Introduction

Toward the revitalization of community mental
health activities
Miyagi Prefecture Mental Health and Welfare Association
Former Chairman Hidekatsu Shirasawa(Director of Tohokukai Hospital)

On March 11, 2011, there was a massive magnitude 9.0 earthquake and a huge accompanying tsunami,
which, combined with the meltdown at the Fukushima Daiichi Nuclear Power Station, caused extensive
damage, mainly to coastal areas. It has been ten years since that day. Since the disaster, there have been
full-fledged reconstruction projects working toward regional revitalization; tangible developments havebeen made, and the construction of disaster public housing has been completed. However, new problems
have arisen in attempts to rebuild the victims’ lives, such as decreased regional and familial power given
the depopulation and aging that has taken place in disaster-stricken areas and the concomitant increased
need for mental health care.
According to resident support data from the Center in FY2019, the number of consultations has decreased somewhat since FY2018 but 5,964 cases remain. When broken down by response, home visits
have gradually decreased, while walk-in and telephone consultations have increased, with each categorycomprising approximately one third of the total. When broken down by consultation background, it canbe seen that family/domestic problems, mental disorders, health problems, and addiction-related problems (including alcohol abuse) are still the top-ranked issues. Focusing on illnesses with a post-disaster
onset, mood disorders, neurotic disorders, and mental and behavioral disorders due to psychoactive substance use are the top-ranking illnesses.
Higashimatsushima has continuously conducted citizen surveys on mental health since 2012. The
percentage of those with a K6 over 15 points has long remained at approximately 8% until 2018, but
this decreased to 6.1% in 2019. When looking at CAGE(CAGE is derived from the four questions of thetool;Cut down,Annoyed,Guilty,and Eye-opener) for drinking problems, those with two or more categories account for 3.2%, indicating the need for focused and continued support.
Regarding the progress of resident support provided by the Center during this time, the number ofconsultations has tended to remain high, and no large changes in consultation content and backgrounds
have been seen over time. Among counselees’ accounts of events, a common story recalls the disaster
experience on that day in isolated public housing, mentally disturbed by feelings of anxiety and sadness,and complaining of physical and mental disorders. Furthermore, after the earthquake disaster, there weremany serious and complex situations of truancy and psychologically unstable children in an unstable
domestic environment, indicating that continued mental care is needed.
In addition to supporting disaster victims, the affected municipalities have also carried out a wide
range of regular health services with many challenges that need to be addressed as they move toward
maintaining and improving local residents’ mental health. However, there is never a sufficient numberof public health nurses in municipalities; thus, there is an urgent need for development of human resources who will be responsible for community mental health activities. We must combine approaches
to the high-risk population in order to develop community mental health activities to achieve publichealth from multiple angles. In order to do so, health centers, municipalities, and mental care centersshould work closely together to share an awareness of the various regions’ current situation and problems and formulate a community mental health plan that is geared toward resolution. Moreover, weshould improve our own skills and develop health activities involving various related organizations andresidents in the region.