Projiect of Cooperating Agencies
and Organizations
Tohoku University Graduate School of Medicine,
Department of Preventative Psychiatry
Tohokukai Hospital
ASW
Miyagi Danshukai– 93 –

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Activities related to disaster psychiatry and healthby the Department of Preventative Psychiatry,
Tohoku University
Kazunori Matsumoto - Associate Professor, Doctor
Department of Neuropsychiatry/Department of Preventative Psychiatry
Tohoku University Graduate School of Medicine

At the psychiatry laboratory of Tohoku University, the whole laboratory, including the
Department of Neuropsychiatry and the Psychiatry Department at the hospital, have been providing
support since the Great East Japan Earthquake and conducting research with the Department ofPreventative Psychiatry that was set up in October 2011 with a donation from Miyagi Prefecture as
the driving force. The active members in FY2016 were Takahashi, Shoji, Usukura, Abe, Mitate andSaito of the Department of Preventative Psychiatry; Matsuoka and Matsumoto of the Department of
Neuropsychiatry and Katsura; and Sakuma, Wada, Hamaie, and Sunagawa of the Psychiatry
Department of the hospital. Additionally, Ueda, who is seconded to Sendai Municipal Hospital, wasalso involved in the activity. Many of our activities were conducted in collaboration/co-operation with
the MDMHCC, and the staff were also working as part-time staff for the MDMHCC.
In response to the Kumamoto Earthquakes of April 14, 2016, the psychiatry laboratory of
Tohoku University sent staff as part of the Miyagi Prefecture DPAT to the second wave (April 23-29,
Matsumoto and Katsura), to the sixth wave (May 13-19, Wada and Shoji), and to the eighth wave
(May 23-29, Ueda and Abe). The second wave engaged with establishing a support regime in
Masushiro-cho for the future activities of the Miyagi Prefecture DPAT; the sixth wave was engaged
with preparing for the conclusion of support, and the eighth wave was engaged with the provision ofmental health training for municipality staff and with the conclusion of support. After the conclusionof deployment, we continued to engage in activities to develop the DPAT regime in Miyagi Prefecture
and to provide support for various projects. For Miyagi Prefecture, it was the first-ever deployment of
the DPAT, and there were many challenges. However, by making the most of the support experienceat the Great East Japan Earthquake, we think that we contributed towards supporting victims in
Kumamoto Prefecture.
We have continued to implement support and research in our job areas in the affected areas, andwe continue to provide regular health check-ups, health consultation at workplace, advice for humanresource managers, and training sessions for staff from the social welfare council and ae municipal
hospital. On the other hand, since a period of time has passed since the earthquake and since the stresscheck system has begun to work in earnest, we terminated the health survey with local authority staff
in FY2017. However, we continue to provide support to the extent possible for mental health inworkplace. We also conducted discussions with those in charge and implemented training sessions.
We are analyzing the research data accumulated so far longitudinally, and we continue with our
research that would be beneficial for post-disaster support for supporters in the future. Local
supporters are victims, in addition to experiencing chronical stress due to their continuous work. We
intend to continue providing support based on demand and to support the continuous enhancement of
mental health measures at workplace.
We have continued to examine the feasibility of the “Skills for Psychological Recovery, SPR, asupport program specialized for the recovery period following the disaster with help from the Hyogo
Mental Health Care Center, and we are also engaged with disseminating it. In FY2016, we invited– 95 –

Professor Tomoko Osawa, an SPR trainer, to a two-day training session in December. Supporters in
the mental health and welfare area who played a key role in the community participated in the training
session. The training session was received favorably, and we plan to hold another one in FY2017. As
for research into the SPR’s feasibility, we have finished with intervention and evaluation and are now
engaged with data analysis.
Regarding the “Training Session on Mental Exercise,” a training program for general public thatapplies the cognitive behavioral approach, the intervention part was completed in FY2015. In FY2016,
we carried out data analysis and conference presentations, and we are currently writing up the papers
for submission. Additionally, in FY2016, we held a training session twice for the general public on a
support basis. In particular, the second session focusing on communication skills was attended bymany supporters of the affected areas as part of their own mental health management.
Regarding the “Class to Improve Psychological Support Skills” aiming to spread the cognitive
behavioral approach in Miyagi Prefecture, in FY2016, in addition to the conventional caseexamination, we offered a series of mini lectures throughout the year for new participants. Many
participants were very keen on the lecture series, and they would continue to attend the lecture in theevening after work, which led to a degree of achievement. On the other hand, the degree ofacquisition of cognitive behavioral therapy varied, and there are future challenges in reference to thelecture content and its level of advancement.
We continued to be active with the mental health training session for school teachers in order tostrengthen young people’s mental health. We held workshops on knowledge about and response tomental illness and improved communication skills among students, parents, and teachers of highschools and specialist colleges in co-operation with projects implemented by the Miyagi Prefecture
and Aoba-ku, Sendai. We regularly attended the study group meeting at the MDMHCC and provided
support for its research activities and co-operated with their surveys.
In addition, we engage with communication and activities for raising public awareness in andoutside the prefecture by providing the lectures in the training session as part of suicide prevention
measures taken by local authorities in Miyagi Prefecture and in the mental health program at
workplace. We also present the situation of mental health in the affected areas and survey results at
academic conferences and symposiums. In May 2016, the Department of Preventative Psychiatry
played a central role in hosting the fifteenth Japanese Society for Traumatic Stress Studies Conferencein Sendai. Latest research findings in the trauma field including post-disaster support were presented
by researchers across Japan, and specialist-delivered lectures were provided. We also contribute to the
public debate on how to prepare for future disasters through our involvement with committees andstudy groups on the disaster regimes of Japan, including Miyagi Prefecture, and abroad.
In FY2016, by experiencing support for the Kumamoto Earthquakes, we deeply felt that ourexperience of the Great East Japan Earthquake and recovery support in its aftermath is useful andvaluable for the future. We, the Department of Preventative Psychiatry, Tohoku University, willcontinue to collaborate and co-operate with the MDMHCC in order to meet various needs such as theenhancement of community mental health in Miyagi Prefecture, the enhancement of the preventative
psychiatric approach and socio-psychological support, measures for psychological trauma, andresponding to disaster mental health care.

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On support for the affected areas provided byalcohol-related problem specialist organizations
Psychiatric Social Worker Toshihiro Suzuki, Community Support
Division, Recovery Support Department, Medical Corporation
Tohokukai Tohokuai Hospital
Sakae Fujita, Support for the Affected Areas Project, ASW
Chairperson, Prefectural Danshukai, Takao Ohira
Planning Division, Stem Center, MDMHCC

1. Introduction
Work on alcohol-related problems that started in the immediate aftermath of the earthquake andcontinues till today is a major community challenge. Since the immediate aftermath of the earthquake,
responses to alcohol-related incidents and preventative measures have been given due attention. The
continued provision of opportunities for supporters including local authority staff to learn knowledge
and concrete measures is necessary. It is also necessary to support the setting up of mutual support(self-help) groups such as the establishment of the danshukai.
MDMHCC has concluded a commissioning contract with three specialist organizations (Medical
Corporation Tohokukai, Tohokuai Hospital; ASW; and Miyagi Prefecture Danshukai) in order toappropriately deal with these alcohol-related problems in the community and tackle the alcoholrelated problems in accordance with the community’s needs. Below, we present reports from eachorganization about the support given so far.
2. Outline of activity(1) Medical Corporation, Tohokukai Tohokuai Hospital (hereafter, Tohokukai Hospital)
Six years have passed since the earthquake, and here, we report on the support provided foralcohol-related problems in collaboration with the MDMHCC.
Substance dependency such as alcohol and drug dependency is described as an illness that
gradually directs the person consuming the substances to suicide. Against the criterion that desire
can be controlled, a negative label that “those who die because they like drinking” becomes abarrier for support. It is rare for this barrier to be explicit, but it is implicit on the part of
supporters and medical professionals. “The narrative of the patient” “stains” this understanding.
The patient refuses to receive medical attention even when complications occur andincreasingly becomes weak because he/she keeps on drinking. Upon having a patient who isincreasingly isolated in front of us, we, the supporters, become more apprehensive about “Why do
you drink in your situation?” However, when we listen to the patient, our question changes to“How have you managed to recover in your situation?” Lament and irritation with the unchanging
patient vanishes with change in the supporters’ understanding. This brings a change in therelationship with the patient. The ground work for a non-brief intervention to prevent dependency
is thus completed.
Based on this perspective, we have been recently focusing on mutual support (self-help)
groups to begin functioning in the coastal affected areas, by asking patients to tell their stories atthe supporters’ training sessions and through case examinations.
The number of cases that come to us is certainly reducing but we continue providing support
to improve the quality of community response.

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The number of supported cases for the past six years is 715, and a total of 1,386 staff
members have engaged with support provision.
The outline of support as a whole is as follows:– 98 –

w(2) Japan Social Worker Association for Alcohol Related Problems (ASW)
In the aftermath of the Great East Japan Earthquake, from September 2011, the ASW started
to provide support for post-disaster alcohol-related problems in collaboration with the Health
Promotion Division of Ishinomaki and the Center of MDMHCC. The project was concluded in
FY2016.
When beginning to provide support, both the ASW and the Health Promotion Division weresensing and attempting to identify the best way to support the victims. In FY2012, the second year,
our support started to focus on “consultation” and “training of supporters.” While the ASW
continued to send its members, there was a limit to the association’s capacity, and because there
was a limit to individual support for the victims, it became a priority for the local supporters todevelop their capacity to deal with mental health problems in the community.
Alcohol-related problems were described as “problems we do not want to be involved with, if
possible” for the local supporters before the earthquake, and those who repeated alcohol-related
problems were “those we do not know how to relate to.” However, when the experienced ASW
members accompanied public health nurses in their home visits to the evacuation center andcontainer-type temporary accommodation and when they related to the family and those had
alcohol-related problems, the public health nurses began to feel that they learned how to relate to
the client. We repeatedly planned training sessions on “alcohol-related problems” and sent

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lecturers to the event. In designing the session, we discussed with the people on the ground how
the local demand could be identified so as not to turn the training sessions into an imposition fromthe external supporters. The public health nurse of Ishinomaki-shi, who was in charge of the
project, was also frank about changes in the community’s demand as the process of recovery
proceeded, and we always had an enthusiastic and frank discussion. The “consultation ofindividual cases” concluded in the previous FY, and from FY2015, we only provided planningand implementation of continued training. This was because the support institutions that were set
up in Ishinomaki-shi after the earthquake became established in dealing with mental health issues
in the community. The content of training had shifted from basic knowledge of “alcohol-related
problems” to practical issues such as “how to run a liaising meeting.”
FY2016 was our last year of support provided, and we planned and delivered the following
training sessions :Table 1: Human resource development training: “Training sessions to improve practical skills
to deal with alcohol-related problems”
Theme
Date
No. of participants
First“EarlyDetectionofAlcohol-Related August 23, 2016 47
Problems and Basic Understanding for
Supporters”
Second Lecture on “Understanding and Response of October 20,
42
the Family with Alcohol-Related Problems” 2016
and case examination
Third
Lecture on “Support for Those with Alcohol- December 9,55
Related Problems: Assessment and Support 2016
Plan” and case examination
Training was delivered by Naoto Okazaki, Sakae Fujita, Sumie Okaga, and Noriyuki
Kobayashi (volunteer). The participants were public health nurses, care supporters, nurses,
psychiatric social workers, staff of consultation and support institutions, and life protection caseworkers.
At the case examination session, the participants provided cases, and the theme was “we areproviding continued support and would like to review the future direction,” which suggested that
local supporters had mastered how to respond to alcohol-related problems and had developed
their skills through these post-earthquake sessions. For the ASW, the project has turned out to bea valuable asset in which we learned how to support in response to developing local needs.
(3) Nonprofit Organization Miyagi Prefecture Danshukai
 Introduction
Six years have passed since the Great East Japan Earthquake, and in terms of recovery,
people are moving from temporary housing to public housing. Nevertheless, the severity ofphysical, psychological, and social problems caused by the earthquake have increased theirseverity.
We, the prefectural Danshukai, have been engaged with setting up Danshukai meetings incollaboration with the MDMHCC, local authorities, and medical professionals in order totackle the worsening of alcohol-related problems in the affected areas where the future
prospects were bleak owing to various problems.
 Outline of activities in each area in the prefecture
a. Danshukai in Motoyoshi Area, Kesen’numa-shi
Home visit at the container-type temporary housing -> a meeting to discuss
abstention -> regular meeting of danshukai– 100 –

The tasks required to raise awareness about the ill effects of alcohol and to establish adanshukai transformed into a regular danshukai meeting run by the prefectural danshukaifrom May 2014 owing to the enthusiasm of local clients and supporters and repeateddiscussions. Since then, the Motoyoshi meeting has been held on the third Monday of themonth in principle, and from May 2016, the regular meeting is held in “Motoyoshi Healthand Welfare Center Ikoi.” Not only the local residents who had been participating since
the time of “The Meeting to Discuss Abstention,” but also staff from the community
support division of Tohokukai Hospital in Sendai attend every meeting.
b. Training session on alcohol-related problems in the Kahoku area of Ishinomaki
A training session entitled “Let’s Listen to Those who are Abstaining from Alcohol”
was held in March 2015, and the meeting has been taking place on the second Thursdayof the month at Ishinomaki Kahoku Comprehensive Center/Health Center modelled on
the regular meeting of danshukai. It also incorporates the reading of “Principles andNorms.” The participants include patients and their families, staff members of the mental
health care center, governmental institutions, the community support division of
Tohokukai Hospital, all of whom tell their story. There are more than 15 participants
every time. We had a meeting to discuss what to do in the next FY in February 2017, andit was decided to move the venue to Ishinomaki Town Center because the number of
those with alcohol-related problems in Ishinomaki had been increasing and the problem
had worsened since moving into public housing. From April 2017, the meeting will beheld in the meeting room of the Ishinomaki Health Center.
c. Training session on alcohol-related problems in Natori Area
In response to an increased interest in the regular danshukai meeting in Natori,
Iwanuma and Watari, the Sen-nan Branch of the Prefectural Danshukai has facilitated aregular meeting modelled on danshukai at the Natori Health Center. The meeting is heldon the second Monday of the month. Participants consist of danshukai members, local
clients and their families, staff of the mental health care center, local supporters, andmedical professionals. More than 10 participants attend the meeting each time. They readthe “Principles and Norms” and tell each other their stories. At the discussion about what
to do in the next FY, it was decided that the prefectural danshukai would host the meeting.
 For the future
We feel that our activities are really small in comparison to the scale of the areas
affected by the earthquake. However, we also believe that it is our mission to keep telling
our stories and recover. We reaffirm that strengthening collaboration with the local
authorities and medical professionals and improving trust with supporters who have beentirelessly working on the problem despite many difficulties in the affected areas is thefirst step to reduce alcohol-related problems.
3. Summary
So far, MDMHCC has been tackling alcohol-related problems in collaboration with threeorganizations: Tohokukai Hospital, the ASW, and the Prefectural Danshukai. We believe that thecapacity of supporters including staff members of the MDMHCC and local authority staff has
certainly been expanded through the collaborative work. Additionally, the birth of a new danshukai,
our utmost wish, has been made possible because of our collaboration.
On the other hand, the project commissioned to the ASW was concluded at the end of FY2016,
and there has been a decrease in the number of cases in the project commissioned to Tohokukai
Hospital. This can be understood to mean that the “commissioned project as support for supporters in
the affected areas” has come to a natural end. However, while the frequency of support has decreased,
the content of support is demanding and requires extensive care. Regarding the support for the “futuredanshukai,” repeated training sessions for the supporters and meetings of clients are held for– 101 –

achieving a realization. There appears to have been a shift in focus from quantity to quality of support
in FY2016.
When we look at Miyagi Prefecture as a whole, we can see that the work on alcohol-related
problems now covers a larger area. We have already received a request for training sessions from theinland for FY2017. As the regime to support alcohol-related problems in the community develops,
collaboration with the support organization will become even more important. From now on, it isnecessary for the whole prefecture to engage with “measures against alcohol-related problems inpeacetime” and not “measures against alcohol-related problems after the earthquake.” We speculatethat this would also lead to raising of the bottom line of mental health in community.
Lastly, ASW has been engaged with support activities in the Ishinomaki area since the earthquake.
Since its activities will conclude at the end of FY2016, we would like to thank them for their support
as we conclude this report.

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