Stem Center – Community Support Division Activity Report

Stem Center – Community Support Division
Activity Report
Miyagi Disaster Mental Health Care Center
Stem Center Community Support Division
Chief, Public Health Nurse Yukie Oba
Assistant Chief, Nurse Ikuko Moriya

Introduction
The reconstruction plan for Miyagi Prefecture stipulates that the reconstruction period is the ten years
after the earthquake, and FY2019 is the second year of the development period of the plan.
In FY2019, the Miyagi Disaster Mental Health Care Center Stem Center Community Support Division has been conscious of the end of the ten-year period and has been developing activities with an eye
to the situation after the conclusion of this ten-year reconstruction period.
In this manuscript, we report on the main efforts of our Division in FY2019 along with a discussion.
1. Activities
The area that our division oversees includes the four cities of Shiogama, Tagajo, Natori, and Iwanuma
and the four towns of Matsushima, Shichigahama, Watari, and Yamamoto in the coastal area of Miyagi
Prefecture (excluding the Kesennuma and Ishinomaki areas). The damage and reconstruction conditions
significantly vary within this region. Secondments and dispatch teams were used to provide support
according to the municipalities’ needs. There were eight and seven staff members in our division in thefirst and second halves of FY2019, respectively, with one individual each dispatched to Natori and Shiogama.
Table 1 shows the composition of the support team and the primary support content.
Table 1. Support team composition and support content by municipality
Municipality name
Matsushima

Support team composition
Two dispatches for 1–3 days per month

Shiogama

One weekly dispatch
One secondment

Shichigahama

February–MarchTwo dispatches at any time

TagajoDispatch at any time

NatoriOne weekly dispatch
One secondment
Two individuals at health salon/once
every two months

Iwanuma

Dispatch at any time

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Primary support content* Case support* Cooperation with workshops* Participation in case study meetings* Raising public awareness of “moderate alcohol consumption” at health festival venues* Case support* Home visits for high-risk individuals in the context ofhealth surveys* Cooperation with workshops* Participation in case study meetings* Supervision of mental supporter training course(secondment)* Home visits for high-risk individuals in the context ofhealth surveys* Provision of alcohol-related communications* Suicide countermeasures network meeting member* Case support (accompanying visits concluded inAugust)* Participation in case study meetings* Case support*Home visits for high-risk individuals in the context ofhealth surveys* Involvement in facilitating case study meetings* Involvement in public awareness projects targeting
residents* Attendance at mother and child support meetings* Hosting of health salons*Home visits for high-risk individuals in the context ofhealth surveys

FY2019 Bulletin Vol. 8
WatariTwo dispatches, 1–2 days per week

Yamamoto

Two dispatches, 1–2 days per week

* Case support* Cooperation with workshops* Involvement in facilitating case study meetings* Participation in regular general conferences(from mothers and children to elderly people)* Attendance at mother and child support meetings* Attendance of and support for liaison meetings* Management of and cooperation with family associations for mental illness and the independence support
council* Case support*Home visits for high-risk individuals in the context ofhealth surveys* Cooperation with case study meetings* Support through community patrol health lectures* Raising public awareness of “moderate alcohol consumption” at health festival venues* Participation in regular general conferences* Attendance at mother and child support meetings

Figs. 1 and 2 show the changes in the division’s hours of activity over the three-year period from FY2017
to FY2019 and the time (in percentages) allotted to each project relative to the total active hours.
The total active hours have tended to decrease since FY2015 (five years after the earthquake disaster),and the hours in FY2019 were about half those of FY2018. When comparing activity hours, the decrease
in resident support has been relatively large compared to other activities.
For the activity hours per project relative to the total number of hours, resident support was the highest
in FY2018, but supporter support was the highest in FY2019, followed by resident support and meeting
liaisons.
０

500

1000

1500

2000

2500

FY2017

Meeting liaisons, etc.
Support for various activities
Supporter support

FY2018Human resource development and training
Resident support
Spreading public awareness

FY2019Fig. 1 Changes in activity hours at the Community Support Division％

Meeting liaisons, etc.

FY2017

Support for various activities
Supporter support

FY2018Human resource development and training
Resident support
Spreading public awareness

FY2019Fig. 2 Percentages for each project’s activity hours relative to the total number of hours- 73 -Stem Center – Community Support Division Activity Report<Discussion>
The overall decrease in activity hours is due to the decrease in the number of divisional staff, but thisis also the time when most of the overseeing municipalities are shifting back to normal work, and it isthought that our division’s policy is a background factor, given the review of support with an eye on
FY2020 and the fact that cases have been taken over by other institutions.
With regard to the percentage of activity hours, the percentages for supporter support, meeting liaisons,and raising public awareness have increased. The increase in meeting liaisons reflects the fact that theextension of the Miyagi Disaster Mental Health Care Center (henceforth, the “Center”) has been confirmed and that there have been many discussions about the future. Regarding supporter support, theincrease is thought to be the result of the special efforts our division made during FY2019.
Below is a summary of the FY2019 activities by project.
(1) Resident support
Most of the resident support consisted of home visits for high-risk individuals in the context ofvictim health surveys and home visits/interviews requested by local governments. Regarding the disaster victim health surveys, there were decreases in the number of surveyed people, and home visit
requests from high-risk individuals also decreased. Cases requested by local governments were often
those with multiple problems, such as alcohol-related problems, mothers who have problems withchild-rearing, elderly people experiencing delusions, and social withdrawal.
Continuous support for high-risk individuals in the context of health surveys was often provided
solely by the our division’s staff, but we began to conduct accompanying visits with municipal staff
in FY2019 in the interest of facilitating a smooth transfer of duties in the future. Furthermore, as a
general rule, we provided support through joint work, such as accompanying visits for new municipality-requested cases other than health surveys.
<Discussion>
Some of the people who needed continuous support from the disaster victim health survey saw improvements in their status and concluded their support. There were also times when we discovered complicated situations in which the health survey acted as a trigger for the manifestation of problems that had
been simmering since before the earthquake disaster, as well as families with other problems; some individuals and families required long-term support. Reconstruction is advancing, and victim support is developing as a regular form of support, but we would like to hand over cases that require long-term continuous support to municipalities and related institutions so that smooth support can be continued, evenafter the shift to normal support.
(2) Supporter support
With regard to supporter support, we tried to share the situation and needs with municipalities andwork together, while looking ahead to community mental health and welfare activities after the conclusion of the Center’s operation. Specific content is as follows.
. Accompanying visits
We accompanied overseeing staff members and jointly conducted home visitations. We
have tried to reserve as much time as possible before and after the home visits to share
information and offer direction.
. Case reviews and case study meetings
Although the number and form vary, case reviews and case study meetings are now held
in most municipalities. Thanks to the public health center participation, the reviews andmeetings were held regularly. The Center’s doctor and clinical psychologist participated in
the case study meetings, and this served as an opportunity to give advice and deliver lectures.
. Training for supporters
Table 2 describes the training for supporters.

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FY2019 Bulletin Vol. 8
Table 2. Workshops for supporters
Municipality

Shiogama

TagajoNatori

Watari

MisatoRifu

Training content and theme
Mental health beginner training
Preparations when engaging in mental healthOn-site mental health lecture
Workshop for raising public awareness of themental health of victims
Practicing Finnish “neuvola” and its connections with support”
Natori gatekeeper training course

Gatekeeper workshop
Living support — Recognizing, leaning oneach other, supporting each other, and connecting
Joint workshop from the Comprehensive
Community Support Center and the Consultation Support OfficeStrengthening cooperation between supporters — Creating a better support system for
multi-problem households
Workshop for at-home care support company
liaison meetings
Alcohol dependence — How to support individuals with alcohol problems
Gatekeeper training course (two sessions)

Multidisciplinary workshop
What is mental illness — Support for thosewith persecution complexes
Attentive listening volunteer Usagi no Kai
member training
Mental care for attentive listening volunteers
Health cooperator workshop
Mental health supporter training course

SupportmethodLecturer dispatch
Lecturer
Lecturer dispatch

Subjects
Administrative officials
Disability support
facility staff
Administrative officials

Number ofparticipants
9
26
24

Management
and cooperation
Lecturer dispatch

Civil welfare officers

70

Administrative officials

54

Lecturer dispatch

Comprehensive
Community Support Center staff

33

Lecturer dispatch

At-home care support staff

39

Management
and cooperation
Lecturer dispatch

Administrative officials

35

Social council staff

140

Lecturer

Attentive listening
volunteers

19

Lecturer

Public health cooperators

29*Lecturer: Community Support Division staff*Lecturer dispatch: Miyagi Disaster Mental Health Care Center staff other than from the Community Support Division

The workshops were held by the municipalities, but there were also consultations about lecturers andtheme selection. For content that was difficult to handle within our division, we enlisted the cooperation of
the Center’s doctor and clinical psychologist as lecturers.
<Discussion>
With an ongoing awareness that the Center is an impermanent institution, we have conducted activities
jointly with municipalities (e.g., accompanying visits) in FY2019 with the objective helping them gain anunderstanding of those activities. There have been comments that the accompanying visits improved supervisory public health nurses’ skills, and we feel that this not only strengthens the ability to provide support
in the area but also improves the skills of the staff in the municipalities and our division.
Our Center’s doctors and clinical psychologists participated in the case study meetings, and they sometimes gave lectures on how to recognize and interact with illnesses and conditions. We believe that this not
only deepened the understanding of the cases but also served as a good opportunity for obtaining clues
about how to behave in other situations.

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The cases discussed at the case study meetings were wide-ranging, with topics such as the elderly andmaternal/child health, in addition to victims’ mental health. There were also many kinds of participants,
including public health nurses, psychiatric social workers, midwives, nurses, registered dietitians, childcare workers, occupational therapists, care managers, Comprehensive Community Support Center staff,
Comprehensive Community Child-Rearing Support Center staff, and independent support office staff.
The occupations involved expanded, and we feel that we were able to recognize the benefits and importance of multidisciplinary collaboration.
(3) Raising public awareness
Tables 3 and 4 summarize the local resident exchange projects (salons) within the division’s publicawareness project, as well as public awareness training for residents.
Table 3. Local resident exchange projects (salons)
Venue

Iwanuma

Activity

Utsukush
ima salon

Hosting role

Subjects

Content

Frequency

SponsorIndividuals who
movedfrom Fukushima
Prefecture
to theIwanumavicinity

The content of the salon isdecided according to theparticipants’ wishes. The salon serves as a place for interpersonal and informationexchange, such as during
cherry-blossom
viewing,dinner parties, and mini lectures. In the latter half of the
fiscal year, we set up forums
for discussion on salon management and conducted thiswhile thinking about what
can be done in collaboration
with members. 19 registrants. 12–16 participants.
Suspended in March.
The salon was held in themorning every month forfive years, while the afternoons were for sobriety
study and individual consultations regarding alcohol
consumption diaries. The
study sessions were concluded in FY2018, and alcohol consumption diary entries were also habited.
Hosted once every twomonths in FY2019. Attempted to have voluntary
meetings with the main
members, but this did notmaterialize. Many members
have improved and now
consume alcohol appropriately, so the hosting plan for
FY2020 is as an alumni association. 13 registrants. 8–
12 participants. Suspended
in March.

Men seeking to abstain fromalcohol

NatoriNatorihealthsalon

Co-sponsor
with the city

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Total number of participants

Monthly

Number ofactivities incurrent fiscal year
10

Bimonthly

5

51

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Residents

Town infirmary

Cooperation
with citysponsorMen under
70 years
who livealone

Watari

Watarimen’s
club
alumniassociation

Implemented
in cooperation with thetown

The implementing body is
the Natori Health Center.
Conducted at three locationsin the affected areas. Content includes health consultation and body composition
measurements. The Centerhas overseen mental consultations. Supporters werewide-ranging and included
care managers, Comprehensive Community Support
Center staff, Comprehensive Community ChildRearing Support Center
staff, and independent support office staff.
Hosted until FY2017, sponsored by our division. Subsequently continued as analumni association withlunch meetings that also
served as a place for reporting recent updates. 3 registrants. Participating members have all been able tolive independent lives, andrelationships with the town
and social resources havebeen built, so meeting as analumni association was concluded in FY2019. The final
meeting involved a large
lunchtime gathering of related parties, where people
reflected on past activities.

Monthly

31

272

Once
every 3-4
months3

9

Table 4. Public awareness training for residents
Municipality
Matsushima
Shiogama

NatoriTraining content and theme

Support method

Number of participants

Raising public awareness of “appropriate alcohol consumption” at the health festival
Mental health supporter course — Protecting
an important life (1)“Mental health and suicide prevention”
Mental health supporter course — Protecting
an important life (2)“Listening to your heart and speaking well —How to communicate effectively”
Mental health lecture“How to cope with stress — Important aspects
for maintaining mental health”
Health education “Health picture-story show
— How the monkey, the pheasant, and the dog
adopt a positive outlook on life”
Health lectures at family gatherings with people with dementia“Know and protect your mental health!”
Health education at the community women’sgroup liaison council“Mental health promotion”

Public awareness through alcohol patch tests
Lecturer dispatch120

In charge of lecture

25

Lecturer dispatch

100

In charge of lecture

24Management and cooperation

17

Lecturer125- 77 -

37

Stem Center – Community Support Division Activity Report
Watari

Yamamoto

Dementia supporter leader course “About dementia/depression”
Dementia supporter leader course “Attentive
listening”
Mental health promotion class about stress,
held in three districts
Raising public awareness of “appropriate alcohol consumption” at the health festival

Lecturer

27

Lecturer dispatch

20

In charge of lecture46

Public awareness through alcohol patch tests

104*Lecturer: Community Support Division staff*Lecturer dispatch: Miyagi Disaster Mental Health Care Center staff other than those in Community Support Division<Discussion>
There are various community resident exchange projects (salons) of different types targeting different
individuals. These projects foster social interaction to prevent loneliness and provide education on healthissues. Many individuals rely on these projects in their daily lives. The projects are however temporary andwe have been exploring whether or not the “Utsukushima Salon” and “Health Salon” projects should becontinued and how they should be managed if they do continue. The “Utsukushima Salon” members haveexpressed their desire for the project to continue, saying that they “do not have any other places to interact.”
We plan to continue the project in FY 2020 and will discuss future directions with members. In terms of
the “Health Salon,” because the idea of temperance and moderation in alcohol has been successfully disseminated among all members, the objective of temperance itself has practically been achieved. Further,members have found places of belonging in their communities and the project was therefore concluded in
FY 2019. In FY 2020, we plan to hold a reduced number of alumni meetings. The “Men's Club Alumni
Association” ended in FY 2019, and members will be entrusted to their towns. Since the salon was usefulfor making friends and preventing isolation, we hope that these individuals will be referred and placed inlocal community salon projects even after this particular one has ended.
We have dispatched instructors and cooperated in the operation of public awareness projects for residents, keeping in mind that these will be handed over to municipal officials shortly. The responsibilities of
appointing training instructors are also being shared between this division and the municipalities. In FY
2020, we hope to take a step back so that municipalities can take the initiative for training.
(4) Human Resource Development
Since FY 2017, this section has been focusing on disseminating knowledge about alcohol avoidance.
In FY 2018, we co-sponsored a workshop for supporters with the Miyagi Mental Health and Welfare
Center (Seiho Center), and when required, went to the municipalities to present lectures. After that, theidea of “alcohol avoidance” was incorporated in the “Miyagi Prefecture Alcohol Health Disorders Promotion Plan,” ensuring that the entire prefecture would be covered.
Thus, from FY 2019 onwards, the Seiho Center and the Planning and Research Division were placedin charge of training workshops. In 2019, this section cooperated with the “Temperance Support andFollow-up Workshop” sponsored by the Shiogama Health Center. At this workshop, public health nurses,
dietitians, and people in charge of companies' health counseling offices reported their efforts to support
temperance. Further, it was felt that the concept of temperance was gradually gaining acceptance.
We believe that this division's role in the future will be to carry out awareness-raising activities toavoid alcohol and provide support if required.

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FY2019 Bulletin Vol. 8
Conclusion
This division set the following as our activity goal for FY 2019: “In light of the end of the recovery/reconstruction period (FY 2020 and beyond), we will work to understand the actual situation in municipalities
and support municipal support staff in their efforts to carry out community mental health and welfare activities smoothly.” We have provided support this year while cognizant of our goal of handing over responsibilities to municipal officials.
Support for residents is based on joint visits, and the case study group has endeavored to expand thescope of gatherings and provide places for collaboration and learning. We have also taken part in workshops
intending to hand them over to the municipalities. It can be said that while a variety of approaches andcontent were implemented, most of our activities in 2019 involved support for the supporters.
In the middle of FY 2019, it was decided that the Center's active period would be extended by five
years. With this extension, the municipalities, the Seiho Center, and the Miyagi Disaster Mental HealthCare Center (MDMHCC) are cooperating to discuss future community mental health activities centered on
public health centers, to resolve issues related to the communities. We addressed this goal at the “Mental
Health Care Implementation Meetings.” Into FY 2021 and beyond, we aim to “maintain mental health for
all, from children to the elderly.” For this purpose, we have decided to focus on implementing “continuous
public health activities” and on “raising the level of community mental health and welfare activities (humanresources development that can be done on-site).” “Continuous health activities” include primary prevention (health education/dissemination and enlightenment, the establishment of a consultation system, andmulti-generational exchange and community development), secondary prevention (health examination andscreening, connection to appropriate medical care/services, and early-stage intervention), tertiary prevention (prevention of progression/complications, rehabilitation, and promotion of social reintegration), andcollaboration/networking with other organizations. “Raising the level of community mental health and welfare activities (human resources development that can be done on-site)” includes joint visits (assessment
and relationship building), case studies (securing a place for learning), and outreach. This division will
carry out visitations in cooperation with municipalities, public health centers, and the Seiho Center andparticipate in case study meetings. The specific content of these initiatives is scheduled to be examined in
FY 2020.
In FY 2020, we would like to work more closely with municipalities, health centers, and the Seiho
Center and consider specific details of our work from 2021 onwards. We would also like to review andsummarize this section's work over the past 10 years and move forward with activities to “maintain themental health of all, from children to the elderly.”- 79 -