Report on Child Mental Health Symposium 2017

Report on the Child Mental Health Symposium 2017
Planning and Research Department, Stem Center, MDMHCCIn Miyagi Prefecture, providing seamless support for residents from children to adults with regard
to mental health care following the earthquake has been set as the basic principle of its restoration plan,with our Center being entrusted with the Regional Base Service for the Children’s Mental Health Carefrom 2016. For this reason, there have been enquiries at our Center concerning children with various
issues, and thus we need to ascertain the current state of children and the circumstances of childrearing for the entire region.
The Children’s Mental Health Symposium was held on December 19, 2017, under the title
Supporting Children Growing Up in a Damaged Region. 68 people from a wide array of occupational
fields were in attendance, including administrative officers and medical institution workers. The
symposium details were as follows:
1. Symposium Summary(1) Purpose of the Symposium
Six years have passed since the Great Tohoku Earthquake, and we have been receiving
increasing numbers of queries concerning the development and behavior of children in the
afflicted sites. We believe that we can neglect neither their immediate reaction after experiencing
the disaster nor the indirect impact of growing up in a devastated region, leading us to conclude
that long-term observation and support are required. This symposium is being held for the
purpose of sharing information regarding how local communities inside and outside Japan haveprovided support in the past or are currently providing support after a major disaster, in order toexamine the state and development of our future activities.
(2) Date and time: December 19, 2017 (Tuesday) 10:00–15:00(3) Location: TKP Garden City Sendai Kotodai, 3F, Hall 5(4) Number of participants: 68(5) Complete Program

Topic:
10:00–10:20

Supporting children growing up in damaged regions
Opening Statement: On this symposium’s purpose and the current state of Japan

Naru Fukuchi, Director of the Planning and Research Department, Miyagi Disaster Mental Health Care
Center (MDMHCC)
10:20–11:20

1.Creating a Safe Supportive Environment for Children After a Major
Disaster
Eugen Koh, Senior Fellow, University of Melbourne (Australia)

11:20–12:20

12:20 –13:20
13:20– 14:20

14:20–14:40
14:50 –15:00

2. How We should Support Survivors and Family Members after the Sewol
Ferry Disaster in South Korea
Jinhee Hyun, Professor, the Department of Social Welfare, Daegu University (South Korea)
Break
3. Children after the Great Tohoku Earthquake
Junko Yagi, Vice President, Iwate Medical University, Iwate Child Care Center
Q&A/Discussion
Closing Statements
Takeshi Yamazaki, Vice President, Miyagi Disaster Mental Health Care Center (MDMHCC)- 41 -

Report on Child Mental Health Symposium 2017

2. Content of the Symposium(1) Opening Statement: On this symposium’s purpose and the current state of Japan
Naru Fukuchi, Director of the Planning and Research Department, Miyagi Disaster Mental HealthCare Center (MDMHCC)(2) Creating a Safe Supportive Environment for Children After a Major Disaster
Eugen Koh, Senior Fellow, University of Melbourne (Australia)① About the speaker:
Dr. Koh participates in various projects as a senior fellow at the University of Melbourne
while practicing at his own clinic in Melbourne, Australia. During his previous employment asa Director of Dax Centre, he campaigned for raising public awareness of mental healthpractices using art. He also concentrated on providing mental health support to the historicallypersecuted Aboriginal community who were affected by the Australian bush fires, having
abundant knowledge and experience working with communities in order to recover frommental and emotional hurt.
② Lecture summary:Children who had been exposed to strong traumatic experiences or severe stressful
situations for long periods of time are known to have a higher risk of developing behavioral
problems (e.g., self-harm) during their adolescence and of developing mental illnesses andcommitting suicide during their adulthood. For this reason, it is important to provide a place inwhich children can learn to feel safe and secure in their households and schools in order forthem to develop in healthy ways. Furthermore, in order for them to acquire the ability toovercome potential adversity, it is necessary for them to experience positive relationships withthose around them, overcoming conflicts and strife by finding solutions on their own, andultimately recovering from despair, loss, and trauma.
When children experience strong anxiety or fear, they in many instances remain very quiet
and avoid attention. The adults around them may overlook their condition, feeling reassured
by the lack of outward distress. However, it is common for children who are not feeling safe or
secure to become withdrawn and freeze up in order to protect themselves. Alternatively, they
may instinctively take action to attract the attention of those around them in an attempt to feelsafe. In such instances, it is important that those around them not perceive the children’s
intention as malicious. The more urgent the situation, the more children need to feel assured
that they have not been forgotten and are being understood.
In order for children to grow up healthy, it is important to maintain the good health ofguardians and families in supporting roles, as well as that of the general groups andcommunities surrounding them. When we go through an extremely painful experience, we areoften at the mercy of symptoms stemming from that experience and cannot maintain thenecessary composure to sufficiently support the children around us. In such cases, adults may
become withdrawn and isolated, losing the ability to provide support to children within thecommunity. In other words, as with children, adults who have been hurt also require special
support and care, especially as it is rare for many adults to seek help themselves. The functionsof the groups they are involved with therefore play an important role in these cases.
In particular, culture plays a significant role in groups functioning properly. Culture
provides people with the ability to understand each other naturally and implicitly, greatly
impacting our own existence and the how we should relate with one another.. We adjust the
distance between one another based on this implicit context, with culture serving as afoundation for when we interact with the world, giving us confidence. There are times that we
feel stifled, being overly preoccupied with culture. However, it also functions as a way ofprotecting and nurturing us. The role that culture plays during the process of a community
recovering from trauma is therefore highly significant, keeping residents who are prone toisolation connected within their communities. When external supporters offer assistance, theymust adequately evaluate the situation by understanding the culture of the group. In manycases, people are suspicious of offers of outside support or feel a sense of shame about theirneed for help.
In Australia, historically the Aboriginals were persecuted for a long period of time andhave experienced very strong trauma as an ethnic group. For this reason, the prevalence ofmental health illness among this group is high, as well as the general crime rate and domestic
violence and abuse.
The speaker of this lecture has experience in supporting the Aboriginal community byeffectively intervening using their traditional culture of arts. Traditionally, the community did- 42 -

Report on Child Mental Health Symposium 2017not use writing, instead passing on messages to the succeeding generation through paintings
unique to their culture, known as "Aboriginal art". By using this form of art to express
emotions through their unique culture, Aboriginal groups are able to confirm their roots andrecover their autonomy thanks to strong community support.
(3) How we should Support Survivors and Family Members after the Sewol Ferry Disaster inSouth Korea
Jinhee Hyun, Professor, Department of Social Welfare, Daegu University (South Korea)①About the speaker:
Prof. Hyun is a social worker who teaches in the Department of Social Welfare at South
Korea’s Daegu University. She serves as vice president of the Korean Society for TraumaticStress Studies and is engaged in and provides support to servicemen and their families at theAmerican Army Hospital in South Korea, as well as specializing in providing support tochildren and their family members who suffer from PTSD or were victims of domestic violence
and abuse. After the sinking of MV Sewol, she has similarly been offering support to thesurvivors and their families.
②Lecture summary:
The sinking of MV Sewol that occurred on April 15, 2014, resulted in the deaths of 299
passengers and crew members, 5 missing persons, and 8 search rescuer deaths, the highest
number of deaths resulting from a maritime accident in South Korean history. In particular, 11 th
grade students from Danwon High School were on board for a field trip. With 295 students deadand 9 missing, the number of victims exceeded that of the survivors.
Instigated by this incident, interest In providing support for people who experienced trauma
increased within South Korea, with many organizations and facilities for supporting survivors
being established. An example of this involved conducting specialist-led interviews with theguardians of the Danwon High School victims. Families of the deceased experienced unbearable
sadness immediately after the incident and felt strongly resistant to seeking help from specialists.
Mental health specialists were not able to help beyond staying close by their side. Meanwhile,
conflicts arose within the community, much of this stemming from the circulation of unfounded
rumors.
After a year, the families of the deceased began to feel that they did not want to see thedeaths of their children to be for nothing, and they wished to create a safe community for thechildren by having the affected families (mainly the mothers) of the deceased come together of
their own volition to engage in mutual activities. Mental health specialists also cooperated byengaging with people in order to establish a connection between the families of the deceased andtheir communities through cultural activities (e.g., making traditional sweets, orchestra, andchoir). However, differences in attitudes began to emerge within these communities, with some
expressing their sorrow toward the families, while others found it unpleasant to even mention
the issue.
After two years, people within the community had started to view their activities related tothe incident as part of their own identity. They felt a sense of worth in selling their work,
donating to the poor, and recounting their own experience at schools. Based on the experience
gained from this incident, mental health specialists began holding workshops to promote therecovery capability of attendants by sharing necessary knowledge. They published leaflets andpapers and engaged in activities to raise general public awareness.
Now that three years have passed, issues still remain for the families of the deceased striving
to live within their communities with a sense of purpose. To "recover" means to findsignificance in their children’s death, and find something that will enable them to continue togrow. Moreover, group solidarity is key to recovering from the hurt that the community as awhole has experienced. Culture will play a significant role in keeping those who have been hurt
from becoming isolated and helping them maintain their connections within the community.
(4) Children after the Great Tohoku Earthquake
Junko Yagi, Vice President, Iwate Medical University/Iwate Children’s Care Center① About the speaker:
Dr. Junko Yagi is a child psychiatrist and vice president of the Iwate Children’s Care Center
who treats children affected by the Great Tohoku Earthquake. She previously worked at theMorioka Juvenile Prison, tackling social issues originating from the environment they were

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Report on Child Mental Health Symposium 2017raised in and developmental disorders from the standpoint of children’s rights. She has been
greatly advancing research as a study representative concerning the longitudinal support ofchildren born after the Great Tohoku Earthquake, along with their families.
② Lecture summary:
The Iwate Child Care Center and Iwate Medical University were established as a base forproviding child mental health care in May 2013 following the Great Tohoku Earthquake. It is
the first medical facility in Iwate Prefecture specializing in children’s mental health and isoperated by 20 staff members engaged in various related occupations, including 4 psychologists.
A branch was established within a hospital on a coastal area, with medical care being provided
by specialist staff members who conduct regular rounds.
The children’s symptoms strongly reflect the psychological state of caregivers close to them.
For this reason, and in order for children to feel they are living in a safe and healthy
environment, it is crucial that the adults around them be mentally and emotionally stable. Three
years on from the earthquake, consultations with middle and high school students increased in
the coastal area, with the ratio of stress-related disorders sharply increasing. However, issues
brought up during consultations directly relating to the disaster itself saw a gradual decrease as
time went on, with a main focus instead on everyday issues including developmental problems
that existed from before. In particular, there have been many consultations relating todevelopmental disorders on the high-functioning autism spectrum. Long delays in the physicalrestoration of surroundings and prolonged periods of children living under stressful situations
are believed to especially impact those who are already vulnerable. Community dispersion
occurred when it became necessary for residents to move into temporary housing or relocate
altogether, which has made it difficult to keep track of the community by school unit, ultimately
rendering this “natural” support system unable to function.
Within disaster-afflicted areas, several cohort studies with children as subjects (temporal
follow-up studies) have been conducted. Here, two such representative studies will be discussed.
One of these used nursery school children aged 3–5 at the time of the earthquake and theirguardians as subjects. Results showed a high percentage of children demonstrating
developmental problems three years after the disaster. Developmental impact was even more
severe in the case of those children who experienced trauma during the disaster itself or when
their mother had a psychological illness. The cohort study involving children born after theearthquake and their guardians revealed that the mother’s mental health was still serious evensix years following the disaster, with correlations found between the mother’s mental health andthe children’s behaviors and development. Generous support is therefore believed to benecessary both children born during chaotic events and their guardians.
In order for children to overcome a painful and unpleasant experience it is necessary forchildren to be in an environment where they can feel physically safe and psychologically stable.
When the surrounding resources for supporting children are not functioning efficiently, thechildren cannot exhibit their own natural healing abilities, leading them to require medical help.
As a specialist who works in the community, I need to acquire support and intervention methods
based on an understanding of trauma (trauma-focused approach). Although the intervention
method is selected depending on the degree of trauma, trauma-focused cognitive behavioral
therapy (TF-CBT) is noted as being particularly effective. It is a treatment program based ontherapeutic components, therefore incorporating a caregiver as a part of the treatment, and isconducted in 8 to 20 sessions. Creating a structure in which patients can be provided specialized
treatment such as TF-CBT as required, along with collaboration between the welfare, medical,
and education systems, is urgently needed.
3. Survey results of the participants
Before starting the symposium, the participants were given a survey to be used as a reference for
future activities, along with resource materials. Although it is not possible to publish the survey resultsin detail here, over 90% of the participants said that the content was “very good” or “somewhat good.”
On the supporting site, adults were bewildered by the various behaviors the children displayed andwere perplexed as to how to handle them. The needs related to children’s mental health care are highwithin the community, and here at our Center we felt it was necessary to continue engaging in raisingpublic awareness.
4. Summary
This symposium focused on children’s mental health care and community-building, being held aspart of an initiative to raise public awareness. Based on his rich experience providing psychological- 44 -

Report on Child Mental Health Symposium 2017support abroad, Dr. Koh gave as his topic of discussion an outline of how a community recovers froma major trauma and what the children growing up in such a community require. Prof. Hyun gave areport on relief support for human-made disasters and the dynamics within such a community. What
was common between these two topics was that the recovery of children and of the community
mutually interact, and that culture was what connects those who have been hurt with the community.
Victims and their families maintained their connection with the community through traditional art
from the Aboriginal community and through making and distributing sweets in South Korea.
Furthermore, there were no major differences between cultures in the psychology of the victims ortheir families who sought help. It was hard for them to admit that they were facing difficulties, and it
required a great amount of bravery to do so. We came to understand that it was normal for them to feelstrongly suspicious toward external supporters.
Dr. Yagi conducted a report on mental care practices for children in the Iwate Prefecture. We wereable to share information on what kind of medical resources are being generated within the community
and an understanding of the functions that it should have. It is predicted that there will be morechildren who will not recover naturally as time passes, with more specialized treatment methods, suchas TF-CBT, required. Presently, such special treatment methods have not been sufficiently spreadamong our community, making it a clear issue that we need to tackle in the future.

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