illnesses will be conducted in collaboration withmunicipalities and health centers using various methods that we have cultivated. We will further establish theunderstanding and interest of residents toward mental health.
Regarding places to gather, such as the salons with which the Center has been involved, there is a need forcontinuously providing venues where residents can connect and be active, and for investigating the ideal formof such activities in collaboration with municipalities and related organizations.
The Bulletin and its English translation, the official activity record compiled in the final fiscal year, etc., arepublished on the homepage. The practice of the Center to date can be utilized for new disasters. Other important
issues to consider include what documents relating to raising public awareness issued by the Center will be kept,and how, such as organizing them by phase.

We will continue to disseminate information to further establish and deepen the retention of information on
mental health that has been spread in the wake of the earthquake. We will provide places where people cancasually gather and give lectures to residents who work during the day. We will use various methods to provide
the necessary information to all community residents. We will collect the knowledge gained through long-term
activities and disseminate the results, to contribute to future disaster countermeasures.

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Individual support

Community resident exchange project

We will visit residents who require support upon request ofmunicipalities. For difficult cases, we will collaborate withrelated organizations to strengthen the team-based supportsystem. We will promote the transition through these activities
so that we can respond as part of the community mental healthand welfare activities where local governments, relatedorganizations, and community residents work together.

Regarding gathering places, such as the salonswith which the Center has been involved, wewill continuously provide opportunities forresidents to connect and be active. We will
investigate the ideal form of such activities incollaboration with municipalities and relatedorganizations.

Supporter consultations

Supporter’s mental health support

We provide professional advice
from the perspective of mental
health in response to requests
from supporters regarding thehandling of difficult cases andproject management.

We will conduct training andinterviews for supporters at therequest of municipalities with theaim of self-care and skill
improvement.

Support for supporters involved inchildren’s mental health care
We will provide consultations andtraining for supporters through cohort
studies so that we can provide
effective support for children’s
mental health care.

Mental health public awareness promotion
project

Dissemination of mental healthinformation

Annual activity report
creation project

We will make efforts that utilize the various
methods that we have cultivated to further
establish the understanding and interest ofresidents regarding mental health. We will
provide information on mental health toelementary, junior high, and high school students
in the prefecture; and we will disseminate
professional knowledge and skills to relatedparties at the request of local governments.

We will disseminate information onmental health through public
relations magazines and thehomepage to deepen understanding
among residents. We will actively
disclose materials to utilize theknowledge that the center has
cultivated, in the event of newdisasters.

We will summarize theactivities for each year
and provide them torelated organizations as
an activity report.

Promotion of plan
① Progress management② Promotion system

After the end of the half-term, manager-level
employees and above will confirm and evaluate theimplementation status of the operation plan. The
steering committee will also evaluate theimplementation status.

It is expected that the system will gradually shrink as
we move toward the conclusion of activities in FY 2025.
Meanwhile, outreach by multiple occupations and support
for supporters need to be developed as an important
project of the Center. We will secure a personnel system
according to the amount of work and promote this work.

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