FY 2018 Bulletin, Issue 7

Ishinomaki Regional Center Activity Report
Miyagi Disaster Mental Health Care Center
Ishinomaki Regional Center Community Support Division
Manager, Psychiatric Social Worker – Shigeru Okazaki
Assistant Manager, Psychiatric Social Worker – Hiromi Arai

Introduction
Following the reconstruction of the Shin-Ishinomaki Joint Government Building, which had been damaged
during the Great East Japan Earthquake, the Ishinomaki Regional Center of the Miyagi Disaster Mental HealthCare Center (hereinafter this center) moved from 1-4-32 Higashinakazato, Ishinomaki, located about 15
minutes by foot from Ishinomaki City Hall, to 5-7 Ayumino, Ishinomaki in Shin-Hebita, about 25 minutes away
by car. The new building is in Hebita district, in the western part of the city. The Sanriku Transit Expressway
runs through the southern part of the district, most of which has been used as agricultural land. The “Ishinomaki
Disaster Reconstruction Plan,” which prioritized the rapid reformation of a livable environment for disasteraffected individuals, proposed the comprehensive development of a new urban settlement in Hebita district. As
dictated in the Reconstruction Preparation Plan, approximately 46.5 ha of the land readjustment project area
would be converted into commercial and residential land. Before the disaster, most of this land was the countryside; since then, however, there has been rapid residentialization. Of the 4,100 houses that the city of Ishinomaki planned to build for disaster-prevention group relocation purposes, approximately 30%--or 1,230
houses, with a potential residential population of 3,500—have been built so far. Disaster public housing now
surrounds the Joint Government Building. We used to make home visits to this area, to administer health sur-

5-7 Ayumino, Ishinomaki石巻市あゆみ野５－７

1-4-32 Higashinakazato, Ishinomaki

veys.
Map taken from https: //www.google.com/maps/d/u/0/viewer?mid =1ipzN07AgD0PmY_5_y5SDuvvvUeH-xf9w&ll=38.42561517557333%2C141.33483136759742&z =12
Figure 1. Tsunami Flooding in Ishinomaki Caused by the Great East Japanese Earthquake－ 53 －

Ishinomaki Regional Center Activity Report

The MDMHCC operates in three locales—the cities of Ishinomaki and Higashimatsushima, and in the townof Onagawa.
In early FY 2018, our center had a staff of ten individuals: one part-time psychiatrist as president, four fulltime psychiatric social workers, one public health nurse, one occupational therapist, one administrator, and twopart-time public health nurses. The occupational therapist was transferred to Ishinomaki; two of the four psychiatric social workers were also relocated—one to Higashimatsushima and the other to Onagawa. Our center
lost two people from the 12-person strong staff it had as of April 2017.
As of September 2018, Ishinomaki had a population of 144,823; 61,348 households; and a land area of 554.5
km2. Higashimatsushima had a population of 40,192; 15,827 households; and a land area of 101.9 km2. Finally,
Onagawa had a population of 6,504; 3,118 households; and a land area of 65.8 km2. Together, these two cities
and one town constitute MDMHCC’s area of operation. Combined, they give us the following figures: population: 191,519; the number of households: 80,293; total land area: 722.2 km2.
On April 1, 2005, Ishinomaki merged with the neighboring towns of Kahoku, Kanan, Kitakami, Monou, andOgatsu—all from the former Monou District—along with Oshika town from Oshika district, to form the newcity of Ishinomaki.
The population of Ishinomaki over the past eight years is listed in Table 1.
Table 1. Changes in the Population of Ishinomaki (Each Year, At the End of September)

Ishinomaki
Year

Households Population

Higashimatsushima
Men

Women

Onagawa

Households

Population

Men

Women

Households

Population

Men

Women

2010

60,818163,216

78,72684,4902011

58,142

153,452

74,254

79,19814,651

40,762

19,981

20,781

3,463

8,607

4,251

4,356

2012

58,809152,250

73,76678,484

14,71740,457

19,80020,657

3,436

8,153

4,007

4,146

2013

59,391

151,068

73,27077,79814,88140,33019,794

20,536

3,323

7,647

3,766

3,881

2014

59,903150,11472,913

77,201

15,07840,16919,753

20,416

3,237

7,229

3,556

3,673

2015

60,412

148,968

72,44676,522

15,30540,18319,757

20,426

3,171

6,930

3,431

3,499

2016

60,988147,926

71,99775,92915,50540,27919,79920,500

3,175

6,779

3,359

3,420

2017

61,268

146,516

71,28375,233

15,66540,26819,787

20,481

3,182

6,668

3,299

3,369

2018

61,348144,823

70,43674,387

15,82740,192

19,753

20,439

3,118

6,504

3,213

3,291

3/2018Aging rate

31.80%

Aging rate

28.00%

Aging rate

37.00%

9/2018Public assistance rate

10.58‰

Public assistance rate

8.16‰

Public assistance rate

10.83‰(East welfare dept.)*2018 figures for Higashimatsushima are current as of the end of July.
*Aging rate and public assistance rate for Miyagi Prefecture: 26.9% and 12.46‰

While the population of each city and town above has declined since the disaster of 2011, in recent years,
the number of households in Ishinomaki and Higashimatsushima has increased, and the number of nuclear
families appears to be rising. The aging rates of these three municipalities exceed the Miyagi Prefecture average,
but their public assistance rates are lower than that of Miyagi Prefecture as a whole.
Here, we will introduce and discuss some of the activities that this center participated in, in FY 2018.
Characteristics of this center and its activities
The primary focus of our activities is resident support, which takes up more than half our time. As a rule,
health surveys that are carried out at the city of Ishinomaki’s urging are conducted by multiple people. Because
staff members at this center have experience working for other municipalities within the prefecture, we believethat having a young staff member visit paired with an older, more experienced counterpart will serve as apositive experience for the young staffer. A public health nurse and the psychiatric social worker together carryout home visit surveys; by conducting visits with different people from varied professional backgrounds, we
believe that we are capable of carrying out assessments by considering multiple angles.
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FY 2018 Bulletin, Issue 7

Other activities characteristic of our center are salon activities (e.g., Koko Farm), mental health care workshops, human resource development training for supporters, and Danshukai experience meetings. These activities have been conducted smoothly thanks to this center’s employees, who actively take on whatever duties
are possible.
In light of this center’s relocation to a new facility (as mentioned previously), several of our salon projects
were brought to a close this year.
We have organized a handicraft (collage) class for apartment-type temporary housing tenants to provide themwith a place to mingle with each other since 2013. This initiative was brought to a close in December 2017.
Further, the handicraft class (renamed life skills class in May 2016) began in September 2015 was brought toa close at the beginning of this year.
We began organizing art exhibitions and social events for tenants of apartment-type temporary housing in
2012. Once we had moved into the new Joint Government Building this year, we decided to thank all of thedisaster survivors who had helped us with this process by holding one last “Gathering for Gratitude” in November 2017. This initiative was subsequently brought to an end.
Since April 2018, the MDMHCC has been involved in only one salon-type activity: the Koko Farm initiative.
1. Resident support(1) Individual support● Individual support
This center’s primary area of operation is Ishinomaki city. Following requests from both Ishinomaki
and the prefecture to assist with a health survey of disaster public housing tenants in the area, westarted providing home visit-based individualized support. We prioritized cases that required continuous support, after notifying the city. Eight years have passed since the disaster, but the issues our people
face have only grown more complex as cases in which several are present at the same time, continue
to increase. There are many instances in which clients and support targets require time-intensive support for multiple issues such as pension-disbursal, welfare payments, and medical examinations forthe sick.
After eight years of activity, this center has built a name for itself, and telephone counseling cases
continue to increase slowly but surely. Although we specialize in support for victims of the Great East
Japanese earthquake; there have been times when we have had to respond to cases that ought to havebeen handled by existing institutions. However, since the entirety of Ishinomaki is disaster-affected it
is often difficult to determine the extent of its effects.
(2) Salon activities for community residents (group activities)● Koko Farm Project
The Koko Farm Project has been running for six years, since 2013. The purpose of the project is to
give isolated disaster survivors living in container-type and apartment-type temporary housing, achance to regain their mental and physical health. Many of the participants had been flagged forhaving high K6 scores, or alcohol-related issues, by the health surveys that had been requested by thecity of Ishinomaki.
Creating a space where people can experience a change of pace, and interact with others while
growing vegetables and flowers, has allowed participants to regain their mental and physical health.
As of FY 2018, this program had served a total of 1,266 people.
Koko Farm participants have achieved the following. They have:・ regained confidence in their physical stamina; become happier; and started part-time employment
・ begun therapy for depression and insomnia, allowing them to resume employment
・ started visiting Type B Continuous Employment Support Offices
・ begun using daycare and nursing facilities
・ moved back to their disaster-affected home regions and into reconstructed housing, where they are
doing volunteer fieldwork
・ lost their family and moved into a facility
・ started participating in the Danshukai while receiving support for alcohol-related issues andeventually became an officer in their neighborhood council
As you can see, this project has transformed participants’ lives in many different ways.
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Ishinomaki Regional Center Activity Report

From March to December 2018, the project was held twice-monthly—on the second and fourth
Thursday of every month—from 9 AM – 11 AM (breaks included). This year 18 people—8 men and
10 women—participated. Only one of the male participants was new to the program.
Since July 2017, participants have used taxis for transport to and from the event, and due to problems
with capacity, we stipulated that any new participants must be able to arrange their transportation. Thishas caused a gradual decline in the number of participants, over time.
August 2018 was quite hot, which forced us to suspend a few meetings, bringing the total meeting
count to 17. The program had a total of 222 participants, 106 of whom were male and 116 female, withan average of 13 participants per meeting.
The average age of participants in FY 2018 was 70.6; male participants were 74.5 years old on
average and female participants, 67.6. One additional volunteer joined the project this year, making
our regular staff three people strong. Staff attended meetings a total of 59 times.
Both participants and volunteers chose which plants were to be cultivated and how the work would
be done. Twenty-two plant species (potato, daikon, carrots, spinach, garlic chives, cucumber, eggplant,bell pepper, squash, Napa cabbage, kidney beans, jute mallow, bok choy, Santouna (a type of Chinese
cabbage), onion, garlic, chili pepper, green beans, chrysanthemum greens, cabbage, and Japanese ginger) and two flower species (cosmos, chrysanthemum) were cultivated. We continued to donate vegetables grown (Napa cabbage, potatoes, daikon, onions, etc.) to three children’s food halls run by the
Ishinomaki Social Welfare Council and NPOs. This initiative began in 2017 at the suggestion of aparticipant.
Participants told us that they felt that like they had had fun and become active thanks to Koko Farmand that this helped them feel better. We believe it contributed to participants regaining their healthand coming to terms with the disaster.
As part of the program, we hold a “harvest festival” in December every year to cap off the year’swork. Participants looking back on their work that year, shared the following thoughts with us: “Everytime I come to Koko Farm and see everyone’s faces, I feel so relieved,” and “I felt so depressed before
participating in the fieldwork here, but now that I’ve been doing it for a while, I feel so much better.”Participants looked forward to seeing each other at each session, and several became quite close as aresult of their participation.
Six years have passed since Koko Farm’s inception; and even as program participants regain theirhealth, they continue getting older. One of the most pressing issues facing the program today is how it
should end, and how to continue to provide the kind of support to elderly participants that will allow
them to continue to live in their home communities. We must consider how best to provide support toKoko Farm participants in the future.
Table 2: Koko Farm Program Details

Activity period
andlengthMarch-December
Twice/month
9:0011:00

Number ofmeetings

Total numberof users

Total numberof volunteers

31

222

59

Total staff

Total numberofparticipants

71

352

2．Support for supporters(1) Transfer① Ishinomaki Transfer
Ishinomaki transfer employees joined the Ishinomaki Health Promotion Division’s Adult Healthteam and were put in charge of health support projects for disaster survivors. They carried out thefollowing tasks: home visit health surveys of disaster public housing areas; contact coordination withvarious support groups; summarizing work; transferring work to other divisions and organizations after
home visits had been completed. Additionally, they formed survivor support teams with city publichealth nurses and accompanied them on their home visits. As occupational therapists, they provided
support to the Disuse Syndrome Prevention Project (also known as the Yuikko Project), the Association
for Families with Executive Dysfunction, and the early-onset dementia projects.
The following is a report of our activities in Ishinomaki.
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FY 2018 Bulletin, Issue 7

Ishinomaki, which is the Center’s primary main area of activity, is working to carry out an independent home visit health survey of tenants of disaster public housing, etc. This project is a support
measure initiative, drawn up by the city, under the Disaster Victim Independent Living Reconstruction
Program. Its objective is to ascertain the health status of disaster public housing tenants; to understandtheir needs, clarify the health issues they face, and connect individuals in need of follow-up to specifichealth support programs. The results of this survey are also being used to promote the support measuresrequired to maintain and improve the health of individuals living in disaster public housing projects.
This project, which was initiated in 2015, uses the results of a health survey that is administered when
individuals apply for occupancy in disaster public housing, to have specialists visit the homes of allhouseholds moving into disaster public housing between 1 to 2 months after they have moved in andconduct an interview-style health survey. The targets for FY 2018 were individuals who had moved
into disaster public housing between February 2018 and January 2019.
This year, the transfer employees primarily responsible for Support for Supporters duties at the Ishinomaki Department of Health’s Health Promotion Division formed a disaster victim support team withtwo public nurses: one that was appointed by Miyagi Prefecture and one who had been dispatchedunder the Local Autonomy Act and were tasked with compiling the results of a home visit health surveyof Ishinomaki’s disaster public housing tenants; mediating requests; contacting contracting organizations, and carrying out joint home visit surveys with the aforementioned public health nurses.
Much as we did last year, we conducted an interview survey of tenants 40 and older about whether
or not they ① felt they tended to forget things often, and ② felt as if their forgetfulness had increasedin the past year. With consent from the individuals or their families, tenants found to be forgetful or tohave the peripheral symptoms of dementia were put in touch with the “Ishinomaki Early Dementia
Intensive Support Promotion Project,” which is run by the Nursing Insurance Division. Due to theirrecent relocation into disaster public housing and other associated changes, a very large number ofindividuals indicated that they were being forgetful.
To develop problem-solving approaches for dementia patients with multiple lifestyle issues, whileproviding them—and their familial caregivers—the kind of unified, sustained support they needed, we
attended the “Early Dementia Intensive Support Promotion Project Team Member Conference,” which
is organized every month by the Nursing Insurance Division, and exchanged information with them.
Our involvement in this project led to our participation in the planning and management of the “Renju
Meeting,” an event for young dementia patients and their caregivers, in Ishinomaki. Next year, at therequest of familial caregivers, we plan to hold social exchange events on six different occasions
throughout the year. In March 2019, the keys to the final, semi-cooperative, disaster public housing
units were handed over, and next fiscal year the “Ishinomaki Disaster Public Housing Tenant Home
Visit Health Survey” project, begun in 2015, will end. In the future, the indices for disaster victims’
health support needs, specifically their mental health support needs, will be determined by yearly
health surveys of tenants living in disaster public housing, conducted by Miyagi Prefecture and thecity of Ishinomaki.
Following requests from the Ishinomaki Health Promotion Division, the staff of this center oversaw
the home visit surveys of 72 out of 90 households and 119 out of 139 individuals between April 2018
and February 2019 (implementation rate 80.0%). Many of these survey targets were single-personhouseholds (particularly men); unemployed; and had no one to confide in. Twenty of the 36 singleperson households surveyed were male-headed. In the future we will conduct home visit surveys offamilial households at risk of the “80-50 Problem,” a social issue centered on what will happen when
the parents of “shut-ins” or recluses (hikikomori), who are entirely dependent on them, grow too old(aged 80) for them to be providers, leaving their adult children (aged 50) helpless. The results of thehealth survey are as follows. The most common primary reason for an individual to need support－ 57 －

Ishinomaki Regional Center Activity Reportinterventions, by our estimation, was lack of post-disaster mental health care (4 households, 6 people), followed by poor health due to disease or illness (2 households, 4 people), financial issues (3households, 3 people), and support for caregiver insurance procedures (1 household, 1 person). Prolonged residence in temporary housing strains the mind and body, and there are many individuals
currently living in poverty who do not meet the requirements for public assistance and are therefore
forced to tough it out. While they did not require any emergency support as of the time of the survey,
we identified individuals that may need support in the future, such as individuals at risk of poor mental
health; youth at risk of developing intractable diseases; and individuals who may require adjusted
nursing insurance. We shared this list with the Health Promotion Division and the Nursing Insurance
Division.
The FY 2018 Disaster Victims Health Supporter Conference was hosted by the city of Ishinomaki,in three sessions, on three separate days: May 16, 2018; December 3, 2018; and February 20, 2019.
From the second session onwards, it served as a place for affiliated organizations, contract organizations, and individuals in the field, to discuss a range of topics, such as health issues affecting disastervictims; concerns about poverty; suicide countermeasures; and how to deepen the relationship between
stakeholders. The FY 2017 Ishinomaki health survey of disaster public housing tenants, outlined themany issues plaguing disaster survivors. It served as the basis for the Ishinomaki Suicide Countermeasure Promotion Plan (formulated in March 2019) and contributed to the formulation of one of its
priority measures: "countermeasures for disaster survivors”. Health surveys of disaster public housing
tenants and the Disaster Victims Health Supporter Conference were listed as key inspirations. According to demographic statistics, the suicide rate in Ishinomaki has remained higher than both the national
average and the Miyagi Prefecture average, since the Great East Japan Earthquake.
The results of the 2017 health survey revealed how the issues confronting disaster survivors havediversified. While sharing this information with the varied divisions, organizations, and contractors
involved in disaster victim support, we noted that all supporters needed to provide “continuous support
tailored to victims’ lives” as well as “comprehensive support.”② Higashimatsushima Transfer
The employee transferred to Higashimatsushima was assigned to the Mental Health and WelfareGroup in the Higashimatsushima Health and Welfare Department’s Health Promotion Division. They
were responsible for assisting district public health nurses; providing individualized support for psychiatric cases; mediating mental health counseling sessions for children; supporting suicide-bereaved
families; assisting and collaborating with affiliated organizations; assisting in the planning and management of mental health group projects; participating in conferences; supervising supporters; andcompiling a variety of documents. The town of Higashimatsushima rated our help quite highly.
③ Onagawa Transfer
The employee transferred to Onagawa was assigned to the Health and Welfare Division of the Onagawa Health Care Center. We received the following report from them.
In FY 2018, progress in the relocation of disaster survivors to reconstructed housing, and the independent rebuilding of damaged structures, expediting the process of disassembling of temporary housing. In September 2018, the new government office was completed, and the town staff was able to go
about their duties in a new environment.
In response to the same request as last year, the transferred employee was assigned to the Health andWelfare Division’s (also known as the Health Care Center) Health Countermeasure System, primarily
to its Mental Health and Welfare Project, where they supported residents by conducting home visits,－ 58 －

FY 2018 Bulletin, Issue 7

etc. Now that they were permanently stationed in the transfer area, they were able to respond ontime to counseling requests, participate in health classrooms, and make an effort to interact with thetownspeople daily. They assisted with health surveys of reconstructed housing tenants and conducted
home visits. Progress in tenant relocation, forging of new communities, and the freedom to meet andmingle with townspeople notwithstanding, some survivors struggle to acclimate to their new environs.
As a result, they become isolated and fall into poor physical health. Such individuals require customized support.
As part of the Mental Health and Welfare Project, we conducted “Mental Health Care Lectures” inassembly halls in each district throughout the town in FY 2018. The transferred employee arranged
for the dispatch of lecturers and assisted in planning and management. Since nearly all townspeople
were expected to complete their relocation into reconstructed housing in FY 2018, this project aimed
to foster support between townspeople and endeavor to help them lift each other’s moods; overcome
stress; and promote health. The part-time psychiatrist at this center has provided mental health support
to Onagawa since 2012; served as a lecturer; and delivered a lecture on depression, dementia, andother mental health issues. These lectures were organized in collaboration with the Onagawa Listening
Volunteers—a group that has been active since immediately after the disaster—as we endeavored tocreate a space where people could talk casually amongst themselves. In FY 2018, we held events in 5
districts. In one of these districts, we received a request for a lecture on listening activities in the area,
for the women’s department; an Ishinomaki Regional Center staff member responded to this request.
We also conducted a seminar on dementia for the Onagawa Listening Volunteers, led by our part-time
psychiatrist. Part-time psychiatrists and public health nurses also responded to counseling requests byresidents as needed.
The transferred employee’s duties continued to revolve around supporting Onagawa town staff andtheir mental health projects. One such project involved sending employees Haato Tsuushin (translation: “Heart Correspondence”) twice a month, as a mental health awareness-raising effort using theoffice network. We also handed out stress check sheets to staff members along with their medical
questionnaire forms, when they attended medical checkups, and we used the results to set up individual
counseling sessions with industry physicians if necessary. The transferred employee totaled the stresscheck figures, mediated and assisted with industry doctors during the checkups, and followed up withthe recipients. Although we assisted with these endeavors in the past, initiatives focusing on staff mental health were given more importance in the aftermath of the disaster. Now that eight years havepassed since the earthquake, and reconstruction is well underway, the staff is slowly regaining theirmental composure. That is why we discussed whether it was necessary to return to the customaryindustry doctor checkup system, and decided to end the practice of requiring our transferred employees
to assist industry doctors with checkups by the end of FY 2018.
The center supports supporters by, for example, accompanying municipal public health nurses onhome visits, participating in case conferences and area meetings, and supporting infant health examinations. Our stance is to “respond to municipality requests as much as we can.”(2) Attendance at case conferences and area meetings
Following requests from the city of Ishinomaki, the Ishinomaki Social Welfare Council, the Miyagi
Prefecture Nursing Association, the Intra-Ishinomaki Regional Comprehensive Support Center, and several other medical institutions, we attended case conferences on alcohol-related health issues and mental
illness. With these different support organizations, we went over relevant cases, confirming the approach
our support initiatives should take and what the division of labor among individuals with different organizational roles would be. We also attended an Hebita area support meeting along with representativesof the Ishinomaki Social Welfare Council, the Hebita Regional Comprehensive Support Center, the Nursing Association, and other professional organizations. We exchanged information with each－ 59 －

Ishinomaki Regional Center Activity Reportother, and reviewed the cases files of several temporary and post-disaster public housing tenants. Rather than dealing exclusively with issues facing temporary housing tenants, and given the progress being
made in relocating survivors into post-disaster public housing, we have also begun sharing information
about post-disaster public housing tenants. However, we ran into some problems with tenants’ personal
information, and there were some issues with the way these meetings were conducted that must be addressed in the future.
(3) Support for infant health examinations
In response to requests, we dispatched a public health nurse for mother-child counseling to the 4month-old, 18-month-old, 2-year-old, and 3-year-old infant checkups administered by the city of Ishinomaki. Juggling these requests and our center duties, we nevertheless managed to provide support fromfive to seven times a month. In addition to offering advice on mental health care to mothers and children
at post-checkup conferences, we oversee the provision of continued individualized support to individuals
who require it.
3．Raising public awareness● Hosting a Danshukai meeting in front of Ishinomaki Station
The “Danshukai meeting experience: the stories of people who have stopped drinking,” an eventthat we have organized at the Ishinomaki Kahoku General Branch office since June 2015, was shifted
in April 2017 to the Ishinomaki Health Center, which is close to Ishinomaki Station. The “Danshukai
meeting experience” events have been held there ever since. In FY 2018, we continued to be the primary hosts of this event, with the city of Ishinomaki providing backing and the Miyagi Prefecture
Danshukai assisting. Participant details, from FY 2015 onwards, are listed in Table 3.
Table 3. Danshukai Meeting Experience Participant Details

FY 2015
FY 2016
FY 2017
FY 2018

No. of meetings
13
13
12
12

Targets
33
17
35
53

Family61364Danshukai
60
48
35
34

Supporters
230
104
41
20

Total
329
182
117
111

* Initially, the event was primarily for supporter education, but at present, it focuses on target needs.
* Some members participate in every single meeting, and two have begun to attend the prefectural Danshukai.
* Supporters are temporary support staff and other SWC members, Tohokukai Hospital staff, administration officials, and employees from our center.

In FY 2018, two members, one of whom had been participating in this event since it was held at the
Kahoku General Branch office, joined the prefectural Danshukai. Other participants that originallyattended along with a supporter began to attend regularly by themselves, and we soon developed asteady group of attendees. Family members too participated for the first time this year. Procedurally,
we may have been the hosts of this event with the prefectural Danshukai serving as the assisting organization; in reality, they ran these meetings from start to finish.
Previously, regular meetings used to be held every Saturday at 7 PM in Ishinomaki city. These same
meetings were soon being held where the Danshukai-run “Regular Meeting of the East Branch Ishinomaki
City Association” was taking place. As of September 2018, the event was being held twice monthly, on
the first and third Saturdays of the month, at 7 PM. However, because they start at 7 PM, which is ratherlate, individuals admitted to psychiatric hospitals, for example, find it difficult to participate.
At present, attendees have expressed high hopes for the future of these meetings. We plan to workwith the Miyagi Prefecture Danshukai; psychiatric hospitals; psychiatric clinics; the Ishinomaki
Health Promotion Division; and the Eastern Health and Welfare Office, among others, to determine
the future of these meetings.
In FY 2019, we plan to change the name of these gatherings to “Danshukai meetings,” and havethe Miyagi Prefecture Danshukai serve as the primary host, with our center in a supporting role. We
intend to provide support so that the Miyagi Prefecture Danshukai can begin holding their meetings,
independently of us, in Ishinomaki.

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4．Human resource development and training(1) Training workshops that address alcohol-related issues
Ever since the disaster, and with every passing year, alcohol-related problems have been surfacing
throughout the prefecture. In collaboration with administrative agencies and support organizations, wehave held training workshops that address alcohol-related issues.
① Ishinomaki Health Care Center
Our center served as co-sponsor of a workshop that was conducted for Ishinomaki-area medical institutions and their staff members; the police department; firefighting headquarters; the regional comprehensive support center; the caregiving support office; and various administrative agencies.
In FY 2018 we co-sponsored a training workshop that was conducted by clinical psychologists fromthe National Hospital Organization’s Kurihama Medical Center, titled, “Things You’d Want to Know
About Alcoholism, How to Support Those Who Have Been Affected and Their Family Members.” Thesession was held twice a day, once in the morning, and once in the evening; 54 individuals participated.
We have been holding a training workshop in Onagawa for the past three years; this year, we held itin the new Joint Government Building, on the topic of collaborations between internal medicine specialists and psychiatrists. Our training workshops in Onagawa have featured lectures by Tohokukai
Hospital’s physicians and nurses; first-person stories told by those who have been affected; and casestudy meetings. we aim to educate individuals about alcohol addiction and encourage collaboration
between internal medicine specialists, administrative officials, and special hospitals.
Some individuals are directly linked to Tohokukai Hospital as well. Several individuals from Onagawa have participated in the Hands-On Training in the Treatment of Alcohol Addiction workshop heldby the Stem Center at Tohokukai Hospital. However, we feel that there are a lot of people in the Ishinomaki area that were discharged from the Tohokukai Hospital and were supposed to visit regularly but
do not, either due to problems of distance or cost. For this reason, we have requested a psychiatrist andan internist from the area to deliver a lecture on the treatment of alcohol addiction in the Ishinomaki
area, to foster the growth of initiatives rooted in the area and to encourage collaboration.
Date: November 29, 2018
Time: 7 PM
Target participants: medical professionals, businesspeople from the regional comprehensive anddisabled person support centers, and administrative officials from the area
Topics• Alcohol addiction
Lecturer: Dr. Naonori Makino, Kodama Hospital• Alcohol-related issues at the Onagawa Medical Center: From the perspective of internists andmanaging physicians• Lecturer: Dr. Atsushi Saito, President, Onagawa Medical Center•
Participants: 77 (may have been easier for people to participate because of the late start time)
For FY 2019, we plan to continue to implement training workshops that focus on regional activities.
•••② Training workshops in Ishnomaki
With the cooperation of the Tohokukai Hospital Regional Support Division and the Stem Center,
Community Support Division, we held two training workshops in Ishinomaki with lectures on 1) understanding what it means to abstain from alcohol, and 2) understanding temperance.
Public awareness activities, including training workshops and resident home visits, in Higashimatsushima
In Higashimatsushima, we held health counseling meetings and training workshops aimed at city
public health nurses and nutritionists, to promote health and healthy living among residents.

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Since 2016, Higashimatsushima Municipal public health care nurses, psychiatric social workers, andthe Center’s public health care nurses have paired up and visited the homes of those aged under 65 whose
γ-GPT was 100 or over (40 cases) at the time of the medical examination. In FY 2017, of the 39 individuals surveyed, we found many with high BMI, high neutral fat, or high cholesterol levels, and we realizedthat food habit improvements were also necessary. Thus, nutritionists began to participate in our home
visits as well, and we aimed to promote healthier living overall. Most of our targets were affected bysome sort of illness; the presence of a nutritionist meant that both the affected persons and their families
were able to learn about their food habits, as well as their alcohol consumption habits. Some shared thefollowing opinions: “I found the information very useful, I’ve been eating only oily foods because thatis what I like, but I will be more careful about the food I eat and how much I drink, and I will take bettercare of myself.” Many individuals listened quite intently to what we had to say, and the intervention wasreceived quite well overall.
Based on the results of specific medical examinations carried out in FY 2018, we conducted home
visits for individuals aged 40–65 years, with γ-GTP of 100 or greater (34 individuals). Just as in 2017,
city public health nurses, nutritionists, psychiatric social workers, and the Center’s employees all participated, and individuals who were paid visits said that our information on alcohol and food choices wasquite useful. Visit recipients and their families noted that they “were probably chosen because of theirtest results,” and welcomed their visitors quite amicably. Those with high BMIs and neutral fat levels
asked questions about safe drinking and food habits, indicating a high level of interest in their health.
Several support targets were already receiving frequent medical checkups, and these visits were anotherchance for them to be reminded of the importance of a healthy lifestyle.
This is the third year that we have carried out follow-up visits after conducting a preliminary medical
examination. Most targets have an internal illness of some kind, and either they or their families haveexpressed an optimistic desire to “live a healthy life.” These visits play an important role in protecting
the health of community residents.
In the future, one issue we must tackle—with the assistance of our regional affiliates—is how to expand our initiatives to protect the health of elderly individuals, people with alcohol-related problems,and disabled people during our health promotion activities. The Center has learned a great deal by assisting in initiatives that actively promote healthy living among community residents. We hope to continue to participate in activities that seek to protect the health of community residents.
③

Training workshops in Onagawa
For the past three years, we have held a training workshop in Onagawa. This year, we held it in the
new Joint Government Building; the topic was the collaboration between internists and psychiatrists.

(2) Various workshops
Child Mental Health Care Community Center Project
Previously, we held a “mental health care training workshop” for education officials from prefecturalmunicipalities involved in supporting children, such as public health nurses and nursery teachers, teachers,
and nursing teachers, clinical psychologists, and regular community residents. In FY 2018, we held thefollowing training workshops.
① “Future Child Mental Health Support Activities in disaster-affected Regions” training workshop
・ Objective: To provide an opportunity for us to think about “mental changes into the future forchildren,” “problems that can affect children,” “other preventative measures,” and “the nature of
support” through the lens of mental health support initiatives that Kohnodai hospital has participated in, in Ishinomaki, since immediately after the disaster.

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・Sponsors: Miyagi Prefecture Mental Health and Welfare Association, Miyagi Disaster Mental
Health Care Center, Ishinomaki Regional Center・

Co-sponsors: Ishinomaki City, Ishinomaki Board of Education, Higashimatsushima Town, Higashimatsushima Board of Education, Onagawa Town, Onagawa Board of Education

・

Lecture: Child Mental Health after the Great East Japan Earthquake: What We Have Learned from
Our Activities Thus Far

・

Lecturers: Masahide Usami (Director, Department of Child Psychiatry, Kohnodai Hospital, National Center for Global Health and Medicine)・Date and time: Thursday, August 9, 2018, 1:30 PM to 4 PM・Venue: Social Hall, Ishinomaki Kahoku General Branch Office Big Bang・

Targets: Professionals involved in public health, childcare, and education in the Ishinomaki City
area, including public health nurses and school teachers (nursery school, kindergarten, elementary
school, middle school, high school, and support schools)

・Participants: 111

On the day that Typhoon #13 affected public transportation, we received many calls asking if the
training session would be rescheduled to the following morning or if it would be canceled. Due to theweather, many individuals had to cancel. Dr. Usami had been in Ishinomaki since the previous day,and we were able to complete the event without any untoward incident.
② Mental health care workshop
・ Objective: To provide an opportunity for specialists involved in nursery schooling and child education in areas affected by the Great East Japan Earthquake to listen to a lecture on topics such as
the characteristics of child development; contemporary issues facing children, and appropriate
supporter responses; taking a close look at child mental health and thinking about how to encourage children to manifest their strength.
・Sponsors: Miyagi Prefecture Mental Health and Welfare Association, Miyagi Disaster Mental
Health Care Center・

Co-sponsor: Miyagi Prefecture Board of Education

・

Lecture: “Mental Health Recovery in Children: Child Support Activities that Foster Self-Affirmation”

・Lecturer: Dr. Daiji Akehashi (Director, Department of Psychosomatic Medicine, Shinseikai Toyama Hospital)・

Date and time: Friday, October 5, 2 to 4 PM・Venue: Aeon Cinema Ishinomaki, Theater 7

・Targets: approximately 200 individuals involved in public health, education, and child care (publichealth nurses, nursery school teachers, kindergarten teachers, elementary school teachers, district
child welfare officers, and foster parents)

・Participants③ Specialist staff dispatch
Requests from the Mother-Child Section of the Ishinomaki Health Promotion Division to dispatch
specialist staff to nursery schools and kindergartens were handled by Center employees and our clinicalpsychologist. In FY 2018, the following requests were received: three requests to visit nursery schools
to help parents better understand their child’s attributes and how to work with them; one request to help
coordinate between professionals involved in cases concerning families with difficult backgrounds; and－ 63 －

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one consultation request for three cases regarding child development, the environment, and interactions with their parents.
④ NPO Baby Smile (Ishinomaki City Child Care Generation Comprehensive Support Center)
NPO Baby Smile supports programs for pregnant mothers of preschool children and was established to contribute to parent-child mental and physical health and the reconstruction of child-rearing
environments in the aftermath of the disaster. They work to create childcare networks; provide pre andpostnatal support; create childcare-friendly communities, and collaborate with regional organizations.
Some of the work they have done involves fielding childcare questions from mothers regarding
baby food; development; growth; play; communication; anger; discipline, etc. It also entails addressing
issues that the mother herself has, such as anxiety; difficulty providing childcare; domestic issues suchas marriage trouble, and her relationship with her husband and her mother-in-law; and domestic violence.
They also deal with children’s problems, including specific responses to developmental disorders. In FY
2018, we were consulted 11 times, responded to counseling for 22 cases, and counseling requests fromsupporters.
Finally, we provided support around five to seven times a month for the 4-month-old, 18-monthold, 2-year-old, and 3-year-old infant checkups administered by the city of Ishinomaki on top of mediating between it and our center duties. We also offered advice on mental health care to mothers andchildren at post-checkup visits, and we oversee continued individualized support for those individuals
that require it. During the checkup, we listened to mothers’ childcare troubles, and we often congratulated them on their hard work. With regards to childcare anxiety caused by poor health or maternal issues,
we followed up with mothers and their children throughout their child’s development and consideredhome support methods via conference. Finally, we provided continuous support for those individuals
needing mother-child mental health care.
Summary
Eight years have passed since the Great East Japan Earthquake, and as disaster public housing, etc., is completed,
the tangible results of disaster reconstruction have started to become more apparent. While some disaster survivors
have reconstructed their own homes or moved into disaster public housing, there are still some whose relocationout of container-type temporary housing remains uncertain. The gaps in the reach of reconstruction efforts havecome into view. Rents have also risen during these eight years, and some people have been forced to relocate ordefault on their rent payments.
Further, reconstruction support organizations have begun to slowly retreat from the Ishinomaki area. The Nursing Association, which conducted disaster public housing health surveys, home visits, and health counselingmeetings will wrap up these initiatives by the end of March 2018. The fact that an organization—that we worked
so closely with when conducting our home visits—is closing its doors, is quite sad.
In terms of our collaborations with other organizations, we held regular information exchange meetings once
every two months in Ishinomaki and once every month in Higashimatsushima and Onagawa. We met with the
Health Care Center once in FY 2018.
The FY 2018 disaster public housing health survey revealed different kinds of cases and people who required
support; by liaising with other organizations, we were able to connect these people to the support they needed. As
a result of this experience, we have decided that we would like to continue being involved in the “Ishinomaki City
Home Visit Health Survey of Disaster Public Housing Tenants” in FY 2019 as well.
Our collaboration with three different municipalities in the Ishinomaki area has also grown much smoother.
This is a direct result of the daily work of our transferred employees, and one of the biggest issues in determining
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agencies’ organizational structure and support systems are also changing.
We have decided that the Center will continue to function beyond April 2021. However, we are still an organization whose doors will one day close. All that has happened is that the deadline to answer questions about what
our activities will do for this region, and what they have done thus far, has been extended. Organizations in thisarea, such as the Ishinomaki Health Care Center and officials at each of the three municipalities, all started theirwork well before the Center did and will continue this work after we are gone. We believe that FY 2019 will be ayear of exploring new ways to deepen our relationships with the Disaster Mental Health Care Network Foundationand the Miyagi Karakoro Station, while simultaneously advancing our projects.
The employees of this center feel for those affected by the disaster; as such, we hope to use our abilities tosupport, encourage, and facilitate survivor independence. We intend to provide disaster-affected residents with thetools they need to avoid isolating themselves and to help disaster-affected people live more fulfilling lives.
Furthermore, there were some projects (e.g., Disaster Mental Health Exchange in Ishinomaki; Suicide Countermeasure Training) in FY 2018 that we intended, but were unable, to implement. In FY 2019, we would like toimplement these initiatives.
By organizing the “Disaster Mental Health Exchange in Ishinomaki” event with the help of an executive committee, we felt like we were able to engage in deep, meaningful conversations with our affiliates and to request
support from them in their areas of specialty, even for routine activities. By doing so, we believe that our capacity
to understand one another has grown.
Finally, we would like to thank everyone that was involved in the creation of this manuscript.

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