Practice report

Implementation of joint projects with self-help groups (danshukai) and support for selfreliance: Reflecting on activities at the Ishinomaki Regional Centers of the Miyagi DisasterMental Health Care CenterIshinomaki Regional Center, Miyagi Disaster Mental Health Care Center
Shigeru Okazaki, Hiromi Arai, Kumiko Miyashita, Takeshi Toraiwa
1. Introduction
The MDMHCC established the Stem Center in December 2011, with regional centers opening in Ishinomaki City andKesennuma City in April 2012.
At the 4th Miyagi Convention of the Tohoku Mental Health and Welfare Society in 2013, Arai of the MDMHCC’s
Ishinomaki Center (“Center”) presented “Thinking about how to collaborate through support for alcohol dependence.”
In this presentation, Arai indicated the importance of understanding the roles and characteristics of each institution
among supporters, and of sharing information by seeking a common understanding among supporters through case study
meetings.
Based on the presentation content, the MDMHCC has provided support to the disaster victims while building face-toface relations with related institutions and organizations through various opportunities.
2. Purpose
The Center was established in April 2012 and has provided direct support to residents through local and salon activities.
Since October 2014, the Center has been cooperating with the Miyagi Prefecture Danshukai (“danshukai”), Ishinomaki
City, and Tohokukai Hospital to deal with alcohol-related problems.
To make danshukai activities take root in the Ishinomaki area, we thought that examining what supporters should beaware of when providing support to self-help groups, how to support “independence,” what the ideal ways of cooperation
are, and their respective roles, while reflecting on the joint projects that Ishinomaki City and related organizations havesupported, will lead to suggestions for community mental health and welfare activities.
3. Methods
1) Targets
Participants included those who provided consent among members who participated in danshukai meetings sinceApril 2017, when the meetings started to be held at the Ishinomaki Health Consultation Center; danshukai directors andofficers, psychiatrists, and on-site public health nurse staff at administrative institutions.
2) Survey proceduresInterviews were conducted with those who consented to the study. The views, roles, support, cooperation, andcollaboration of each of the interviewees were summarized from the perspective of the future development ofcommunity mental health and welfare activities.
3) Implementation
May 29–October 10, 2020
4) Survey method
The joint researchers divided the subjects into stakeholders, danshukai, administrative institution public healthnurses, and psychiatrists. They were interviewed based on the following items.
【Interview items】① Related party
a. Motivation for participation b. Good and bad aspects of participationc. Lifestyle changes owing to participation d. How to proceed with current danshukai② Danshukaia. Progress in Ishinomaki b. Past collaboration with administrative institutions and the MDMHCC
c. Good and bad aspects of collaborationd. Future policy and what you want to do③ Public health nurses
a. Changes before and after danshukai meetings
b. Good and bad aspects of community mental health welfare activities (activities of public health nurses)c. How easy the current system is for supporters to use
d. How you feel about changes in participating members
e. What the danshukai should be like in the future(4) Psychiatrists
a. Status of related party before participation－− 428 －−b. Status of related party after participationc. Lifestyle (treatment) changes owing to participationd. Therapeutic positives and content evaluation【Interview period】
Implementation of interviews from June to July 2020
The participants were narrowed down because the COVID-19 pandemic made face-to-face interviews difficult toconduct. We conducted a group interview for the danshukai participants, but individually for all other participants.
【Subject attributes】
Related party (danshukai meeting participants): 2 peoplePublic health nurses: 1 person
Psychiatrists: 1 person

Danshukai: 5 people

4. Results
The following are excerpts of comments from the interviews that may be a reference for future activities.
●Motivation for participation
・I was invited by a danshukai sponsor and MDMHCC staff while I was hospitalized.
・An MDMHCC staff member visited together with a nurse from the nursing association and talked to me
about danshukai. I was interested in it, and they visited me many times, and I felt bad declining the offer after
all they did.
●Good and bad aspects of participation
・I was able to stop drinking and continue working (rehabilitation). In the past, I used to tell my friends that one
should never drink alcohol, but now I’m starting to think that one can just start over. I think it’s important to build
friendships, bonds, and relationships of trust.
・I was able to make friends who are abstaining from alcohol.
・Good aspects: I was able to quit drinking. I can say anything about myself. The number of people who care aboutme (they still call me and worry about me, encourage me, and understand my pain) has increased.
・Bad aspects: At first, I did not like talking in front of people who did not know about my past (associates,supporters). I did not like that there were people who would leave in the middle of a participant’s talk.
●Lifestyle changes owing to participation
・I am able to continue abstaining from alcohol. I can listen to the painful experiences of my danshukai friends andtheir past drinking stories.
・I was able to stop drinking by keeping my promise to stop drinking in front of my danshukai friends, and I’ve beenable to establish a lifestyle rhythm and improve my physical condition. Because I quit drinking, I was trusted andappointed as the deputy director of the temporary housing community association, and I was able to serve in that
position until I left the temporary housing.
●How to proceed with current danshukai
・I’ve only recently started participating, so I can’t think of anything. I want to continue participating.
・I want to increase the number of members, and I want to do those activities. For the time being, I would like toread the “guidelines and norms” in danshukai meetings. As for the number of meetings, when I first started
participating, it was difficult for me to talk. I think it would be good to take it easy and start from once a month andgradually increase to twice a month. I think once a month is good for now.
・I’m paying the membership fees as a member of the danshukai, but I attended danshukai meetings without missing
any days, so I think of myself as a member even before I paid the membership fee. I participated in last year’sdanshukai and the Miyagi Convention because the director wanted me to participate. The director always comes toIshinomaki, so I decided to go to Sendai as a favor to the director and to be of help.
●Past collaboration with administrative institutions and MDMHCC
・Regular meetings were held collaboratively. In Ishinomaki, the venue is being secured with the cooperation of thecity hall and mental care center. I’m worried about whether we can continue to lease the venue. It is important tokeep the danshukai venue open. In Sendai, the COVID-19 emergency declaration has been lifted, and even whenthe meetings were resumed, the number of participants has not increased like before. In terms of keeping the venue
open and securing the venue for that purpose, I think the three parties have been able to collaborate in Ishinomaki.
●Future policy and what you want to do
・It would be nice if meetings could be held every week or twice a month. If local people can host it, then I would
want them to become independent. It’s important for local people to make an effort. We need more members forthat.
・There are many people who have participated in regular danshukai meetings, and many of them think that they
will stop drinking immediately if they participate with their families. As is the case with psychiatric hospitals, it isdifficult for a single hospitalization to lead to alcohol abstinence. Many supporters agree. When conducting
alcohol-related consultations, I would like supporters to introduce danshukai to the individuals and their families,－ 43 －− 9 −and to recommend participation. I would like supporters to mediate those opportunities and provide advice to thefamilies.
・Collaboration with hospitals specializing in alcohol, psychiatric hospitals in the area, and supporters such as publichealth nurses●Status of stakeholders before and after participation
・It seems that [participant x] was conscious about alcohol abstinence ever since he was hospitalized for the firsttime. He had a high awareness and consciousness of the need for alcohol abstinence. I had the impression, even in
the medical examinations, that going to the danshukai itself occupied a large part of his life. It was an element thatgave him the motivation to quit drinking.
・Participation in danshukai was a positive for treatment. At the time of medical examinations, [participant x] always
talked about danshukai.
・Even if there is the wish to abstain from alcohol, many people do not recognize or know its necessity. It is difficult
to reach the level where the individual recognizes that necessity. It is incredible that [participant x] went fromrecognizing the necessity of alcohol abstinence to practicing and finally achieving it.
・If there is an information leaflet, then it is possible to refer patients, and once the COVID-19 pandemic settles
down, hospitalized people can also be referred.
● From public health nurses
・Having a place where referrals can be made has given me a sense of security, along with the fact that theMDMHCC has provided support. There is the problem of the COVID-19 pandemic, but it is reassuring that themeetings are held at a fixed time and place. They are easy to use, which is a good thing.
・I try to cooperate as much as I can in securing the venue.
5. Discussion
The basics of our activities were to keep the venue open for danshukai and to secure the venue for that purpose. Thefact that venue preparation was being done by three parties in collaboration made sense when considering theiroverlapping activities during the COVID-19 pandemic.
Many people participated through referrals from the MDMHCC, public health nurses in Ishinomaki City, and otherplaces, but the comment of “they visited me many times, and I felt bad declining the offer after all they did” showed
the need for encouraging participation above all else, and that it should not be a forced invitation.
We believe that it was important for stakeholders to participate in danshukai, utilize the experience there, and expand
the circle of understanding, including friends who would welcome the individual warmly even if they made a mistake,supporters who would encourage the individual to continue participating, and their family.
For the supporters, having a place to refer individuals helped with them being able to provide support with confidence.
Support for the continuation of those events and the accumulation of small actions while each institution andorganization played their respective parts served as the basis of collaborative work.
・Participation in danshukai should be encouraged at every opportunity and persistently.
・The cooperation and understanding of psychiatric medical institutions, including psychiatric hospitals within thejurisdiction, should be obtained.
・Continued participation in a self-help group is essential for recovery from alcohol dependence, and there is a need tosteadily build up supporters to encourage the parties and their families to promote continued participation and thesignificance of participating in danshukai.
・Supporters, such as public health nurses who can create opportunities for participation, should encourage individuals
to participate in danshukai, feel its atmosphere, and continue participating; and they should serve as an opportunity
for promoting participation and a reference for advice.
・The friends, bonds, and relationships of trust in danshukai were great motivators for alcohol abstinence.
Finally, looking back on this activity, we can see that “building friends, bonds, and relationships of trust” must be
cultivated among supporters, such as danshukai, Ishinomaki City, and MDMHCC. From FY 2021, the MDMHCC will
be taking a new step forward, but we would like to continue activities aimed at “building friendships, bonds, andrelationships of trust.”
This article is a partial addition to what was presented at the 11 th Tohoku Mental Health and Welfare Society Meetingon October 11, 2020.

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