State of Activities
Trends over the last five years and looking ahead
Report on the Kumamoto Earthquake disastersupport activities

–8–

Trends over the last five years and looking ahead

Takeshi Yamazaki – Vice Presidents, Clinical Psychologist
Miyagi Disaster Mental Health Center (MDMHCC)
Introduction
The Miyagi Disaster Mental Health Center (hereinafter, “the Center”) was established in Sendai on
December 1, 2011. Since its establishment, numerous staff members have examined needs in areas struck by
the earthquake, made business plans, and carried out interviews involving the staff members. In April 2012,
the Ishinomaki Regional Center and the Kesennuma Regional Center were founded, and together with theStem Center they began regular activities. In the following I will address these collectively.
1.

Toward the acceptance of the Centers in the community
When the Centers were established, we decided that the basis for our activities would be the six pillars of“resident support,” “support for supporters,” “human resource development,” “support for various activities,”“research,” and “raising public awareness.” Resident support is based on carrying out visits through cities andtowns. Support for supporters is also carried out through the cities and towns. However, even facing thecommunity, we were often asked by supporters or staff at administrative bodies, “What do you do at theDisaster Mental Health Center?,” and it took a lot of time for the existence of the Center to be recognized andthe work of community support to go smoothly.
In 2012, disorder continued in the cities and towns struck by the earthquake, and there was a state of labor
shortage. We carried out support not only as part of the specialist activities of the Disaster Mental HealthCenter, but also as far as possible responding to the needs of the areas struck by the earthquake. Moreover, we
proactively attended the area meetings and salons that we were already carrying out in areas struck by theearthquake, and built connections with various relevant organizations and bodies and supporters.
Moreover, from 2011 the prefecture started to carry out annual health checks for residents of temporary
housing, and the cities and towns referred people to the Centers for follow-up interviews if those healthchecks revealed that they needed support. Through those follow-up interviews, our relationships with cities
and towns were strengthened, and the Centers became recognized and trusted. Through these activities,
gradually requests came in from towns and cities such as problem case consultations and training lecturer
deployment.
2.

Personnel
In April 2012, when core activities began at the Centers, there were 50 personnel: 30 full-time and 20 parttime. These were mainly recruited through interviewing specialists who had been found around the country.
Some had connections in the prefecture and others didn’t, and their ages ranged from their twenties to their
sixties, and they had worked in various occupations and also had a wide range of years of experience. Almost
all specialists who had a passion for support in disaster areas worked in the same place doing the firstinterviews. These staff organizations were characteristic of “Disaster Mental Health Centers” established for alimited time after a large earthquake. Each division in the Centers concentrated efforts on forming teams thatvalued communication. Moreover, once a month all staff members held assembly meetings and established as
many opportunities for interaction as possible.
Above all, we sensed the importance of paying attention to the mental health of staff members, because
support and mental health care in areas struck by disasters is very stressful work. The managers paid attention
to the mental health of staff members through actions such as understanding their working conditions,carrying out staff interviews with each person at least once a year, and providing opportunities for training
outside of the prefecture. From 2016 onwards, the president introduced “staff development interviews,” andthe staff’s psychological care was planned through interviews carried out by their direct supervisors threetimes a year. We believe that it is very important to pay attention to and create structures for staff members’
mental health.
3.

–9–Training
In April 2012, beginning teachers’ training was held once a week. This was for all staff members, and wasa good opportunity for them to meet together. In 2014, workshops were held in monthly general meetings forall staff. The contents were mainly designed in response to staff requests. Even the experienced staff were
often inexperienced in disaster site support, so training was very important.
As the years passed, trainings attended by all staff together became less and less common, but in theirplace, single workshops were carried out for each regional center or division.
4.

Relocation system
The intent of the relocation system has been recorded in detail in the section about the relocation system inthe fourth edition of the bulletin. The relocation system officially started in April 2014. It is a support system
whereby the Centers search for specialist staff such as psychiatric social workers, and temporarily transfer
them to cities and towns affected by the earthquake to make up for staff shortages there. Their status is Center
staff, but their duties are carried out in whatever form was indicated by the cities or towns to which they wereposted. Based on the needs of the areas struck by the earthquake, 13 relocated staff members were deployed
to as many as six cities and two towns. This system was very highly valued by the cities and towns thatreceived the relocated staff. However, there was no legal basis for relocation under municipal law, anddifferent staff members understood this “relocation” differently, so the system was not designed well enough,placing a large burden and a lot of hardship on the relocated staff. The problems and future structure of therelocation system need to be discussed further.
5.

Future trends
The prefecture formulated a 32-point plan for reconstruction after the earthquake in 2011. The Centerswere founded through assistance payments from the prefecture, and activities began at the Stem Center basedon these reconstruction plans.
From 2016, we followed a reconstruction plan from the prefecture entitled “seamless mental healthsupport from child to adult” (kodomo kara otona made kiremi no nai shien), and the Centers took charge of
the “Regional Projects for Children’s Mental Health Care” (kodomo no kokoro no kea chiiki kyoten jigyou).
Requests increased for such services as counseling about children, and staff consultation in institutions suchas kindergartens on how to respond to problem children.
In 2016, an inquiry survey was carried out through questionnaires and interviews in order to understandneeds in areas struck by the earthquake. Regarding resident support, people expressed the opinion that there
was a need for long-term mental health care, including care for children. Regarding support for supporters,
many asked for advice with cases of hardship. Bringing together the results of this study, we formulated amanagement plan for the Centers from 2017–2020.
The activities emphasized in the management plan include concluding the Centers’ activities andresearching what should be left behind afterwards. The Department of Preventive Psychiatry was established
as a three-year program at the Tohoku University Graduate School of Medicine through a donation from theprefecture in October 2011, but this was extended by another three years in October 2014 and is expected to
be extended by another two and a half years in October 2017. As a specialist organization, the department is
an important partner to the Center when carrying out research, and we believe this cooperation will become
increasingly important going forwards.
The number of staff as of the end of March 2017 is 48 full-time and 23 part-time, and 7 of the full-time
staff have relocated to the cities or towns. Our budgeted scope has gradually decreased, and our number ofstaff will have to decrease going forward. We believe it will be important to clarify the order of priority forour projects in order to consolidate.
6.

– 10 –

Report on Kumamoto Earthquake disaster support activities

Yuichi Watanabe – Director, Psychiatric Social Worker
Planning Division, Stem Center, MDMHCC
The story from earthquake to deployment
At 21:26 on April 14, 2016, a magnitude-7 earthquake struck, with its epicenter in Kumamoto Prefecture.
28 hours later, on the 16th, another magnitude-7 earthquake struck, the largest ever recorded, and followingthat a succession of earthquakes followed in a wide region, including the Aso District of Kumamoto
Prefecture and Oita Prefecture.
At the time of writing, on April 18, 2017, 225 people have died (from the 2016 235th report on the state ofdamage due to issues such as the earthquake in areas of Kumamoto), and at its peak the number of evacuees
was over 180,000.
In response to this, Miyagi Prefecture decided to dispatch DPATs (Disaster Psychiatric Assistance Teams),
and Miyagi Psychiatric Center first responder teams departed for Kumamoto on the 18th. Since it is necessary
to take wheeled vehicles that can be used on-site and support materials such as medical supplies, they actually
took 1500 kilos all the way to Kumamoto Prefecture. Afterwards, the second and third responders took over
the wheeled vehicles and support materials that they had brought to the site, and took turns continuing support
activities for one week each.
1.

Photograph 1: The farewell party
Miyagi Disaster Mental Health Care Center
staff (one psychiatrist, two psychiatric social
workers) formed teams with nurses deployed from
MedicalCorporation
Kokorono
Hospital
Furukawa Green Hills, and these acted as the
fourth responders (Photograph 1). On May 3rd,following the transfer of air lanes from Sendai to
Fukuoka, they travelled by high-speed bus fromthe hotel in Kurume City which they had gone tofrom the airport. That evening, they took overfrom the Sendai team of third responders, who had
returned to their hotels after finishing their support
activities (Heartport Sendai). The materials madeon-site were handed over to the logistics officer of
the Sendai team (the coordinator). They wereintroduced in detail to images and maps of thepresent state of the towns of Mashikimachi and Kousamachi for which they were responsible, and points toremember concerning support activities were clearly specified. Although there was considerable tension andunease about the support activities from the following day onwards stretching on for a week, there was also astrong sense of duty associated with properly taking over the activities that had been carried out by the prior
Miyagi team.

Beginning of support activities
The first day of support activities was May 4th. This also happened to be during Golden Week, so we left
our lodgings a little early, shortly after 6 am. However, contrary to our expectations, there was no significant
traffic on the highways, and we arrived at the meeting place, the Mashikimachi Health and Welfare Center,quite a bit earlier than the meeting time. The Mashikimachi Health and Welfare Center was an evacuation
shelter, so there were many evacuees and supporters from outside of the prefecture coming in and out, and apeculiar buzz hung in the air. There were collapsed buildings and tower blocks nearby, and the marks left by
the earthquake remained pronounced.
Apart from the various teams related to medical care and welfare that flowed into Mashikimachi, which
was very severely damaged, support activities were also being carried out by multiple DPAT teams. We
2.

– 11 –

decided that when counselling related to mental health had been provided to residents, all teams would reportto the Miyagi Prefecture team, and the Miyagi Prefecture team would triage with the DPAT teams.
Communication was carried out by cellphone and DMIHSS (Disaster Mental Health Information Support
System), but personally I as the manager was not experienced using iPads or DMIHSS, and we were in anarea with bad radio wave reception, so communication with organizers was not necessarily smooth.
To respond to cases continuing on from the day before, we visited several safe shelters. Movement was
unexpectedly difficult because we were in an unfamiliar place, highways had collapsed, and our navigation
system was old. We were contacted from a phone number that was not stored in our phone. “This is the team.
There is someone from safe shelter X who would like you to come over, but how long would it take for you to
get here?” I didn’t remember hearing the person’s name before, and the location of the safe shelter didn’t
come to mind, so I had no idea how long it would take to get there. The first day of support we didn’t know
our left from our right, and the day continued in chaos.
We believe that our experiences in the Great East Japan Earthquake did come in handy to some extent.
However, we learned that carrying out activities in an unfamiliar place can be very hard work. It broughthome to us how much hardship was experienced by people who came to support us with the Great East Japan
earthquake.
Experiencing DPAT (extract from results of Miyagi Prefecture meeting)From April 18 to May 29, 2016, a total of 33 people were dispatched as eight DPAT teams from Miyagi
Prefecture. These were nine temporary staff, eight nurses, four public health nurses, three psychiatrists, six
psychiatric social workers, and three office workers. There were 101 people providing consultations (among
them 88 providing medical examinations and 20 prescribing medicine), and apart from responding toresidents, the main activities were adjusted to suit the circumstances during the time of deployment, such as
referrals related to support such as public health nurses, referrals to primary school teachers, lectures and staff
consultations for Mashikimachi administration, and coordination of activities for DPATs in otheradministrative divisions.
When I was deployed, it was right at the time when Hiroshi Kato from the Hyogo Prefecture Disaster
Mental Health Care Center was also visiting Kumamoto Prefecture, and under his coordination we were able
to convey to people connected with Kumamoto Prefecture some of the initiatives from our experiences during
the Great East Japan Earthquake and the Miyagi Disaster Mental Health Care Center. You learn a lot about
disaster support through experience. Just as I had benefitted in a variety of ways from instruction from Hyogo
and Niigata, I hope that my experiences might in some way have benefitted people.
In the questionnaire survey for people dispatched from Miyagi Prefecture, “Inquiry into DPAT activities
responding to the 2016 Kumamoto Earthquake,” 56.3% (18 people) of the people from the teams deployed at
this time from Miyagi Prefecture stated that they had prior experience of support, but many of these wereduring the Great East Japan Earthquake (Table 1), so these support experiences were at home, so to speak.
Moreover, only 28% (9 people) had received training in DPATs, and many people, myself included, had noexperience of such training (Table 2). Moreover, since a high proportion of the initiatives had not previously
been required, such as “training for deployed workers” and “creating a deployment system,” it might benecessary to further strengthen the creation of systems that assume deployment outside of the prefecture.
3.

– 12 –

Table 0-1: Number of people deployed withexperience in other earthquakes
Name of Earthquake
Great Hanshin Earthquake
Chūetsu Earthquake
Northern Miyagi Earthquake andMiyagi-Offshore Earthquake
Iwate–Miyagi Nairiku Earthquake
Great East Japan Earthquake
Other

Table 0-2: Training received in each deployment team

People
3
0

Ratio
9.3%
0.0%

2

6.3%

5
18
1

15.6%
56.3%
5.6%

Deployment
team
1
2
3
4
5
6
7
8
Total

Training experienceSomeNoexperience
experience
4
1
2
2
2
2
1
3
3
4
4
4
9
23

Total
5
4
4
4
3
4
4
4
32

The survey responses also mentioned, “In carrying out support activities, we took care to ‘avoid burdening
local supporters.’” In a place in chaos, there are times when supporters advocate for their own wants andwhen local supporters are overwhelmed. If we could manage to be considerate to people in their home town,
then that would simply mean that we had put to good use the lessons we learned in the Great East Japan
Earthquake.

Works cited“Heisei 28 nen Kumamoto jishin hassei ni tomonau saigaihaken seishin iryou chiimu (DPAT) haken
katsudou chousa ni tsuite (Inquiry into DPAT activities responding to the 2016 Kumamoto earthquake),”Miyagi Prefecture Welfare Division for Persons with Disabilities, Miyagiken Seishin Public Health Center.

– 13 –