Research Report

4. Changes Over the Past Six Years (FY 2012–2017)(Including Child Support)－ 99 －

Research Report from the Department of Preventive Psychiatry－ 100 －

Research Report

Considering the Role of a Post-Disaster Mental HealthSupport Center– An Analysis of Our Activities Using Our Business
Statistics –Naru Fukuchi – Director, Doctor
Tetsuro Higuchi – Manager, Psychiatric Social Worker
Research and Planning Division, MDMHCC
1. Introduction
In Japan, whenever a large-scale natural disaster—especially an earthquake or tsunami—occurs that greatly
affects a particular region or community, a “Disaster Mental Health Care Center, DMHCCC” is establishedin the administrative division(s) affected. These centers are not set up via legislation; they are the result ofcivilian organizations receiving investment funding and project consignments from national reconstruction
budgets, and they often function to improve and preserve the mental health of the municipalities in which
they are located. To date, six such “Disaster Mental Health Care Centers” have been established, each with
its own unique activities (Figure 1) 1). The following Disaster Mental Health Care Centers were establishedafter large disasters: the “Hyogo Disaster Mental Health Care Center” 2) after the Hanshin-Awaji Earthquake
in 1995, the “Niigata Mental Health Welfare Council Disaster Mental Health Care Center” 3) after the 2004
Niigata Prefecture Chuetsu Earthquake, the “Iwate Prefecture Disaster Mental Health Care Center,” “Miyagi
Disaster Mental Health Care Center,” and “Fukushima Disaster Mental Health Care Center” after the 2011
Great East Japan Earthquake, and the “Kumamoto Disaster Mental Health Care Center” after the 2016
Kumamoto Earthquake. Management guidelines are left to the discretion of the administrative divisions inwhich these centers are located, and because the organizations that take up these public consignment
projects vary greatly, so too do the guidelines by which they are governed.
The Miyagi Disaster Mental Health Care Center (hereafter MDMHCC) opened in December 2011, andas of the end of FY 2017, has been involved for seven years in support activities in the field of mental healthfor disaster survivors.4 In addition to doctors, our staff includes psychiatric social workers, public healthnurses, psychologists, nurses, and occupational therapists, among others, all of whom work together inteams of diverse composition. The special characteristics of our Center are the following: (1) we placeemphasis on outreach support rather than walk-in, and (2) we commit ourselves, as a rule, to the guidelines
and policies of the Mental Health Department of the local municipality and carry out our support in linewith them. A long time has passed since our Center was founded, and as the reconstruction situation of eachregion changes, the things these municipalities and the organizations affiliated with them ask of us alsochange. In this article, we will provide an overview of the activities of our Center until now, consider thelarge-scale nature of our post-disaster mental health-related activities by longitudinally analyzing thecontent of our activities, and thereby prepare ourselves for future post-disaster reconstruction and support.

－ 101 －

Research Report from the Department of Preventive Psychiatry

Figure 1: “Disaster Mental Health Care Centers” in Japan

2. Methods
At our Center, we have developed an in-house business statistical system based on the Disaster Mental
Health Information Support System (DMHISS) to collect data on our activities. At our founding, ourmanagement structure was still unfinalized, and we were unable to collect detailed data on our activities in
FY 2012. From FY 2013 onwards, quantified information on our projects has been collected as data. In thisarticle, we have used activity report data from FY 2012 and business statistical system data over the five
years from FY 2013 to FY 2017 to analyze four of the six project categories of our Center—community
resident support, support for supporters, raising public awareness, and human resource development—in aneffort to examine our achievements.
3. Results(1) Community Resident Support
 Support Methods
Changes in support methods can be seen in Figure 2. We totaled methods of support used incommunity resident support using the following categories: at-home visitation, walk-in counseling,
telephone counseling, and other. We dealt with a total of 6,000–7,000 cases each year; the yearly total
increased until FY 2015 and then began to decline. Since FY 2012, at-home visitation has remained
the most common form of support, with a total of 4,400 cases seen in FY 2015. The number ofcounseling support cases involving individuals coming to one of the various community support
branches of our Center hovered around 1,000, while the figure for telephone counseling hoveredaround 1,500. Additionally, between FYs 2012–2014, we did not provide patients with distinguishing
ID numbers. Thus, if we provided the same individual with support multiple times, each of these
support cases was counted as a new case. In FY 2015, we began to issue patients ID numbers to better
enable us to understand the true nature and progress of our support activities, and we began to record
the total number of support cases handled and the number of new subjects separately. As a result, thecontinuous case counts shown in Figure 2 reflect totals across these five years.

－ 102 －

Research Report Paths to Counseling
We have categorized the various ways in which individuals come to receive counseling in Figure 3.
Immediately following the disaster, Miyagi Prefecture and other municipal authorities worked toprovide survivors with health surveys and check-ups. Much of our support in that period was forindividuals deemed high-risk by these surveys. Additionally, “requests from governmental agencies”(including municipalities) and “requests from patients themselves” both increased over the years.

Figure 3: Changes in Paths to Counseling－ 103 －

Research Report from the Department of Preventive Psychiatry Reasons for Counseling
We have depicted the various background reasons that led our subjects to seek counseling in Figure 4.
From FY 2013 onwards, “family/household problems,” “mental disturbances,” and “health-related
problems” have comprised the bulk of the cases we have seen. “Changes in living environment” and“financial difficulties related to reconstruction” peaked in FY 2013 and have declined since then.
“Family/household problems” and “mental disturbances” have increased over the years.

Figure 4: Reasons for Counseling Sex/Age of Counselees (Figure 5)
No significant difference in counselee (individual receiving counseling) sex was seen for any specificyear or across all years. Approximately 50% of all subjects were either in their 60s or older. Among
women, older age ranges tended to have more subjects. For men, subjects in their 40s increased in2014, but declined slowly afterwards. Many of these men were unemployed.

－ 104 －

Research Report

Figure 5: Changes in Counselees by Gender and Age Range

 Subjects by Illness Classification and Occurrence Time (Figure 6)
From FY 2013 onward, approximately 30–40% of our subjects had been seen by a psychiatrist.
“F1: Mental and Behavioral Disorders due to Psychoactive Substance Use,” “F2: Schizophrenia,
Schizotypal, and Delusional Disorders,” and “F3: Mood (Affective) Disorders” described more thanhalf of these. In FY 2014, F1 and F2 diagnoses increased, and cases that had begun before the disasterwere more numerous. F3 and “F4: Neurotic, Stress-Related, and Somatoform Disorders” increased
from year to year, and cases that occurred after the disaster were particularly numerous. Finally, while
their total percentage was quite small, and we have not included them in Figure 6, an increasing trend
was observed in “F7: Cognitive Impairment (Mental Retardation)” and “F8: Disorders of
Psychological Development.”－ 105 －

Research Report from the Department of Preventive Psychiatry

Figure 6: Subject Percentages by Disease Classification and Occurrence Time (F1–F4, top 4
classifications shown)(2)

Support for Supporters
The total number of support-for-supporters cases peaked in FY 2014 and declined afterwards(Figure 7). As for the breakdown of supporters receiving support, governmental officials made up thelargest part. A great deal of the support we offered involved offering guidance and advice on difficult
cases, including alcohol-related problems and abuse (Figure 8). Finally, we were requested to analyze
data related to survivor support as well as assist in various aspects of psychiatric social work, andthese activities made up, as they have in the past, a significant portion of our work.

－ 106 －

Research Report(3)

Raising Public AwarenessThe number of activities undertaken to raise public awareness increased until FY 2014; it fluctuatedaround approximately 400 per year thereafter (Figure 9). As can be seen in their breakdown, “raisingpublic awareness training” and “salon activities” comprised the bulk of these efforts (Figure 10).
“Raising public awareness training” involved general lectures on health or training for alcohol-related
problems, and the number of participants increased over time. “Salon activities” are gatherings
designed to strengthen connections between the residents of a particular area, and their objectives
primarily centered around moderation in alcohol, dementia education, preventing loneliness, andrelated endeavors.

－ 107 －

Research Report from the Department of Preventive Psychiatry(4)

Human Resource Development
No longitudinal change in the total number of human resource development undertakings wasobserved after FY 2013 (Figure 11). While we mainly catered to governmental officials, participants
came from a variety of different fields, including education officials and welfare commissioners. As
can be seen in the breakdown, “addiction-related problems” training and “support skill training”
comprised the bulk of these efforts (Figure 12).

－ 108 －

Research Report

4. Discussion
The founding principles of this Center are as follows:  to create an organization that places an emphasis
on outreach, and  to unequivocally ensure that our primary clients are cities, towns, villages, and othermunicipalities. We conduct our work with these principles in mind. Immediately after the disaster, we went
to work in each municipality, conducting health surveys and home-to-home visitations to confirm the safetyof people determined to be at high risk; these efforts comprised the bulk of our business at the time. So soonafter the disaster, the limited municipal personnel available—such as public health nurses—were unable todeal with these issues, and many of them requested our Center for help. Our Center was newly formed after
the disaster, and at first we were at a bit of a loss as to how best to form collaborative and cooperative
relationships with organizations in the area. The opportunity to assist in home visitations for safety checkups
became a foundation on which much cooperative work would later be built. For the employees of thisCenter, this project was an invaluable opportunity to take to heart the techniques of outreach work. Little bylittle, we built relationships of trust with each municipality, and eventually the support requests we received
from governmental agencies began to increase. As per the analysis of our early activities contained in thisarticle, our proactive, dedicated work on the difficult, exhausting work of home visitations built a
relationship of trust with community organizations and served as the foundation for a great deal of futurecollaboration.
The reasons why individuals seeking counseling came to us changed over time. Individuals reporting“changes in living environment” and “financial problems related to reconstruction” decreased over time, andthose with “family/household problems” and “mental disturbances” increased. As has been pointed in many
analyses of disaster support, issues with mental health do not surface immediately after the occurrence of adisaster; the problems of individuals hard up for basic necessities like food, clothing, and shelter are the firstmajor issue to be addressed. As long as physical problems like this remain, reconstruction is able to blithely
progress; the psychological tension remains under the surface. As reconstruction proceeds, physical－ 109 －

Research Report from the Department of Preventive Psychiatry

problems are solved and, little by little, discord in the home and mental health problems become apparent.
As can be seen in Figure 3, “Paths to Counseling,” requests from patients themselves increased from FY
2016 onward, and we felt this point marked a shift whereby people began to come to us for help of theirown accord. From these results, we see that there is a slight time lag until survivors come to seek help forthemselves, and that it is vital for supporters to situate themselves in an appropriate place and space thatenables them to receive these requests at any time.
From changes in the age range and sex of those that came to us seeking support, we saw that elderly andunemployed men and women were most numerous.
A certain bias is present in this data, however. Nearly all of our activity is limited to weekdays, and that
too, during the day, and the primary method we make use of is the home visitation. Inevitably, therefore, thecommunity residents whom we come into contact with are far more likely to be those at home during the
day on weekdays. However, even after considering this bias, we know from Miyagi Prefecture healthsurveys that many elderly individuals live alone in prefab temporary housing, and their isolation andlifestyles are major issues facing the prefecture in the future.5 Additionally, as can be seen in Figure 5, we
receive many requests from men in their 30s–50s, the prime age for work, and many of these men have
employment and other financial problems as their chief complaint. Thus, we can surmise that for this age
group, the psychological burden of supporting their household or community is quite great. From theseresults, we therefore see that while the particulars may depend on the characteristics of a specific affected
region, following a large disaster, isolation among the elderly and anxiety among middle-aged men who
support their home/community are two issues to which special attention should be paid.
Most of the illness classifications of those seeking support were the following four: F1, F2, F3, and F4.
The great majority of those with F1 experienced alcohol-related problems and many had had some sort ofproblem before the disaster. As has been pointed out in previously published research,6, 7 new illnesses thatspring into being after the occurrence of a disaster are by no means common. Instead, the amount drunk by
individuals with pre-existing cases increases and becomes more of a problem. The great majority of thosewith F2 diagnoses with schizophrenia, and most of these had had this issue since before the disaster.
Because schizophrenia is an illness that requires a close relationship with treatment providers to control its
symptoms, we believe the disaster may have contributed to their worsening by cutting off patient access tohealthcare, which necessitated outreach support. Post-disaster F3 and F4 diagnoses increased with time, andas mentioned previously, a slight time lag occurred before they manifested clearly. Because the period
immediately after the disaster was a psychologically tense time, symptoms like depression and anxiety wereunlikely to emerge. As physical and material reconstruction proceeded, peace and stability were established,and psychological symptoms began to surface.
From the case counts of support for supporters, public awareness, and human resource development
activities, we can infer the needs of the community. With regard to support for supporters, “work support”
in each municipality was most common. This is because the work amount for municipal employees
increased dramatically following the disaster and help was needed to supplement those duties. While thissort of work might appear to have no direct connection to mental health, we believe it is behind-the-scenes
work that allows municipal employees to return to their normal duties and become accessible to community
residents again. Additionally, despite the fact that “guidance/advice from specialists” decreased year to year,
it still comprised a great deal of our activity, and case study/supervision by experienced staff of this Center
was another large role we fulfilled. As for raising public awareness, our most common activities were“raising public awareness training” and “salon activities,” and the content of these events reflected theissues of the communities in which they were held. In particular, at all of our community centers—
Kesennuma, Ishinomaki, and the stem center—gatherings for alcohol-related problems (Danshukais,
temperance meetings, etc.) were formed, and our Center assisted in their operation. With regard to humanresource development, “addiction-related problems training,” including alcohol addiction, numbered highest,
indicating that community needs in that area were high.
5. Limitations
This article has several limitations. First, the specific nature of public/community mental health care in eachadministrative division of Japan differs, and there is no guarantee that the changes we experienced will also
occur in other communities. Next, the community with which we interacted made up only a small part of－ 110 －

Research Report

those who needed support, and it is difficult to imagine that our totals reflect the situation of all disastersurvivors as a whole. Finally, because our Center is not a medical organization, we involve ourselves,
insofar as we can, primarily in connecting together pre-existing community resources. As a result, we areunable to ensure that all individuals seeking support reach recovery, and we cannot analyze the extent towhich our efforts contribute to an individual’s recovery.
6. Conclusion
It is clear that as post-disaster reconstruction efforts change phase, the issues of community residents whoneed support and the things asked by the community of support organizations also change. As anorganization of supporters, we believe that it is necessary to quietly observe these changes and provide
appropriate support at the correct time. Additionally, we realize that there are many support organizations
like ourselves in this country and would like to highlight the fact that our figures do not represent thecommunity in any way. The conclusions we draw from our figures are therefore but theories that require
careful analysis to be taken as fact.
References
1) Supervised by Akio Sakai, Shinichi Niwa and Hideo Matsuoka. Mental Health in Disaster Situations.
Igaku Shoin. Tokyo. 2016.
2) Disaster Mental Health Care Center Activity Report, FY 1999. After 5 Years of Activity. Hyogo
Mental Health Welfare Council Disaster Mental Health Care Center. Hyogo Printing. Hyogo. 2004.
3) Disaster Mental Health Care Center 10-Year Activity Record: Taking Back our Homeland and ourHearts—Ten Years of Walking Alongside Survivors. Niigata Prefecture Mental Health Welfare
Council Disaster Mental Health Care Center. Hokuetsu Printing Company. Niigata. 2014.
4) Matsumoto, Kazunori, Akiko Obara, Mizuho Hayashi, Keizo Hara, Hidekatsu Shirasawa. The
Activities of Miyagi Prefecture Psychiatrists Following the Great East Japan Earthquake. Psychiatry,
55:391–400, 2013.
5) Sato, Yaeko and Juri Hashimoto. About the Nature of Survivor Support in Light of the Health Survey
Conducted on Minashi Temporary Housing Tenants. Public Health Nurse Journal, 74(3):200–206,
2018.
6) Matsushita, Sachio and Susumu Higuchi. Disaster and Alcohol-Related Problems. Traumatic Stress,
10(2):, 2013.
7) Rubonis, AV, and L. Bickman. Psychological Impairment in the Wake of Disaster: The DisasterPsychopathology Relationship. Psychological Bulletin, 109:384–399, 1991.

－ 111 －

Research Report from the Department of Preventive Psychiatry－ 112 －