Department Initiatives
Stem Center Community Support DivisionCommunity Support
Division, Stem Center

Activity Report
Community Support Division, Stem Center

Division manager Public health nurse Iku AMAKASUAssistant manager Public health nurse Yukie OBA
Introduction
The region managed by the Stem Center Community Support Division of the Miyagi Disaster Health Care
Center (MDMHCC) includes the entire prefecture except for the Kesennuma and Ishinomaki areas. There are
Activities conducted with 17 staff members (of which two are dispatched to Natori City, one is dispatched to
Shiogama city and one is a secretary). Managing staff are assigned to nine municipalities with regular requests forsupport and we continue to provide needs-based support as a point of contact at the municipal department in chargeof disaster victim support. This paper reports the activities at our center.
Support Activities
1. Regional resident support
As shown in Figure 1, individual consultations based on home-visits to victims and outpatient interviews
comprised over half of the support activities run in FY 2015. The main activity in 2014 was also outreachconsultations, but the center hosted salons and meetings as the sponsor in 2015. Its content is reported in Section(3). Additionally, the “raising of public awareness”, as presented in Figure 1, included direct support for residents
by establishing consultation corners at the time of community health check-ups and events hosted by variousorganizations, as one of the mental health checks in the disaster area. Individual consultations remain frequent.
Figure 1 Percentage of activities by amount of time required - Stem Center, Community Support
Division * Investigations, research, and staff training not included

Raising public awarenessResident support

76

Care worker training and development
Care worker support
Various activity support
Conference coordination（Total hours＝3923.2 hours）※Excludes municipality dispatches

Table 1 Activity content for 201f (number of cases)

Resident support

Staff members of theCommunity Support
Division staff (13 staff
members, excluding
secretaries)
2184

Dispatched staff(3 individuals)

838

Care worker support

660

170

Raising publicawarenessCare worker training
and development
Various activity support

86

19

28

2

(Training in Miyagi
University)１
562

0

Conference
coordination

154(1) Individual Consultation
When evaluated by region, the number of visits is virtually proportional to the number of victims.
Observational functions are designated at Matsushima Town and inland areas such as Yamato andTomiya Towns due to the lack of support organizations (e.g., support centers) in their towns.
Opportunities for home-visits often arise during follow-ups after health surveys are conductedannually in the prefecture and its municipalities. Standards for extracting high-risk individuals fromsurvey responses vary according to the manpower and local challenges of that municipality and arefollowed up with independent priority criteria. There are many municipalities which target individuals
who have the following criteria which may require mental health care: “A K6 score higher than 13
points”, “poor physical conditions”, “a disturbed emotional state”, “interruption of treatment”,“drinking problems”, “insomnia”, and “nobody to consult with”. The center accepts all patients with“high K6 scores” and “disturbed emotional states” independent of the municipality. Follow-up systems
also vary by region, but most municipalities engage in activities in collaboration with the support team.
The second most common opportunity is requested by administrative agencies. There are morepatients with mental health problems who consult with public health nurses regarding their diagnoses
and treatment policies. Severe case consultations that cannot be managed by the staff alone haveincreased, and multidisciplinary consultations from public health nurses, care managers, center staff,
nursing teachers, and welfare officers have been conducted.
2015 marks the 4th year since the start of our research. The fraction of individuals with high K6 scores
have continued at a fixed rate since our inception. However, not all individuals with high K6 scores
have mental health problems. Additionally, many activity hours have been spent on consultations
regarding responses to severe cases including alcohol-related problems. These types of patients often
do not respond to health surveys, so we were beginning to feel the limits of shoring up mental healthproblems from a purely research-based standpoint. Concerning disturbing emotional states, we hadthought that this had decreased over time, but if anything, many patients have begun to realize theirpoor health in the fifth year and have begun to talk about their painful and traumatic experiences.
The health division of Tagajo City wanted to know what types of people participated in post-survey
follow-ups, what kinds of problems they faced, and how they should plan their policies accordingly.
There was a discussion around how to summarize these aspects and the center was primarily tasked
with responding. These results are shown in Table 2. Home-visit support was conducted on 299
individuals with high K6 scores who responded to the survey but residents with depression and suicidal
feelings were connected to health care services and patients were encouraged to continue treatment.
Additionally, we were able to confirm that they gradually stabilized by continuing to provide respectfullistening and accompanied support. Ongoing care workers comprised approximately 10% by the end of
the year. A portion of the summaries was reported in the 2016 Japanese Society for Traumatic StressStudies (JSTSS).
－ 42 －

Table 2 Status of disaster victims who received health support in Tagajo City

1. Attributes
1) Age andgender2) Damageby theearthquake

Age

20-29
years
7

30-39
years
23

40-49
years
33

50-59
years
28

60-69
years
43

70-79 yearsMen

19 years and
under
2

Women

1

7

19

34

31

37

Total

3

14

42

67

59

80

Completely
destroyed

Large-scale Partially
Unknown
partial destroyed Partiallydestruction
damaged
114
112
3
20

Total

Multiple

Livingalone

Elderlycouple

Other

Total

275

48

40

4

392

143

3) Family
structure4)Medical
history

Elderlylivingalone
25

Mentalillness

Diabetes
mellitus

Hypertension

CancerHeart
disease

42

23

63

15

23

Total

37

80 yearsand over
13

47

30

206

84

43

392

186

392

Cerebral Respiratory Dialysis OtherNo
Unknowblood
organsdisease n
vessels
121
21
12
5
91
58

Total
474
(Duplicate)

3 Support for supporters
Suspected of

2. Opportunity depression
to home-visit
K6

Suicidal Suspected of Al-related grief

mentalissuesPTSD
Questionnaire
items

illness

feelings

55

12dementia

Socialinsomnia anxiety
Other than survey
withdrawal

Drinking
19

Treatment7
20
interrupted

32Other

9 From care6
workers

Emergency
84
support

Other
11

60

16

9

1

10

22

299

4. Support activities
1) Physical care2) Need forcontinuous
detailed mental
health support
3) Social work

Illness
consultation
47

Diagnosis
recommendation
22

Trauma care Grief care
21

7

Provision of social

A1

Nutrition
consultation
5

Other
6

Suicide risk

26

Other

9

30

Referral to aCon

specialist

recom

→

20

Referral to the

Helping patients

Introduction of

resources

Consultation officeconnect with othercommunity salons46

24

organizations4)Observation

listening
70

10Social observation
22

Status check257－ 43 －

32

Loss of

Other

11

13

appetite Total

417(Duplicate)5. Outcomes１）Held once2) Completedwith continued

DenialEnd of support

Connection to

Other

Deemed completed

Total

Moving out

Rejection

no contact

Other

Total

0

3

5

5

57

* Meets OK indicators forsupport standards and deemed
unnecessary by conference

other organization

support33）Deemed

Lost contact

Total

completed*Could not meet but follow-up deemed
unnecessary based on information otherthan inspection

564) Continuing

Total
54

(2) Salon events
There have been a series of consultations of patients with alcohol-related problems in Natori City, andneither care workers nor nearby residents knew how to handle this situation. Our center staff members
developed an approach for these stakeholders by acting vigorously and in a leadership role and bringing
them to the point where the stakeholders themselves wanted to have a place and role during the day.
Additionally, multiple discussions were held between Natori City, the Iwanuma branch of the Shiogama
Health and Welfare Office, Tohokukai Hospital, and our center, and we supported residents in a twostep structure consisting of “meetings for temperance” and “health salons (sobriety group)”. The“Meetings for temperance” were formed to act as mock Danshukai meetings but were re-allocated as
preparatory Danshukai meetings because stabilizing stakeholder attendance took a significant amount oftime. We renamed the group “meetings for temperance” to encourage participation. “Health salons” wereorganized to operate while incorporating the wishes of the stakeholders and we anticipate volunteering
activities for this group in the future.
Public health nurses in the Health Promotion Division of Watari Town determined that there were many
chronically ill individuals when researching the health of solitary men who moved into public housing
and so launched “Men’s club” salons to promote health and preventing isolation and we have cooperated
in its operation and budget.
In Matsushima Town, Shiogama City, Tagajo City, Tomiya Town, and Yamamoto Town, we have
implemented “meetings of pastel art”, which are fun (finger art) gatherings and talking sessions, toprovide interaction opportunities for victims among residents involved in post-health survey follow-ups
who may have experienced similar to those who tend to be isolated and cannot find care worker
connections.
The status of these activities is as shown in Table 3 but all of them have been effective as places forcommunication and talk.
－ 44 －

Table 3 Main activities such as salon and events

Activity name

Numberof times

Number ofparticipants

Municipality

TargetIwanuma City

Other general public

11

115

Ochakko Salon(Yamamoto Town the Social Council
Supporters Sponsor Town ground,
temporary)

Yamamoto
Town

Residents ofcontainer type
temporary housingin Shishiori area

10

81

Meetings for Temperance

Natori City

Other general public

10

22

POLARIS JAPAN “Mental healthcare café

Yamamoto
Town

Other general public

541

Health Salon (Sobriety Group)

Natori City

Other general public

4

28

Watari Town Men’s Club
(Meeting for solitary men under 60)

Watari Town

Other general public

38

Natori City Salon activities for
affected children “Natori Genkikko”

Natori City

Other general public

2

37

Dear Home Town

Iwanuma City

Residents of private
housing2

9

In the Shiogama
area

Other general public

2

7

Natori City

Other general public

1

60

Iwanuma City

Public housing(disaster recovery
public housing)1

12

Yamamoto
Town

Residents ofcontainer type
temporary housingin Shishiori area

1

6

Sobriety group preparatory meetings

Natori City

Other general public

1

5

Meguriai-no-kai, a group ofearthquake victims

Natori City

Other general public

1

5

Utsukushima Salon（Salons for those who evacuated（Total）

from Fukushima to Iwanuma city）（Salons for mothers and children
who evacuated from Fukushima to
Iwanuma city）
Meetings of Pastel Nagomi Art（ Shiogama Health Care Center andShiogama Health Center Kurokawa
Branch area Salon for affected
residents
Let’s listen to those who quit
drinking!
（ Meetings for Temperance ）Tea Salon “the disuse syndrome
prevention and stretching”（ The relocation area in Iwanuma
City ）
Exercise class（ Yamashita Public Housing ）－ 45 －

(3) Mental health consultation booths at the time of community health check-ups
Individual consultations were conducted at a corner called “Fatigue check” at community health checkup sites in Matsushima town and Iwanuma City. This is a project that was set up and is conducted by theadministrative government since the earthquake to allow for individual consultations after “stress andfatigue measurement” inspections so that as many residents as possible can receive proper care. The
center dispatched two staff members each so that they can administer individual consultations. Residents
who became patients were often people with daily stresses that had no one to consult with and were not
only limited to earthquake-related issues and most residents were able to reduce their stress due toextended listening sessions and respectful casework. Approximately 10% of patients required continued
support and so this was provided to them.

Counselee background

Table 4 Mental health consultation at the time of community health check-ups
place name
Matsushima Town Iwanuma City
Number of events
10days
２days
Number of counselees
41
19
Men
８
６
Women
33
13
20～29
２
１
30～39
０
０
40～49
４
２
１
１
Age (years) 50～59
60～69
10
６
70～79
21
８
80～
３
１
K6 results 13 points or more
６
No investigation
depression
２
３
PTSD
Content
mental20

Al３

Adjustment disorders

１

１

grief
insomnia
physical
Other

(4)

１

22
15

９
２

Problems related to caregiver
fatigue, family, economic status,
personality, and work

Consultation activities at events hosted by other organizations
In Iwanuma City, the Social Welfare Council primarily hosts “Utsukushima Salons” for residents who
have evacuated to the Sennan area from Fukushima (Table 3). Dozens of residents participate each time
and the center conducts consultations on-site.
The “Genkikko” event hosted by the Lifestyle Reconstruction Division of Natori City is an event thatseeks to provide consultations for parents and children in need of support by providing disaster area
children with a place to play. The center has focused on fulfilling mental health needs by observing
participating children and communicating with their parents. A conference was held with a child who
was in an unfavorable parenting environment, but this was deemed to be a case where connecting withassociated organizations was not necessary and no individual follow-ups were conducted.
In Yamamoto town, health consultations were regularly held once a month as part of victim support
programs of the regional general support center directly operated by the town. Since most participants
were senior citizens with physical problems, we responded by proposing exercise in coordination withoccupational therapists. Many residents in container type temporary housing at Yamamoto town
relocated during this time and the program ended in August 2015 due to the lack of participants. Somewere sad about the loss of local opportunities for their stories to be listened to but we intend to host these
events in a different format. The types of consultations in this area were more related to health problems
and frailty concerns due to aging rather than psychological problems.
－ 46 －

2. Caregiver support(1) Support for supporters
As can be seen in Table 5, expert advice in case conferences comprised many support
activities in FY 2015. Alcohol-related problems were more common than PTSD andcomplicated grief about specialized content. In other cases, caregivers who provide
support for those with developmental disorders or social withdrawal that are notconnected to existing mental health organizations had nobody to consult with and so weprovided consultations for them.
Also, as shown in the Table, administrative support is increasing. This indicated thatthey are accepting the responsibilities of documentation during case conferences between
care workers, as well as documentation to help non-overseeing administrative staff
understand the purpose of these activities.
Table 5

Content of support by the supporters

Support activities

Numberof Events
134

Report after a home-visit orinterview
Guidance and advice fromprofessionals

Summarized

112

PTSD

44
3
4
16
5
5
14

Abuse
Other

53

Alcohol-related
problems Gamblingproblems Drugproblems
Depression
Complicated grief

Local issues

4

Need for continuous detailed
mental health support
Case conference (In cases
where the subject is absent)
Opening the mental wellness
Consultation booth
Health examination support

6
197
3
8

Administrative support

190

Other

6
*Staff dispatched tomunicipalities excluded－ 47 －

(2)Trends and challenges surrounding caregivers’ consultation content
Cases requested by caregivers are not only limited to high-risk individuals extracted from healthsurveys and tend to include many difficult-to-treat cases. Many patients arrived at the center withbackgrounds and these were cases of individuals under the age of 65 or with developmental disorders
requiring long-term care who had trouble scheduling with existing consultation organizations or who haddifficulty connecting with consultation organizations due to age-related factors. Additionally, we havebegun to receive more advising requests on how to promptly react on-site from occupations that directly
provide support, such as care workers in temporary housing, welfare commissioners, and government
officials. These roles were thought to be important for the support of high-risk patients who tend to be
hidden in the region and we actively responded to these requests. We have trouble discerning how ourroles are being continued in the context of standard community care with regards to support for difficult
cases surrounding alcohol-related problems and this remains a difficult issue.
Providing postvention for supporting the families and caregivers of individuals who have committed
suicide in the region is thought to be an important activity carried out by the center but in 2014, we
provided support for two cases in two regions. Of these, one case involved multiple organizations because
it occurred in container type temporary housing, and hearing surveys were conducted for each of the
stakeholders and individual consultations to fully understand the sentiments involved. We did not
implement group work in the framework where general postvention methods were introduced.
(3) Specific caregiver support by the supported municipality
We supported mental health consultation activities at the time of community health check-ups in
Matsushima Town and Iwanuma City. Matsushima Town is one of the few regions that did not set up
container type temporary housing after the earthquake. There are no support centers and the town has
conducted victim care with standard health welfare activities. The center actively supported the project
to increase consultation opportunities for its residents.
Public health nurses from the Social Welfare Division of Iwanuma City voiced that they wanted tothink about not just pursuing high-risk individuals but also what they can do for the entire district froma preventative perspective. In 2016, they have requested study groups for district diagnoses at the mental
health care study groups. The center has provided support by dispatching lecturers to these districts.
Health salons with the objective of sobriety have been launched in Natori City and we provided
operational support so that public health nurses in the sobriety program could provide post-check-up
advice for patients.
Gatekeeper training courses were requested by Shiogama City and Matsushima Town but there havealso been discussions on managing the lectures and exercises on these days and on providing
participation opportunities for students as well. We are considering all of these together.
The content of the support provided to each of these municipalities has looked past the content ofstandard mental welfare activities and goes beyond the framework of post-disaster support. Meanwhile,
given that recovery is still a work in progress and residents still are in container type temporary housing,
we are concerned about the fatigue and loss of motivation among support staff who continue observation
support. Support staff who have closely supported residents of container type temporary housing haveapproached the period where their support needs to be taken up by others and we are investigating
regional systems in each area designed to evaluate support staff activities, take up their work, and ensurethat residents are receiving the observation they require. As a member of the study group, the center
continues its participation in these initiatives.
3. Raising public awareness
Lectures conducted as information sharing for general residents on the topic of mental health are as shownin Table 6. Lectures for residents in any given area have more content designed to provide backup support sothat residents themselves can exert more effort using lifestyle improvement or communication methods rather
than focusing on mental health that is directly related to the disaster. These are preventative measures that havebeen implemented precisely because there was a disaster and the government has indicated that they would
like to continue and reinforce these initiatives. Progress has been made to date for the support of high-riskpatients but we have personally experienced that this only results in a “whack-a-mole” situation and these
initiatives can be said to be the result of the needs formed in each region.

－ 48 －

Specifically, Natori city has conducted community lectures on the theme of “drinking wisely” as part ofpublic awareness activities on alcohol-related problems. These are part of initiatives to reduce individual
support for alcoholics, as well as to promote early intervention before problems surface. Following thesecommunity lectures, we have hosted “health salons” for patients at higher risk of addiction so that they haveplaces to stay and to increase their role in the region; as well as to promote health, of which residents have highawareness.
Additionally, in the same city, we conducted mental health public awareness workshops in conjunction withliberal arts courses sponsored by the community center, targeting residents that are likely to become
gatekeepers in the region. The primary purpose of this workshop was not just to increase public awareness but
to incorporate the wishes of the community center that residents who are likely to become gatekeepers willlearn how to interact with any “concerning individuals” that they may encounter in daily life. The method oftaking advantage of opportunities where residents may gather in daily life and subtly providing knowledge andculture has been an effective way to respond to residents and clients, and we would like to continue these
efforts.
We have been requested every year to host mental health workshops for individuals with hearing impairments.
This year, we conducted lectures on the theme of “good ways to deal with stress” at the “Miyagi Mimisuppo”
Shiogama city Deaf People Information Center. It is thought that we have much to learn with regards to postdisaster care for individuals with hearing or visual impairments and that it is important to have preparations forproviding support immediately after a disaster.
Table 6

Community lectures and workshops

Workdays

Main activities

Place

February 10th,2016
October 15th,
2015

Talking about mental health” healthlectures at the Shiogama Mimisuppo Salon
The Iwanuma City Family Workshop for
People with Mental Illness
We took requests for workshops inadvance. In FY2015, we conducted thefirst workshop on familiar alcohol-related
issues and the second workshop on dailyinteractions.
Lectures on how to drink wisely

Shiogama City Other generalpublicIwanuma City Other generalpublicMental health workshops ～ Good way to

Natori City

September 5th,
2015
July 22nd, 2015

Natori City

deal with stress ～（ Temporary housing
complex in East Medeshima ）May 11th, 2015

Mental health workshops ～ Good way to

Natori City

deal with stress ～（ housing complex for
employment promotion ）June 24th, 2015

Mental health workshops ～ Good way to

Natori City

Mental health workshops ～ Good way to

Natori City

deal with stress ～Residents of container type temporary
housing in Uematsu Iryu
July 8th, 2015

deal with stress ～－ 49 －

Subject

Numberof Events
9
11

Other generalpublicResidents ofcontainer
type
temporary
housing in
Mitazono

31

Residents ofcontainer
type
temporary
housing in
Mitazono
Residents ofcontainer
type
temporary
housing in
Mitazono
Residents ofcontainer
type

7

7

4

6

（ Hakozukayashiki temporary housing ）June 10th, 2015

Mental health workshops ～ Good way to

Natori City

deal with stress ～（ Hakozukasakura
Temporary Housing
July 22, 2015

Mental health workshops ～ Good way to

Natori City

deal with stress ～July 2nd, 2015
February 19th,
2016

2015 Yurigaoka Kouza Yurinoki Juku “For Natori Citya good night’s sleep”
FY 2015 Mental health lectures in Rifu
Rifu Town
Town“Do not miss it! The SOS from yourheart: Focus on your mental health”

temporary
housing in
Mitazono
Residents ofcontainer
type
temporary
housing in
Mitazono
Residents ofcontainer
type
temporary
housing in
Mitazono
Other generalpublicOther generalpublic

7

7

20
30

4. Care worker training and development
Experience from prior disasters like the Great Hanshin-Awaji Earthquake has shown that confusion andstruggles with psychiatric illnesses among the staff providing direct on-site support tend to become a barrier tothem fulfilling their roles in these situations. The center has also predicted from the outset that alcohol-related
problems, social withdrawal, and dementia will increase in the mid- to long-term of recovery and has,accordingly, hosted care worker training and development programs based on these issues. Consultations on
alcohol-related problems have increased from an on-site perspective and have been treated as difficult cases.
Additionally, these types of patients rarely come to consultations of their own accord so the situation is suchthat administrative public health nurses and support center staff members need to track them down with postsurvey and daily observations and are struggling as a result. Many of the workshop applicants wereadministrative public health nurses and support centers, staff members.
As shown in Table 7, we conducted training programs on “listening skills”, “communication skills: cognitive
behavior therapy”, “home-visit skills” and “responding to personality disorders”. In Tagajo City, outreachsupport is contracted to teams composed of various occupations, and they are trying to provide the support thatstandardizes patient assessment criteria by conducting training programs on “Depression, PTSD, and suicidal
thoughts” as well as, “grief”. The center also co-hosted the “workshop for care workers providing support forindividuals with alcohol-related problems”, which is sponsored by the Shiogama health care center, andconducted lectures on Measures against Alcohol-related Harm outlined by the non-profit organization ASK(National citizens association for alcohol and drug problems). We hosted a workshop entitled “Workplacemental health in the future” in Natori city for public awareness to municipality managers. We hosted these overtwo sessions to ensure that all managers could participate. Stress-check systems have become mandatory in theworkplace and we predict more consultations relating to workplace mental health in the future.

－ 50 －

Table 7

Content of workshops on human resource development

Date

Workshop content

Activity nameLocation

Subjects

December
9th, 2015

Addiction-related
problems: alcohol

TagajoCity

SeniorwelfareDecember
16th, 2015

Addiction-related
problems: alcohol

WatariTown

Administrati
ve associates

27

February
2nd, 2016

Addiction-related
problems: alcohol

Iwanuma CityAdministrati
ve associates

64

February
24th, 2016
March
17th, 2016

Addiction-related
problems: alcohol
Addiction-related
problems: alcohol

NatoriCity
Iwanuma CityAdministrati
ve associates
Administrati
ve associates

5

Septembe
r 25th,2015
June 10th,2015

Senior mental
health workshop

Workshop for care workers providing support forindividuals with alcohol-related problems(sponsored by Shiogama health care center)
Workshop for countermeasures against alcoholrelated problems: “How to support individuals withalcohol-related problems”
Workshop for countermeasures against alcoholrelated problems: “Merits of early intervention forsobriety support”
Sobriety workshop (for public health nurses andnutritionists with specified health guidance)
Workshop for countermeasures against alcoholrelated problems: “Responses during the precontemplation stage”“On dementia” (for management staff in Tagajo city
temporary housing)

TagajoCity

18

Mental health support development lecture: “How tomaintain mental health”

MatsushimaTown

Temporary
housing
support staff
Generalpublic2015 Kurihara city comprehensive life support
project consultation support workshop:“Understanding depression and the role of care
workers in suicide prevention”
2015 Kurihara city comprehensive life support
project consultation support workshop: “When you
hear the SOS from the heart”

Kurihara
City

Welfarecommission
ers

60

Kurihara
City

Welfarecommission
ers

34

2015 Kurihara city comprehensive life support
project mental health care worker training
workshop: “on listening”

Kurihara
City

Generalpublic15

2015 Kurihara city comprehensive life support
project mental health care worker training
workshop: “on listening”

Kurihara
City

Generalpublic12

Mental health promotion workshop:~Connect, support, you as a supporter ~ I(Gatekeeper training lecture)

Shiogama CityGeneralpublic10

Mental health promotion workshop:~Connect, support, you as a supporter ~ II
(Gatekeeper training lecture)

Shiogama CityGeneralpublic13

Mental health promotion workshop:~Connect, support, you as a supporter ~ III(Gatekeeper training lecture)

Shiogama CityGeneralpublic13

Misato town welfare commissioners study group:“How to listen and relate to clients during theconsultation: depression and suicide prevention”

MisatoTown

Welfarecommission
ers

6

Watari town care worker mental support project: “onthe Dohsa method”
Yamamoto town welfare commissioners training:“Current status of mental health in the disaster areaand future directions”
Dementia supporter leader lecture: “On listening”

WatariTown
Yamamoto Town

19

Yamamoto town Council of Social Welfare
Yamamoto recovery support center care worker
targeted workshop: “Preparing for consultation

Yamamoto Town

Supportcenter
Welfarecommission
ers
Regional
generalsupportcenterCouncil ofSocial
WelfareAugust6th, 2015
August20th, 2015
October
8th, 2015
October
28th, 2015
November 4th, 2015
November 11th,2015
November 18th,2015
December
8th, 2015
August21st, 2015
November 26th,2015
July 6th,
2015
August4th, 2015

Workshop for
problems relating tosuicidecountermeasures
Workshop for
problems relating tosuicidecountermeasures
Workshop for
problems relating tosuicidecountermeasures
Workshop for
problems relating tosuicidecountermeasures
Workshop for
problems relating tosuicidecountermeasures
Workshop for
problems relating tosuicidecountermeasures
Workshop for
problems relating tosuicidecountermeasures
Workshop for
problems relating tosuicidecountermeasures
Workshop for
problems relating tosuicidecountermeasures
Care worker mental
health training
Care worker mental
health training
Support skills
training: onlistening
Support skills
training: onlistening－ 51 －

Watari
Town

Number ofparticipants
45

11

20

50
13

9

Septembe
r 16th,2015
October
7th, 2015
October
21st, 2015

Support skills
training: onlistening
Support skills
training: onlistening
Support skills
training: onlisteningsupport”
Natori city disaster support organization training:“Pointers on disaster victim-accompanied listening”

NatoriCity

Supportcenter33“Pointers on victim-accompanied listening” (forNatori city disaster victim support organizations)

NatoriCity

Supportcenter29

Shibata town regional support care network
communication meeting: “about listening” (day one)

ShibataTown

140

October
22nd, 2015

Support skills
training: onlistening

Shibata town regional support care network
communication meeting: “about listening” (day two)

ShibataTown

November 4th, 2015

Support skills
training: onlistening
Support skills
training: onlistening
Support skills
training: onlistening
Support skills
training: dementia
Dohsa treatment
Support skills
training: other
Support skills
training: other
Support skills
training: other

Natori city support center Dotto Natori care worker
study group: “on listening”

NatoriCity

Regional
generalsupportcenterRegional
generalsupportcenterSupportcenterNatori city support center Dotto Natori care worker
study group: “on response techniques”

NatoriCity

Supportcenter9Natori city support center Dotto Natori care worker
study group: “on listening”

NatoriCity

Supportcenter9

Theme-based care worker training: “Communication
skills improvement ~dementia treatment, dementia
Dohsa method basics”
2015 Shiogama health care center staff workshop
relating to responses to acute psychiatric illnesses
Theme-based care worker training: “Facilitation
training”
Watari town residential care support project
associate meeting training group: “how to interact
with those who have psychiatric illnesses”

TagajoCity

Administrati
ve associates

41

Shiogama CityOsaki
City
WatariTown

30

Septembe
r 14th,2015
November 13th,2015
January
18th, 2016

Support skills
training: otherShiogama city Iboishi temporary facility support
center staff training: “on co-dependence”

Shiogama CityAdministrati
ve associates
Administrati
ve associates
Seniorwelfarecommission
ers
SupportcenterSupport skills
training: other

Watari town caregiver mental support projecttraining program: “requirements for home-visits”

WatariTown

Supportcenter9

Support skills
training: other

Natori city recovery support center Hiyori – internal
training: “how to handle social withdrawal cases”

Natori
City

17

January
19th, 2016

Support skills
training: other

NatoriCity

February
17th, 2016
February
24th, 2016
March 9th,2016

Support skills
training: other
Support skills
training: other
Support skills
training: other

Natori city home-visit care organization training:“personality disorders (how to support those who are
difficult to associate with)”2015 communication skills improvement lecture (1):“mental reactions of post-disaster children”
2015 communication skills improvement lecture (2):“opened relationships”
2015 recovery period mental care workshop II:“assessment techniques and how to advance caseconferences”

Temporaryfacility
support staff
Organizatio
ns12

June 1st,
2015

Training on
psychiatric illnesses
and disabilities
Training on
psychiatric illnesses
and disabilities
Training on
psychiatric illnesses
and disabilities
Training on
psychiatric illnesses
and disabilities
Training on
psychiatric illnesses
and disabilities

Dementia support leader lecture: “on dementia”

Watari
Town

GeneralpublicGeneralpublicDisability
welfarecommission
ers
GeneralpublicMinamihama Chuo Hospital workshop: “dementia
care”

Iwanuma CityMedicalassociates

34

Health Division regular meeting study group: “ondepression, PTSD and suicidal thoughts”

TagajoCity

Medicalassociates

8

Shiogama city Iboishi temporary facility support
center staff study group: “Understanding andresponding to mood disorders”
Tagajo city health division caregiver study group:“on grief, etc.”

Shiogama CityAdministrati
ve associates

6

TagajoCity

Administrati
ve associates

7

November 18th,2015
December
16th, 2015
November 20th,2015
July 6th,
2015
August18th, 2015
Septembe
r 11th,2015

July 29th,
2015
November 25th,2015
December
14th, 2015
December
16th, 2015

－ 52 －

Shiogama CityShiogama City
Osaki
City

70

8

16
43

5

12

12
37

12

January
7th, 2016

Workplace mental
health training

January
8th, 2016

Workplace mental
health training

April 13th,2015
February
25th, 2016

On disaster zone
conditions andcenter activities
Case study
investigation

March
14th, 2016

Case study
investigation

July 17th,
2015

Other

August3rd, 2015

Other

August4th, 2015

Other

Mental health training program for Natori city officemanagement staff: “Future workplace mental healthfor managers and directors (first round)”Mental health training program for Natori city officemanagement staff: “Future workplace mental healthfor managers and directors (second round)”
Newly-appointed public health nurse training(Shiogama City)

NatoriCity

Administrati
ve associates

40

NatoriCity

Administrati
ve associates

34

Shiogama CityAdministrati
ve associates

4

Iwanuma city regional general support center staff
training

Iwanuma City13

Support center study group/case study investigationgroup (for Shiogama city Iboishi temporary facility
support staff)
2015 4th Natori city disaster victim support
communication meeting: “on support during
recovery periods”
Shiogama city support center study group: “support
issues during recovery periods”

Shiogama CityRegional
generalsupportcenterSupportcenter45

Tagajo city maternal health staff training program:“Developmental confirmation pointers in infant
neurological and psychological development andmaternal health screening”

TagajoCity

Temporaryfacility
support staff
Regional
generalsupportcenterInfantwelfarecommission
ersNatoriCity
Shiogama City51040

5. Various activity support
As part of recovery activities, non-governmental organizations have laid out a variety of activities such as
survivor support, playgrounds and education support for children, and life-purpose-building events, and there areeven municipalities that have incorporated mental health care in their new projects. A list of activities for which
we have received cooperation requests from each organization and which we have co-hosted is shown in Table 8.
Table 8: Activities co-hosted with each organization
Location

Activity nameSponsoring organization

Activity content

Natori City

Meguriai-no-kai

NPO Soshi

Survivor support

Natori City

Playing event:
Genkikko

Natori city support center
Dotto Natori

Playing and psychologicaleducation spread, and individual
consultations

Iwanuma City

Utsukushima salon

Iwanuma city social welfare
community meeting:recovery support center
Smile

Fukushima nuclear disasterevacuee gatherings andindividual consultation

Iwanuma City

Playgrounds forchildren

NPO Adventure playground:
Sendai / Miyagi network

Individual consultations withparents

Yamamoto
Town

Disability support

NPO Polaris

Stakeholder and caregiverconsultations

Yamamoto
Town

Fuji kindergarten

Japan UNICEF association:
Japan play therapy
association

Continuation of mental
consultations with disasterkindergarten staff

Watari Town

Men’s club

Watari town healthpromotion division

Mental care in health education
locations for solitary men－ 53 －

6. Research
The two research activities that we have been involved in in 2015 are as follows.
The first is that we tabulated and analyzed “cooperation between multiple organizations andmultidisciplinary caregivers” and “trends on individuals who require continued support”, among those who
receive ongoing individual support from contractors dispatched from Tagajo City. We conducted statisticalprojects and reading projects to present a poster at the 2016 Japanese Society for Traumatic Stress Studies
conference as part of reporting on support activity from Tagajo City.
The second is that we reflected on and investigated the activities and networking of caregivers in the periodleading up to the establishment of “health salons” designed with the objective of sobriety in Natori city. The
context in which this salon was established and the conditions of the stakeholders are explained in a separate
section. The present research content is scheduled to be presented at the 2016 Japan alcohol-related problems
conference.
Discussion
The needs requested by the center have evolved. At the start of our center’s establishment, we employedhuman wave tactics where we identified suffering residents with screening tests and patrols and continued withhome-visits. Five years after the earthquake, requests for disaster-specialized victim support gradually decreased
and perspectives that frame resident responses as part of standard psychological health care practices havebecome more common. Simultaneously, regions have shown tendencies of being more aware of daily mental
health strategies, emphasizing how they can incorporate preventative perspectives in residents and stating thatthey want to strengthen their regions for these developments. Additionally, regions have expressed a desire todevelop human resources by expanding the range of regional support systems so that non-specialists and general
residents can mutually support one another and not just rely on direct support from specialists and have begun
to focus on this regional development. As these are thought to be in line with the mental health plans of these
districts and we believe that these should be developed based on local networks, we believe that it is importantto further work closely with regions and to strengthen our cooperation with associated organizations.
We do not have many successful cases with regards to alcohol-related problems, but when reflecting on
cases, we have directly experienced that building relationships with stakeholders is tantamount to success. It isnecessary to further focus on their mental health and be more frequently involved to establish these
relationships, which requires a massive amount of time and manpower. However, municipalities’ efforts are
spread out in rebuilding their primary duties and the current status is such that they often cannot provide thetime and resolve that these initiatives require for support. In the future, it is essential to analyze with all care
workers as a group what kind of system the region requires for utilizing its specialized skills and providing
effective support for these initiatives. On our end, we hope to dispatch out to these regions and be involved in
activities as much as possible to help fill the gaps in regional mental health care. Additionally, we believe that
we must first strengthen our development to reinforce our specialized skills. We co-host study groups forhuman resource development by deepening our connections with existing associated organizations and wehope that these will result in a type of steady and routine back-up support for these regions.
Conclusions
During the process of medium- and long-term mental health care, the role of the Community Support Divisionin the Stem Center has become to provide support activities that conform to standard psychological health andwelfare activities. However, in Natori city, there were still many residents who have been forced to live in
temporary housing until as late as 2018 and the disparities in its recovery are large when compared to that ofmunicipalities who have already finished temporary housing provisions. These feelings of emotional irritationand hopelessness are feared to result in chronically poor health. As disparities in recovery continue to grow, wemust re-examine the self-evident issues of each region and question whether we should continue our activities－ 54 －

as we always have. Future challenges include the re-examining of priorities and summarizing the activities ofstaff and dispatched individuals as well as for deciding what we will leave behind after extensive discussions.
For this, we will need to further coordinate among regional managing teams. And so, after five years, we havefinally just begun to recognize the period of “reconsidering mental health care activities by being conscious ofclosing the center”. In an era where multi-layer and comprehensive support is in demand, the current situation
is such that we need to once again re-examine how to end our support, and re-consider “what is mental care”
and “what is mental recovery”, both individually and among staff.
Finally, to improve upon the techniques mentioned in the discussion, we append the support division's internal
workshop plans for 2016 here.
Table 9 Support division internal workshops plan for 2016
Training content
On early intervention
for alcohol problems

Coordinating organization
Health care center Iwanuma
officeFamilytherapyprogram
On listening

Health care center Iwanuma
officeOnresident-based
activities
Case
study
investigation

Miyagi Prefectural support
center support project center
Selection from cases

Specific content
Natori City “Health salons”, “sobriety
meetings” establishment process andprogramtechniques for the “Happy program”
Learning about crafts

Duration
April

Learning about what it means to accompany
victimsThree-part series
What is necessary for residents to be able tolayout regional activities

April-June

May

June, JulyIn
preparation

References
1) B. Raphael (Author), Tadashi ISHIMARU (trans.): “When a disaster strikes”, Misuzu Shobo, 1989.
2) H. KATO: “Mental health care: from the Great Hanshin-Awaji Earthquake to the Tohoku region”, Kodansha
Gendai Shinsho, 2011.

－ 55 －