2017 Programming Review

2017 Activity Review
Naru Fukuchi – Director, Doctor
Tetsuro Higuchi – Manager, Psychiatric Social Worker
Research and Planning Division, Stem Center, MDMHCC

Introduction
For seven years now, the Miyagi Disaster Mental Health Care Center (MDMHCC) has been
providing mental health care services in six focus areas in local areas affected by the earthquake,with the Stem Center, which opened first in December 2011, and the Kesennuma and Ishinomaki
Region Centers in April 2012. Since 2017, we have also taken charge of community initiatives
aimed at children’s mental health, with programs intended to provide continuous mental healthcare to children throughout adolescence up to adulthood as part of Miyagi Prefecture’s “Vision for
the Future and Earthquake Disaster Recovery Plan.”
Below, we review statistics on MDMHCC’s activities throughout the fiscal year of 2017 andfocus on the current issues of areas affected by the earthquake. Additionally, looking at trends
over the past years, we consider the current state of mid- to long-term support provided and goals
for the future.

1. 2017 Statistics
Table 1 shows statistics relating to MDMHCC’s activities in 2017. Resident support cases had beenon an upward trend since the Center first began its activities up to 2015, until 2016 when the numberof cases decreased. However, in 2017 the number began increasing again. (Number of cases per year:
7,680 in 2015; 6,752 in 2016; 7,237 cases in 2017.) In contrast to the Stem Center Resident Support
Division and Ishinomaki Region Center, whose case numbers have decreased since 2016 (StemCenter Community Support Division: 1,727 cases; Ishinomaki Region Center: 1,341 cases), both thenumber of cases at Kesennnuma Region Center and the number of outsourced cases has increased.
(Cases in 2017: 1,235 at Kesennuma Region Center; 2,233 transfer cases.) From this, it is apparent
that there are differences in each region when it comes to circumstances and appropriate programming.
No significant changes were seen in other areas of provided services from 2016.
Table 1: Number of cases by affiliation
Divisions

Planning
Dept.

Stem C
Mgmt.

TemporaryorContract

Other

Total

50

65

14

17

7237

Kesennuma

Ishinomaki

Stem

Municipal
Transfers

2100

918

1602

2471

Support for Supporters

82

139

430

700

1

109

3

28

1492

Raising Public Awareness

166

47

61

18

61

37

8

1

399

Human Resource

11

19

20

21

21

62

15

3

172

Support for Various Activities

6

1

0

0

0

5

0

0

12

Planning and Research

0
631

0
126

0
384

1
467

1
223

8
41

0
4

0
0

10
1876

Resident Support

Meeting Liaison

2. Area of Focus Development
The effectiveness and results of MDMHCC’s six focus areas are reviewed below.

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2017 Report(1) Resident Support
Various community support programs aimed at local residents were initiated with the aim of
improved mental wellness in affected areas and a preventive approach to mental health care.

 Target Demographics

a. Number of Support Cases and Comparing Response Methods
Table 2 shows the total number of cases of each type of response method. MDMHCC
provided various types of consultation and support via home and walk-in visits, phone,etc., based on requests from residents, municipalities, and various disaster relief
organizations. The total number of cases increased from 6,671 in 2017 to 7,121 in 2018.
Outreach remains the primary form of connection to those seeking support, with home
visits making up the largest number of cases. The number of cases of walk-in visits has
increased significantly, while other forms of support correspondence remain relatively
even. (Numbers differ as Table 1 excludes support correspondence by mail.)
Looking at the breakdown, the number of home visits has decreased from 3,068 in
2017 to 2,913 in 2018, while the number of walk-in visits has greatly increased from
1,211 to 1,700. Cases of telephone counseling have also increased from 1,843 to 2,131.
This increase in walk-in visit and telephone counseling cases can be thought to reflect
the Center’s adapting to the changing needs of patients.
The number of patients who were directed to the Center via home outreach or thehealth survey has also decreased (Table 3). (1,425 cases in 2016; 926 in 2017; 671 in
2018.) There has also been an increase in the number of patients referred by family or apublic organization or who otherwise found the Center on their own. Before, many of
the Center’s cases were follow-ups in response to individual government referrals
following the prefectural health survey. Furthermore, although a new health survey
this time directed at public housing residents has now begun, the number of surveyed
households has decreased, and the response rate is also lower. From this, we can expect
the downward trend of home visit support cases to continue.
Table 2: Number of cases by support type(Excludes mail correspondence; N = 7,121)
Support Type

Table 3: First time visit referral sources(Multiple choice; N = 1,313)
Cases

Referral Source

Cases

Home visit

2,913

Health survey, Door-to-door visit

671

Walk-in visit (at counseling help desks, etc.)

1,700

Administrative agency

308

Telephone counseling2,131

No referral

258Group activity

203

Family member

122

Case conference (for those seeking counsel)

29

Physician, Welfare Center

29

Accompanied doctor's visit

97

Support center, Temporary support staff

19

Other

48

Other (Neighbor, Workplace, Unknown, etc.)

123

Total

7,121

b. Sex, Age, and Employment Demographics
Looking at the demographic breakdown of support targets by age, the most served
demographic is the 60-to-70 age group, making up 1,348 cases. Unemployed persons makeup around 60% of the 20s, 30s, and 40s age groups, and about 75% of the 50s and 60s age
groups. (Figure 1)

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2017 Programming Review

c. Disaster Casualties Current Status
Although the total numbers have decreased, the ratios of support targets by bereavement
status is largely the same (Figure 2). Regarding type of bereavement, there was no
particular change in the numbers of those who identified as bereaved partners, siblings, andextended family members, but there were fewer cases of bereaved neighbors (Figure 3).
The total numbers of those who reported dealing with a disaster-related injury to self or aclose relative (Figures 4 and 5) or housing damage (Figures 6 and 7) have decreased from2015 to 2018, while the percentages have hardly changed.

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2017 Reportd. Housing Status
With regard to the housing situations of support targets, the numbers of those who live incontainer-type temporary housing and apartment-type temporary housing has continued todecrease from 2016, while the number of cases of those in public housing are increasing(Figure 4). Container-type housing in particular has seen its numbers nearly halve every
year since 2015. (1,898 in 2015; 908 in 2016; 439 in 2017.) The number of those with theirown home has increased by more than 900 since 2015. The housing situation also differs byregion. 70% of Kesennuma Region Center’s patients live in their own homes and 16% inpublic housing. At Ishinomaki Region Center, only 25% live in their own homes and 55%
in public housing. The Stem Center sees 51% of its patients living in their own homes and
33% in public housing. (Figure 8)
The number of single-member households is increasing across all types of housing.
The degree of those in container-type housing or apartment-type housing has increased
considerably by 13 points since 2016 (Figure 9).
Table 4: Current housing situation(Total; N = 7,121)
Housing TypeCases
Own home

3,983

Prefab housing

439

Private rental home

292

Emergency disaster housing

2,114

Other, Unknown

293

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2017 Programming Review

e. Backgrounds of Clients
From 2015 continuously through to 2017, the most common concerns and topics ofcounseling were “changes in mood,” “health problems,” “family and household concerns,”
and “addiction” (Figure 10).
“Interpersonal relationship issues” were less common than “issues due to lifestylechange” and “financial concerns” in 2015 and 2016 but became more prominent in 2017.
Otherwise, while “anxiety about the future,” “financial concerns,” and “employment
concerns” became less common, the rate of “mood swings” has increased by 7.7 points andsurpassed 3,000 cases for the first time. “Issues due to lifestyle change” appears to be lessof a problem with each year (20.7% in 2014; 18.9% in 2015; 13.5% in 2016), accounting
for only 7.3% of cases in 2017. This is likely due to the steady improvement of housingdevelopment.

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Psychological Symptoms
Looking at specific mental health-related symptoms from the concerns regarding“changes in mood” in these three years (Figure 11), it is apparent that although “anxiety”
has overtaken “physiological symptoms” in 2017, overall there has been little change.

g. Medical History, Time of Onset, Treatment History
The percentage of those with a known medical history has increased each year, from 35.8%(2,716 cases) in 2015 to 44.1% (2,948 cases) in 2016 and 46.8% (3,335 cases) in 2017
(Table 5).
Although cases of “F2: Schizophrenia, Schizotypal, and Delusional Disorders” haveovertaken cases of “F3: Mood (Affective) Disorders,” F3 cases have not decreased and infact have been on the rise year by year (729 cases in 2015; 806 cases in 2016; 888 cases in2017). Moreover, it is apparent that many cases of “F3: Mood (Affective) Disorders” and“F4: Behavioral Syndromes Associated with Physiological Disturbances and PhysicalFactors” manifested after the disaster (Figure 12).
Table 5: Medical history and current treatment plan of support targets(Total; N = 7,121)
Psychological Medical History
Cases

Existing medical history(Currently in treatment)

2,350(Treatment ended)

269(Treatment interrupted)

610(Untreated)

21(Treatment history unknown)85

No medical history

2,764

Medical history unknown

1,022

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2017 Programming Review

 Description of Support Provided

a. Cases by Support Method and Division
From the data below, we can see that the number of cases served by the Kesennuma Region
Center is increasing, particularly the number of walk-in visits, which has come to exceed
the number of home visits. The number of cases served by the Ishinomaki Region Centerand Stem Center are decreasing, but the high proportion of home visits (50.3% forIshinomaki Region Center and 65.3% for the Stem Center) remains unchanged from lastyear (Figure 13).

b. Support Targets
82.6% of all cases are of persons seeking counsel for themselves. The next most prominentgroup are those seeking counsel for relatives at 11.3%. These are typically the mostcommon demographics in any given year. In 2016, the number of cases of government
officials or “other parties” seeking counsel decreased slightly (Figure 14).

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2017 Reportc. Affiliated Organizations
The percentage of municipal affiliates has increased year by year, with 45.6% in 2014,
52.8% in 2015, 65.7% in 2016, and 72.8% in 2017 (Figure 15). Such data may be
a reflection of the shrinking role of temporary support staff and support centers establishedafter the earthquake, with local governments preferring to aid in relief efforts throughexisting administrative channels.
MDMHCC is also cognizant of the role municipal support staff have provided as we
look toward the end of our role and prepare for the handover of our services to local
governments.
In addition, it should be noted that there are differences in the significance of theaffiliations with welfare centers and other health care centers depending on the region(Figure 16).

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2017 Programming Review

 Support Case Termination
In 2017, 1,224 support cases (17.1%) were closed, a decrease of 184 cases since 2016.
Compared to 2016, a higher percentage of cases closed with an “improved situation” status, but
the number of such cases decreased by 178 (Table 6). Additionally, of closed cases referred toanother organization, the percentage of referrals to municipal organizations remains high at alevel similar to that of 2016, particularly in contrast to years prior to 2016 when most referrals
were to other health care organizations, before dipping in 2017, when welfare center referrals
became more common (Figure 17).
Table 6: Case outcomes (N = 7,121)

Continuing

Status

Cases

Fixed-term

3604

Continuing basis

2291

Other
Closed0Situation improved

1081

Referral to another org.

107

Denial of support

36

Other

2

 Miscellaneous Resident Support
Regarding resident support programming, various community social events or “Gatherings” toaddress different community needs have been held in addition to the usual one-on-one
counseling services provided, such as the field vegetable gardening gathering, “Koko Farm”(Ishinomaki Regional Center); the meet-and-greet socializing event for migrants from
Fukushima Prefecture, “Utsukushima Salon” (Stem Center); and the apartment-type housing
resident get-together, “Kokoro Café” (Kesennuma Regional Center).
Statistics on gathering events are included in the “Social Activities” section of (3) Raising
Public Awareness.

 Summary2017 was the first year a decrease in overall resident support cases was seen. With thedevelopment of recovery efforts leading to a decline in temporary housing residents, thecompletion of public housing construction, etc., it was thought that the health care needs ofresidents would continue to decrease. In fact, 2017 has brought about an increase of support
cases. Cases involving both adults in their 40s – the so-called prime of one’s life – and young
people under age 20 have increased, with the number of cases dealing with under-20s
increasing for the third consecutive year. Despite home reconstruction efforts and theavailability of public housing providing stabilization of the housing situation, there remain
many complications in people’s lives regarding work, education, and more. As various support
groups shutter their doors over time, it is likely that the number of people needing support will
only continue to rise in the future.
As people deal with the anxiety and instability of the life changes they have experienced on
the road to recovery, the lasting effects of disaster on mental health are clear. From the Center’s
counseling records, cases of people dealing with “mental health concerns” have exceeded 3,000
for the first time. In the seven years since the disaster, the number of relief effort support
workers has decreased. Community restructuring is under way as more people move into public
housing and disaster relief is being shifted to the care of existing government projects.
Under such circumstances, fine-grained support measures are needed to aid
disaster-affected areas, and MDMHCC aims to center its work on support for local communities.

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2017 Report(2) Support for Supporters
To provide aid to support workers in affected areas, training sessions and counseling sessions areheld and specialists are dispatched to local governments.

 Targets of Staff Support
As in previous years, administrative organizations far surpass any other type of organization,
which seems to point to the continuing role of various municipal governments in disaster relief
efforts. At the same time, child welfare organizations have surpassed health care organizations
and private organizations. In addition, there is increasing support for committee members andward officials (Figure 18).

 Types of Support
Support cases for support staff numbered 1,492 in 2017, continuing the annual decline in
numbers since 2014 with 1,915 cases, 2015 with 1,606, and 2016 with 1,549 (Table 7).
The number of cases involving “professional guidance and advising” has decreased since2016. 57 of cases concerned alcohol problems, which marks a decline overall although they still
make up a high percentage of all cases (107 in 2015; 90 in 2016). There was also a large
number of cases concerning abuse (60 cases). At the same time, the broad category “Other” hasbeen on the rise for three years in a row, which includes many cases involving advising on casesof children’s mental health (Table 8).
Table 7: Support cases for support staff case types(Total; N = 1,492)
Support case info

Table 8: Professional guidance/advice
topics (Multiple choice, Total; N = 367)

Cases

Targets

Post-visit/interview report

166

287

Professional guidance/advice

367

Regional problems

25

Topic

Cases

Alcohol-related

57

1,352

Gambling problems

1

174

Prescription medicine

1

Depression

23

Complicated grief

2

Workplace mental health11

16Case conference (aimed at support staff)

280

1,276

Setting up a counseling help desk

89

134

PTSD

5

Health exam support

34

517

Abuse

60

Administrative support

447

848

Other

265

Other

Total

73

644

1,492

5,248

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2017 Programming Review

The breakdown of forms of support for supporters shows that although the relative
numbers for each division remain much the same, the number of cases of transfer staff has seen
a considerable rise (615 in 2016 to 700 in 2017). In the Stem Center Community Support
Division, it is understood that the proportion attending case meetings is higher than at the
Kesennuma or Ishinomaki area centers. Among seconded staff, the number of cases attended bya case meeting has increased greatly (50 in 2016, 138 in 2017). As in 2016, both the StemCenter Community Support Division and transfer staff cases saw large numbers. Types andnumbers of cases of support for supporters are likely greatly impacted by regional
circumstances and local government policies. (Figure 19)

In terms of receiving specialist guidance and advice, transfer staff and the Stem Center
Community Support Division saw large numbers of cases concerning alcohol problems.
Additionally, in 2017 the Stem Center Management saw numbers of cases concerning abuse at asimilarly high rate as the year before. The large number of “Other” cases is due to the increasechildren’s mental health care guidance cases for cases other than abuse (Figure 20).

 Professional Aid for Local Governments
In response to requests from local governments, in 2017 MDMHCC again dispatched 8
employees as transfer workers to 7 municipalities. They were largely psychiatric social workers,
although there were also 1 occupational therapist and 1 clinical psychologist included amongthem.

 SummaryWith the decline of support workers from external organizations, the increasing demand forsupport services for certain support workers (such as the rapid increase in support cases fortransfer workers) was concerning. However, it must be noted that the overall number of cases
has been on the decline for the past three years. “Report following home visit or interview”
cases have decreased from 246 in 2016 to 166 in 2017, likely due to the decrease of home visits
overall.

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2017 Report

Cases of “specialist guidance and advice” have also decreased to 367 from 411 in 2016.
Cases involving alcohol problems have decreased but remain relatively high. Furthermore,cases categorized as “Other” have continued to increase over the past three years, which
include cases concerning children’s mental health care such as supervising child protection
case study conferences.
Meanwhile, the number of “mental health help desk” and “health exam” cases are on therise, with health exam support persons seeing a considerable rise of 517 people. This is likely
due to the increase in support workers seeking specialist guidance regarding infant healthexams. The need for support for supporters dealing with children’s health care is expected toincrease accordingly.
In continuation from 2016, 8 staff members were deployed as transfer workers to 7
municipalities. The number of programming cases have increased overall since 2016,providing some on-site relief for local governments. In light of the eventual cessation of
MDMHCC services, such deployments are important for joint planning for the future withlocal governments.
(3) Raising Public Awareness Means of Spreading Public AwarenessWe aim to raise public awareness of mental health and wellness following disasters throughvarious means, including distribution of flyers, media appearances, community educational
workshops, social events, etc. (Tables 9, 10)
In addition to PR magazines introducing MDMHCC and its regional activities issued
September 2017 and March 2018, the Center has also reissued its own pamphlets. Details
regarding training sessions, workshops, conferences, and other events are also posted on the
MDMHCC home page to reach widespread audiences. The Center also maintains a blog andmailing list for regular online updates.

Table 9: PR Magazine Issues
Issue
CopiesMonth
No.
printed
17

September

2000

18

March

2000

Table 10: Pamphlet information
Print
Type

CopiesprintedMDMHCC Pamphlet

Reprint

1500

MDMHCC Pamphlet (Revised ed.)Reprint

2000

Let's Know! How to Engage with Alcohol

Reprint

4000

Distribution area

Prefecture-wide

Title, Contents

 Educational Workshops
In response to requests from local governments, 84 mental health workshops (for both support
workers and general community members) were held. Workshops aimed at the generalcommunity involved not only lectures, but also made use of presentations involving images,
music, exercise, etc., to make them more readily accessible to all residents. The total number of
events held has decreased since 2016, although the number of events related to addressing
alcohol problems increased by 4, with 25 events held. As for workplace support, 13 lecture
events reaching 495 persons were held to address mental health in the workplace, such as thecollaboration on the “Deploying Presenters for Mental Health Building Seminars” project with
the Miyagi division of the National Health Insurance Association (Kyoukai Kenpo) (Table 11).

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2017 Programming Review

Table 11: Educational workshop topics (N = 84)
No. held
2
1

Total attendees
78
31

Basic listening skills workshop (for bereaved
families, etc.)222Addiction problems (incl. alcohol)
Earthquake's effect on children
Stress and mental health care, self-care
Physical healthWorkplace mental health

25
7
34
0
13

104
550
823
0
465

Current status of affected areas and
MDMHCC programming

00

Emotional response to the earthquake
Mental illness

 Salon Events
Community-centered social events where residents could talk and communicate with each other– called “salon” events – totaled 132, with 117 events being directly organized or co-organizedby the Center and 15 events with the Center in an assisting role to another organization. This isa decrease since 2016 (Table 12).
Table 12: Salon events (N = 132)
Center Division
MDMHCC held or jointly held
Cooperation with another org.

Kesennuma

Ishinomaki

Stem

Outsourced

38
4

31
0

37
5

1
6

Other

Total

10
0

117
15

 Summary
The primary purpose of public awareness activities is to provide education and spread
information on better understanding mental health care to community members. We do this via
a variety of means including pamphlets and other paper publications as well as through theInternet. MDMHCC also responds to media requests in order to further publicize the importantrole of mental health care following the earthquake. We believe that mental wellness practices
adopted into daily life are beneficial for keeping up overall mental health, and this is the aim of
public awareness efforts.
At the same time, our social events not only to provide education on mental health care,
but also provide validating spaces for people to experience various new things in a social
environment. In this way, they can be thought of as a type of group therapy for local
communities, acting in fact as a form of Resident Support. Social activities are an effective wayof combatting the isolation often felt by residents during the process of building a newcommunity.
Spreading public awareness about the effectiveness of social activities in combatting
isolation is of great benefit for many community members, and it is important to keep this inmind as we continue social event programming.
(4) Human Resource Development
A key area of focus for MDMHCC is developing human resources for mental health care specialists
and support workers working in disaster relief, allowing network-building through conferences andother types of programming. 172 such events or programs were held, an increase from 152 in 2016.
The number of attendees has also increased.

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2017 Report

Training workshops and lectures aimed at local governments and other organizations providing
support services were held at levels similar to previous years. Alcohol-related problem training was
conducted at the request of various regional organizations both in coastal and inland areas. Staff
who have undergone sobriety-related training in other prefectures presented these new approaches
to public health nurses at 3 different sessions across Miyagi. Training related to alcohol problems
included 24 sessions on addiction-related problems and 3 sessions on “support skills (for supporting
alcoholics, etc.),” for a total of 27 sessions. (Table 13)
Table 13: Human resource development activities (N = 172)
Description

No.

Attendees

Earthquake relief conference
Media conference
Addiction problems

1
0
24
(24)
(0)
53
(6)
(5)
(42)
9
16
22
1
16
4
6
17
3

56
0
433
(433)
(0)
1718
(114)
(528)
(1076)
260
352
1245
56
24
555
604
148
96

172

5547

(Alcohol)(Other addictions)Support skill workshop(Listening skills)(Stress and mental health care, self-care)(Other)Supporter mental health workshop
Workplace mental health workshop
Children's mental health workshop
Senior mental health workshop
Countering suicide workshop
Mental illness/disorder workshop
Affected areas and MDMHCC programming
Case study
Other
Total

 Conferences
The “Miyagi Earthquake Relief & Mental Health Care Conference” was held by the Ishinomaki
Region Center in the city of Higashimatsushima. Both running the event itself and the planning
process presented many opportunities for different groups and organizations to connect witheach other, and an executive committee was formed. The planning process involved spendingtime with many local groups and joint discussions right up to the day of the event.
As in previous years, the “Miyagi Earthquake Relief & Mental Health Care Conference”
was held only once, although with three different regional sessions. However, a “Miyagi Mental
Health Care Forum” event was held for the first time. An outline of items related to the forum isreported on in (5) Research.

 Professional Training
The Center conducted 53 training sessions for support workers to gain specialist insight andmaster technical skills related to their support work.
The MDMHCC was the principal organizer of the all-day Training of Trainers (TOT)
workshop on WHO Psychological First Aid (PFA), a technical workshop focused on early-stage
approaches to mental health care. We were able to train 7 PFA instructors at this TOT session.
A separate session focused on children’s PFA was also held jointly with Save the Children
Japan.
In addition, we have continued our collaboration with the Tohoku University Graduate
School of Medicine Department of Preventive Psychiatry from 2016 by jointly holding the“Exercise for Heart & Mind,” “Skills for Psychological Recovery,” and “Psychological Skill
Training” training sessions.

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2017 Programming Review

 Summary
Up to now, our efforts in human resource development have involved the planning andimplementation of development and training programs centered on sharing techniques andknowledge relevant to the support services required in disaster relief. In 2017, as we finallyreenter a period of stability, training has centered on the concepts of “prevention” and“preparation” in particular. With alcohol-related problems, the implementation of the former isthe sobriety-related training, while the latter is the PFA training (including children’s
PFA training). Both are relatively accessible and practical approaches; it is important that nonspecialists and those working closely with residents in the community be able to easily adopt
these approaches.
Nonetheless, it is also important to continue providing more specialized training. Practicalalcohol-related problem training and interpersonal skill training must include following up on
cases.
Even more so than technical training and continuing education, providing networking
opportunities for support workers is indispensable for future community development, and it
will become increasingly important to hold conference-type events.
(5) Research
As we enter a time for the MDMHCC to reflect on its seven years of service, we have changed thename of the Planning Division to the Research Division to promote survey research and otherresearch projects. External advisors and reviewers were invited to form an ethics committee andimprove the research quality.
In addition to implementing health surveys for local governments and the Council ofSocial Welfare in cooperation with the Tohoku University Graduate School of Medicine
Department of Preventive Psychiatry, we have also conducted several research surveys regarding
programs and services like resident support programs, supporter networking, social events, etc.
We are also currently carrying out the “Longitudinal Support Study on Children Born after theGreat East Japan Earthquake and Their Families” in collaboration with the Iwate PrefectureChildren’s Center.
8 research projects and 2 symposiums have been announced in 2017 (Appendix).
Looking back on support services in the six years following the earthquake, a forum
centered on the future of community-based mental health care in Miyagi, the “2017 Miyagi
Mental Health Care Forum,” was held. The forum focused on the mental health care services
provided during the six years after the earthquake and future goals. A symposium on similar
matters was also held following reports from local governments, the Center, and the Tohoku
University Graduate School of Medicine. Attendees were able to connect and exchange ideas andinformation, and the MDMHCC and its activities were introduced at the event through an
exhibition area.
(6) Support for Various Activities
Many of the Center’s activities were made possible with the sponsorship and cooperation ofvarious other support organizations. The Center also took on interns from various educational
institutions.
3. Summary
Seven years since the earthquake, residents of container-type housing and apartment-type housing
have continued to move into disaster public housing. However, the needs of those who cannot movemust still be addressed. Furthermore, those who do move form part of a bigger picture of community
rebuilding, and the change in lifestyle and environment can render them especially prone to isolation.
At the same time, the number of temporary support workers is on the decline as external support
groups begin to withdraw from the area, increasing resident support demand for administrative
workers. This is likely the cause for the increasing activity seen from administrative organizations
with regard to support work.
As for salon events, although they are still actively being held in different communities, they too
are on a decline. Both salon events held by the MDMHCC and other organizations are decreasing in
number, with the number of salon events held or jointly held by the Center this year being lower than

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2017 Reportin 2016. Nonetheless, they continue to be run. Besides salon events, other social events like meet-ups
have been taking place in different regions. Such meet-ups are important by providing opportunities
for isolated persons to connect and form bonds in a new community.
It is difficult to pinpoint the effects of the results of counseling cases, which now number over
7,000. Even with further training and consultation, it is difficult to assess to what extent diverse needs
could be addressed. We feel that there is a constant change in the challenges different communities
face as time goes on, and the Center’s role is in providing support services in line with the views ofboth community members and local support workers. Some problems that have been identified since
the Center’s opening – such as alcohol-related problems – still persist. As scissor-like disparities
become more apparent, it is our humble desire to continue our work to address the continuing needsof local communities.

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2017 Programming Review

Report on the 2017 Miyagi Mental Health Care Forum
Research and Planning Division, Stem Center, MDMHCC

Introduction
In March 2017, Miyagi Disaster Mental Health Care Center (MDMHCC) established its planned
services for the next four years based on Miyagi Prefecture’s policies for reaching the 2020
reconstruction goals. In 2017, the organization-wide “Miyagi Mental Health Care Forum” research
project was established to contribute to research on disaster relief measures, with project
administration centered at the Stem Center.
The 2017 Miyagi Mental Health Care Forum had the main theme of “6 Years of Post-Disaster
Mental Health Care Services and Future Goals” and a secondary focus on “Examining Post-Disaster
Mental Health Care via Survey Research.” The forum took place on November 29, 2017, with thesupport of Miyagi Prefecture and the city of Sendai, and it hosted a total of 130 attendees who wereprimarily support staff from local governments.
1. Content of the Forum(1) Objective
The main goals of the forum were to provide a platform for institutions like the MDMHCC or
Tohoku University to report on their activities in the six years following the earthquake; exchange
of information and ideas from speakers from other organizations; and jointly consider future
rehabilitation aims and plans in community mental health and welfare. For the next few years up
to 2020, the forum will continue to be held in hopes of becoming a cornerstone of the synthesis of
mental health care approaches for those psychologically affected by the earthquake anddiscussion of the future of mental health care in the region.
(2) Date:(3) Location:(4) No. of Attendees:(5) Program:

Wednesday, November 29, 2017 10:00a.m. – 3:30p.m.
TKP Garden City Sendai, 13F Halls 13A & 13B
130 (50 internal or municipal administrative staff）(Table 1)

Title “Six Years of Post-Disaster Mental Health Care Services and Future Goals”
Subtitle“Examining Post-Disaster Mental Health Care via Survey Research”

Table 1: Miyagi Mental Health Care Forum Program
Photo 1: Practical Reports
Photo 2: Social Exchange─ 21 ─

2017 Report
Conference Address
Practical Reports
Part 1
Practical Reports(10:00a.m. – 12:00p.m.)
Opening Address:

Yuichi Watanabe

Community Support
Department Director

Part 2
Symposium(1:00p.m. – 2:30p.m.)
Opening Address:

Kazunori Matsumoto
Vice President
Part 3Social Exchange(2:30p.m. – 3:30p.m.)
Exhibit area

1. Chika Chiba
Associate Chief, Regional Welfare Division of the City of
Tagajo2. Kaori Hoshi
Health Promotion Division of the Town of Watari
3. Akemi Akasaka
Technical Vice-Director, Sendai Health and Welfare Office
Iwanuma Branch, Miyagi Prefecture
4. Wataru Shoji
Tohoku University Graduate School of Medicine
Department of Preventive Psychiatry
5. Naru Fukuchi
Director, Planning and Research Division, MDMHCC
Keynote (1:00p.m. – 1:30p.m.):

Hiroshi Kato

Director, Hyogo Mental Health Care Center
Discussion (1:30p.m. – 2:15p.m.)
Conclusion (2:15p.m. – 2:30p.m.):

Hiroshi Kato

Attendee group discussion
Forum Closing Remarks
Panel Exhibits & Slideshows (9:30a.m. – 3:30p.m.)(6) Event Operations
While the inaugural assembly of the Miyagi Mental Health Care Forum was held by the StemCenter mainly under the direction of the Planning and Research Division, assuming the event’s
continued operation into the next four years, future renditions have been planned to be held by
the different regional centers and their Resident Support Divisions.
2. Programming(1) Part 1: Practical Reports
Considering the subtitle and secondary theme of “Examining Post-Disaster Mental Health Carevia Survey Research,” Chika Chiba, Associate Chief of the Regional Welfare Division of the Cityof Tagajo, spoke on the current and future outlooks of inter-organization or inter-field support
projects and team approaches, as well as the role of public health nurses in the disaster relief
support network. Kaori Hoshi, leader of the Health Promotion Division of the Town of Watari,
spoke on the role of health surveys not just as a means of data collection, but also as a tool tofacilitate at-home support to residents, and the importance of conferences to bring the different
fields involved in support work together and unify their approaches. Akemi Akasaka, TechnicalVice-Director of the Iwanuma branch of the Sendai Health and Welfare Office of Miyagi
Prefecture, reported on the use of arts and crafts as an at-home educational tool for families
identified by the health survey to be afflicted by problems related to alcohol. Wataru Shoji fromthe Tohoku University Graduate School of Medicine Department of Preventive Psychiatry
reported and followed up on the health survey aimed at staff of the Social Welfare Council.
Finally, Naru Fukuchi, Director of the Center’s Planning and Research Division, reported on thestate of mental health care support in the period since the earthquake.

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2017 Programming Review(2) Part 2: Symposium Keynote:“Victim Support during Disaster Recovery”
Hiroshi Kato, Hyogo Mental Health Care Center Director
 Discussion:
Hiroshi Kato and speakers from Part 1: Practical Reports took the stage andtook comments from the audience, as well as discussing topics such as the significance of thehealth surveys, current approaches to health care, alcohol problems in the community, andchildren’s mental health support. The contents of the discussion are summarized later in thisdocument.
(3) Part 3: Social Exchange
A space was provided for attendees to mingle, review and discuss the topics mentioned during
the symposium, and share their daily support work experiences with each other. Attendees
appeared to be quite active in engaging with each other during this time.
(4) Panel Exhibits & Slideshows
Slideshow exhibits from the MDMHCC and its regional centers were displayed throughout theevent. These exhibits
introduced the Center and its past and current work to the attendees,
who were able to view them before the start of the forum, during intermissions, or in the freeSocial Exchange time, and ask questions regarding their contents. There were attendees still
looking at the displays during break times and the Social Exchange time, and staff were spottedfielding their questions.
3. Attendee Questionnaire Results
Questionnaires were included among the pamphlets handed out to attendees before the start of theforum, with their responses meant for administrative use following the event. Questionnaire responses
cannot be published here, but the results can be summarized as follows. The event was generally
found to be “Quite good,” with many remarks stating, “I was able to better understand the current
circumstances and next steps [for mental health care].”4. Summary
The Miyagi Mental Health Care Forum Report aims to become a key event in the synthesis ofcurrent approaches to mental health care for disaster-affected individuals by mental health carecenters, Tohoku University, Miyagi Prefecture, and municipal institutions, as well as in examining thefuture prospects of mental health care in the region. The inaugural Forum was held in 2017 by theStem Center in the hope that its operation would continue for the next four years. Under the theme of“Examining Post-Disaster Mental Health Care via Survey Research,” municipal bodies and healthcare institutions were able to report on their activities through a practical reports session anddiscussion followed via the symposium. The practical reports session saw deliveries on thesignificance of the health surveys and their results, as well as the necessity of cooperation among
different support workers and the current state of inter-city collaborative efforts on the matter.
Speakers from different municipalities remarked that the Forum provided a good opportunity toshare their work with other support workers that had been previously hard to come by. There weremany attendees (around 50) who were presumably support workers from administrative organizations,and the questionnaire results point to a generally high level of satisfaction toward all parts of the event(including the practical reports, symposium, social exchange, and panel exhibits and slideshows). The
questionnaire results also showed that the event programming was effective in giving attendees anopportunity to listen to others’ work in the field and then actively share and discuss the contents.
The symposium also facilitated a great deal of discussion. However, the subject matter tended tofocus on the issue of alcohol-related problems with less discussion of other topics. It is important for
future forums to also facilitate other topics (such as support worker fatigue, demand for various typesof survey research, support worker coordination, Hikikomori, PTSD treatment, grief support, andchildren’s mental health.).

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2017 Report

Symposium Discussion Remarks
Matsumoto: With the subtitle of this year’s
forum “Examining Post-Disaster Mental
Health Care via Survey Research” in mind,
I would like to begin by focusing on the healthsurvey research conducted. Despite known
disadvantages to health surveys such asdifficulty in their implementation and lack ofunderstanding of “high-risk” criteria, the pros
and cons were considered and a health survey
aimed at residents of emergency temporary
housing was conducted by the prefecture.
I believe other health surveys may have been
conducted as well. For the sake of futuredisaster relief efforts, we must see how useful
the results of this survey research may prove,and if not, how to best proceed. I would like toinvite some speakers to the stage now who
have more to say on these matters.

Many residents live in apartment-type
housing outside the township, but because of
insufficient manpower to conduct home visitson them all, we requested the prefecture to
conduct a prefectural health survey to mostadequately grasp the full health situation of its
residents. The prefectural health surveys wereconducted on a large scale on residents of
temporary housing and public housing.
However, the citizen response to the original
survey was quite good, with many earnest anddetailed responses, making us believe that
continuing to proceed this way is the best way
forward. Although we are recently finding thatmany are not responding to the K6 assessment,
it appears that the overall responses to thesurvey have been quite earnest since thebeginning, with results that are telling.

Chiba: In Tagajo, the prefecture has
conducted not only a health survey, but also asurvey of the state of disaster victims living in
isolation in the city. Based on the results of thetwo health surveys discussed this morning, wehave extracted the following three criteria tofollow up on.

Akasaka: The prefectural health survey was
carried out by cities and townships without
direct involvement from health centers.
Nonetheless, health centers make use of thissystem of municipality-managed operations
for their own support services. For example,
after conducting a health survey in adesignated municipality, those deemed “K6high-risk” or any other residents otherwise
needing a follow-up check can be provided
further care by both the government and healthcare center. The health survey provides an
opening to address additional issues. This
proved to be highly effective in cases such as ahousehold with alcohol problems or ahikikomori where accompanying a municipal
official could open doors for further
counseling.

The city-wide disaster victim survey was
carried out by what was then the Life
Rebuilding Support Center. Home visits andother forms of support were also provided
based on responses to an item on survey
regarding current health status.
It was decided that the city survey
questions and format would be revised by theLife Rebuilding Support Center every year
until 2016, whereas the health survey
questions remained the same every year for
five years. This allows for ease of comparison
when looking at, for instance, changes inalcohol consumption or percentage ofindividuals deemed by K6 assessments to behigh-risk.

The health survey data was also incredibly
useful for analyzing and understanding
a community’s issues. We would definitely
like to make use of anything in the results that
could be implemented in future policymaking.
Shoji: Although the last three speakers
reported on the health surveys aimed at
residents, what I would like to discuss today is
the health survey of other support workers that
Tohoku University conducted with thecooperation of municipal governments.

Hoshi: In Watari, the health survey was
conducted on a rolling basis. Survey
respondents were citizens of the town andvisited door-to-door, where they could inform
us of their current living and health situations,
feelings, concerns, etc. and respond to us
directly on-site, with attention paid to more
serious situations. In this way, the survey was
not a simple questionnaire, and participant
responses up to a given point could beconsidered as the survey continued.

Our survey was originally conducted forboth research and support purposes, but the
research portion of our work has now
concluded and providing “support for
supporters” remains our sole objective. The

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2017 Programming Review

for municipalities’ existing approaches tosurvey research.

survey made it clear that support workers face
heavy workloads and a great deal of stress. Of
course, we kept in mind how organizations
could benefit from the survey when
considering things like how to design,
implement, and follow up on it.

In addition, regarding surveys as anintervention strategy, Dr. Kato spoke in the
keynote on how individuals can be identified
as high-risk based on on-site assessment rather
than whether they simply meet a number ofpoints on a paper assessment.

Although the survey’s original focus was
specifically on supporters’ work following theearthquake, it eventually shifted to topics
about mental health in the workplace ingeneral. In that respect, we can consider
becoming a platform for change in attitudes
toward workplace mental health issues anotheraccomplishment of the survey.

For our audience members who would liketo share their opinions based on their related
experiences or otherwise, would you pleaseraise your hand?
Makabe: Hello, I’m Makabe from the Miyagi
Prefecture Support Center Office. Our support
centers have been established in various
communities
followingthe
TohokuEarthquake, and our staff numbers, whichhave exceeded 1,000 during busy periods,
include many support workers employedmainly by the Social Welfare Council who are
related to earthquake victims and new to thefield.

Fukuchi: I would like to speak on the pros
and cons of health surveys. In my opinion,
conducting the health surveys was overalla good idea. Although the health surveys
served to identify high-risk persons, as Ms.
Akasaka mentioned, they also provided
valuable information on community needs andthe overall picture of what has been going on.
There are areas, though, that struggle withissues of manpower when having to makehome visits as more high-risk persons are
identified, and who feel that as these numbers
increase, they start feeling like a quota.

The Support Center Office was set up to
back the activities of the various support
centers across the prefecture where these
support workers work at as a whole, and theprefecture has entrusted our administration to
the Miyagi Prefecture Social Welfare
Association. Starting with support worker
training, we continue to coordinate withdesignatedadministrative
bodiesandassociations (the Social Welfare Council). Our
active support staff currently numbers around
400 but continue to shift into other roles such
as LSA (Life Support Advisors).

I believe the reason for this kind ofaversion to surveying is due to there being
areas we are unfamiliar with when it comes tothe standards of screening, identifying, andfollowing up with high-risk individuals
following a large-scale disaster or emergency
situation. As a result, there are those who
question the point of these types of surveys
after a disaster.

We have heard about the health surveys asa public need, but it also seems like everyone
is on the same page regarding concern about
the potential for confusion when residents are
getting so many different surveys to fill out
from the university and NPOs. Hearing this,I thought that there should be some adjustment
to how the surveys are conducted.

The usefulness of survey research is not
limited to just understanding the impact of
a disaster. We conduct surveys in cases of, forexample, bullying or suicide cases at schools,
or when there is an incident in a workplace,etc., as well. They are a result of humaninnovation, and one way of looking out for ourcollective wellbeing, and I believe it is very
important for us to adopt surveys as anecessary part of our standard practice in
response to emergency situations.

Additionally, at the support center we havebeen discussing the need to hear our staff’s
thoughts on not only identifying issues
through the surveys, but also addressing
residents’ aspirations regarding their living
situations and roles in their communities.
Perhaps there need to be items on the survey
regarding future goals.

Matsumoto: Thank you very much. Tosummarize the agreed upon points, it isnecessary to consider how to make use of
surveys not just as a simple questionnaire but
also as a catalyst for outreach and connection
with its target respondents. And for issues of
manpower, we must change the structure of
future surveys and come up with new solutions

I would like to ask Dr. Kato and the otherspeakers for their thoughts and advice on these
two matters.

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2017 Report

Matsumoto: Thank you for your question.
You have pointed out some very important
issues. I also believe it must be disconcertingfor residents to be inundated with so many
surveys. As different organizations draft theirsurveys independently, there are surely points
that overlap and the schedules on which they
are conducted must be disorganized froma resident’s point of view. Dr. Kato, do you
have any experiences you would like to speak
on, or otherwise any opinions, regarding thisissue?

Matsumoto: Thank you. It is certainly
a problem that residents are getting so many
surveys not only regarding mental health, butalso physical health, building reconstruction,community rebuilding, and more. Even withthe proper ethical considerations, the sheer
volume of surveys is still an issue froma respondent’s point of view. From theresearchers’ side, I think many surveys arebeing conducted without knowing how toestablish a point of contact, how to ensure
non-invasiveness, when the best times to
conduct the survey would be, and so on.

Kato: As stated, a lot of surveys take placeespecially in the early period of a disaster,
many of which don’t seem to have a clear
purpose and can be invasive and not ethicallyaccounted for. Such was the case following theGreat Hanshin Earthquake, with an
overwhelming number of questionable surveys
taking place.

Even though each survey may have realsignificance, the end result is still disruptive tocommunity members. We must consider better
approaches to survey research in the event ofdisaster with residents’ perspectives in mind.
I believe this is one of the issues that
MDMHCC’s Dr. Kodaka raised at the
beginning of this forum.

There have truly been many so-called
researchers coming to disaster-affected areas
and disturbing residents for their own gain.
I would like to see survey research following
the proper ethical considerations, and I hope
we have been able to control the situation a bitby having surveys ethically approved throughthe proper avenues, with the purposes of datacollection
properly
outlinedandcommunicated back to respondents.

On another note, I’m of the personal
opinion that surveys should not just be under
the jurisdiction of researchers but should
involve the residents themselves in the design
process. As residents would have a better
sense of the significance of a survey, they
could help us directly in their design and there
would be a better channel of communication
between residents and researchers.
Would anyone else like to contribute
anything? It doesn’t have to be related to thecurrent topic.

After the Tohoku Earthquake, psychiatricacademic societies released comments on thesurveys. Those who read the comments wereable to give proper consideration to surveys;
it’s those who did not who are the problem.
Conducting research without keeping an eye
on such literature is very problematic and I
think it’s very important for the media toreport on these problems, and for us to demandhigher ethical standards from survey
researchers.

Fukui: I’m Fukui from the Japanese
Association of Social Workers in HealthServices and we’re involved in support
services in Ishinomaki. In our daily work, wedeal with issues affecting those trying torebuild independent lives, such as problems
related to alcohol, addiction, and in particulargambling.

As for the other point regarding
respondents’ aspirations and goals, I think thatis indeed very important and would bevaluable to include in surveys. In one survey
followingtheHanshinEarthquake,sociologists proposed the question, “When did
you stop regarding yourself as a victim?” The
responses were very interesting. For those
whose homes were completely destroyed, they
could not regard themselves as anything but
victims even 5, 7 years after the disaster.
These considerations of the future lead me tobelieve it would be good to include questions
about not only PTSD and depression, but also
hopes and goals for the future.

A common theme in our work is
considering whether the dependency problems
were existing problems that were exacerbatedby the earthquake, or new problems that arosefrom the earthquake. In Ms. Akasaka’spresentation, she mentioned being shocked by
the numbers when looking at the newest dataon alcohol use. Has the earthquake
exacerbated an existing trend? What is thedifficulty in treating these problems? Should
we be approaching those who had existing
dependency issues differently? I am interested
in hearing everyone’s thoughts on thesequestions with regard to the survey results.

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2017 Programming Review

been established based on a degree of evidence.
The proof could be seen even at this very
event, with audience comments from thismorning remarking on their “significant
effectiveness.” As Dr. Kato mentioned, it isvery important to try new approaches.

Akasaka: Among those we have establishedcounseling relations with following the survey– whether in person at the center or by phone –I have seen an increase in those dealing withproblems with addiction outside of alcohol,
including those related to gambling, spendingor shopping, etc. In my morning talk on artsand-crafts
as a form of
in-homepsychoeducation, the psychoeducation ismeant to address not only alcohol dependency,
but addiction in general, and involves theparticipation of the whole family, not just theperson of concern.

It is clear from our experience that disasterand addiction issues are strongly connected, so
it is something that we should be prepared forin future disasters. In the future it will bedifficult to see the direct relationship between
disaster and addiction, but as the wholecommunity becomes weak, as mentioned in Dr.
Fukuchi’s story, various problems will arise in
weak people, so indirectly I think that it is anindispensable matter. I think this is also
necessary for raising problems and issues in
the future. I think that it is necessary toincorporate the programs introduced to Mr.
Akasaka all over the prefecture.

At the Iwanuma branch, the feeling is thatrather than people who began drinking due tothe earthquake, there are cases of those whohave always had latent issues that then came tothe surface due to a catalyst related to theearthquake, such as losing their home or job.
However, I think there are still morecounseling cases for people that don’t haveanything to do with the earthquake.

In addition, I hope to hear more and moreopinions from you.
Sano: I’m Sano, a school nurse from Shizuoka.

Matsumoto: Would Dr. Kato like to add
anything?

Since I’m quite a ways away from thedisaster-affected area, hearing about theprevalence of issues related to alcohol today
was completely new information for me.

Kato: Along with raising awareness andworking with family associations and sobriety
groups, it is very important to coordinate withlocal physicians and health care practitioners.
People struggling with alcohol dependence
have poor liver function and are likely to makefrequent visits to the hospital, so I feel itwould be valuable for medical associations
and hospitals to educate their staff on
addiction problems. After the Hanshin
Earthquake, attempts at coordination withphysicians were made, but we were told they
were too busy to take on such responsibility
and there was little collaborative support foralcohol dependency. In one interesting case, I
was asked to advise a sake brewing company
on alcoholism but was completely ignored.
“We’re the ones selling it, so no thanks.”
Cigarettes have public health warnings written
on the box, so why not do the same foralcohol?

I have a few things I’d like to ask. Since
problems with alcohol are largely seen in men
in their 50s and 60s, I was wondering whatsort of impact or influence this has on children,and if children’s problems are screened for in
the health exam. For children identified ashaving health issues, are they able to beconnected with local health care workers or
specialists and receive the support they need?
Matsumoto: Thank you. Yes, we have notbeen able to discuss issues pertaining tochildren much today, and I think it would begood to hear more on that subject. Does Dr.
Fukuchi have anything to say on this topic?
Fukuchi: Thank you for the question. I’d liketo respond as someone who specializes inchildren’s psychiatry. The prefectural healthsurvey currently uses the K6 scale in assessing
mental health, but this scale is not designed toassess those under 18 years of age. The
surveys are sent out to households where they
are usually filled out by one representative of
the household. There were cases of reports ofchildren as young as three exhibiting anxiety,

Matsumoto: Alcohol-related problems wereregarded as a major factor in the solitary
deaths that occurred after the Hanshin
Earthquake. We can see alcohol becoming an
issue again with the Tohoku Earthquake, but
I think what is relatively new this time is thepresence of the sobriety program, which has

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2017 Reportmother and child mental health care. A motherand child mental health care survey would be
filled out as part of the checkup. This was a
five-year endeavor, and after the first andsecond years, children’s mental health issues
were able to be identified and gradually
addressed. We could see that as issues with theparents became clearer, supporting the parents
was in fact very important for the mental
health of the children and their overall
development. After this five-year project, theindustry is continuing to develop in the cityand clinical psychologists are still continuing
their work, so I think it’s very important tosupport parents like in the case I’ve mentioned.

but this data could hardly be used, and wewere unable to check up on these reports.
However, we are fortunate in Japan tohave a system where nearly 100% of children
have access to education, which acts as ourprimary point of contact to reach out, andpsychiatrists or counselors are able tointervene at nursery centers, elementary,
middle, and high schools in emergency
situations to provide support to children ofconcern.
Matsumoto: Has the health center ormunicipality had any experiences withchildren?

There have also been cases where, once
parents’ problems were identified via a healthsurvey, the problems of the children in thehousehold would become apparent, or a home
visit would reveal that the problem was evenmore extreme, like cases of abuse. It’s
important to be prepared with a variety ofintervention plans.

Hoshi: There were some cases that were moreclosely related to the mental health of themother. In Watari, much as Dr. Fukuchi
described, health care centers mainly focus onschools when it comes to providing support forchildren, so the survey tends to focus on theparents.

Matsumoto: Thank you very much. It seems
that the work in Natori shows the importanceof looking at care for mothers and children
when providing children’s support. This caseshows an example of work that began as a partof the city’s budget then continued as a new
project of its own.

Kato: A survey was conducted six years after
the Hanshin Earthquake that touched onchildren’s health. Parents were able to describe
any concerns they had about their children’s
wellbeing along with their own problems. The
results showed a very high correlation between
troubled children and households withtroubled parents, pointing to the importance ofconcurrent support for parents while providing
support for children. For instance, it would be
helpful to provide after-school childcare
options for those in temporary housing.

Does anyone else have any questions?
Omiya: Hi, I’m Omiya, a public health nurse
from Sendai’s Wakabayashi ward office where
I work on supporting victims of the disaster.
This may be somewhat unrelated to mental
health issues per se, but I would like to speak
on some of the prefecture survey results. In
our ward, we looked at the results for the K6
assessment, day drinking, discontinuation oftreatment, and ageing questions, and this year(2017) we’ve been following up on
respondents who reported “lacking counsel ora confidant” and “households with comprising
a single person or couple aged 75 or older.”After listening to the stories of these people
during home visits, we’ve started some“salon”-type community social events with
exercise as the base theme, but we’ve recently
been facing the issue of a lack of engagementfrom the elderly citizens that we’ve been
hoping would come out to these events. I waswondering if anyone has any advice orsuggestions on how to address this problem.

As Dr. Fukuchi mentioned regarding
schools as an avenue for support, after the
Tohoku Earthquake, a significant increase inschool counseling staff was found to be very
beneficial. The Board of Education also
worked hard during the Hanshin Earthquake toenlist a “rehabilitation teacher” at every school
and followed the care of children identified as
at risk or of concern for around 10 years.
Matsumoto: Would anyone else like to share
their thoughts regarding children’s issues?
Arakawa: I’m Arakawa, a public health nurse
from Natori. In the second year after theearthquake, the Miyagi Pediatric Association
sent a clinical psychologist to perform
checkups on infants as part of a project on

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2017 Programming Review

Matsumoto: Thank you. I think this may be
our most difficult question so far. Dr. Kato,
what would you do to address the lack ofengagement from intended participants?

creative programming and repeated outreachtranslated into successful results. It would begreat to hear more about this on anotheroccasion.

Kato: As mentioned earlier, there really is aproblem of participants in gathering type of
events being primarily outgoing women, withlittle engagement from those most in need ofsupport – single men. I think all communities
face this problem.

Our time is almost up, but I would like toturn to something Dr. Kato brought up earlier.
As a part of thinking about support exit
strategies, the need to support people affectedby disaster will continue regardless of how
budgeting changes in the future. I would liketo open up the floor for free discussion on
anything regarding future issues. Let’s takepeople one at a time.

I have heard of several approaches toattempting to address this problem. One was
the “Ojikoro” program aimed at middle-aged
men in Ishinomaki, and I’m curious about howthat turned out, if there’s anyone who knows
more about it. In any case, we can only dowhat we think of, meaning we just have to try
different things, I suppose.

Chiba: We have quite a few worries related tothe transition to regular work. In Tagajo, thecity’s general disaster victim survey already
ended in 2016, outreach to high-risk
individuals is declining, and we are now
focused on how to proceed with our support
services with those left. Among them, we are
beginning to connect with those newly
identified by the household health survey as
people struggling with alcohol problems or
hikikomori. Support for alcoholics or suicidal
people is not something that can be dealt withinstantly, and there are many support workers
who are currently working with such people astep at a time for incremental change. I thinkproviding this sort of personalized support will
only get more difficult in the future as we wait
for the transition to regular work and numbersof available public health nurses dwindle. As
we receive advice from city staff, the mental
health care center would like to continue
providing support into the future.

Matsumoto: Karakoro Station’s Ojikoro
initiative is quite well known for its name, as
well. Is anyone here able to speak more on it?
Karakoro Station“Ojikoro” is a monthly social salon aimed
at middle-aged men dealing with alcohol
problems or isolation. In the morning,
everyone is split into groups to make lunch
together, and the afternoon is recreational free
time. The event fosters connection andcommunication in the community, and every
fall, there’s an excursion to the Ishinomaki
seaside where a fishing contest is held.

Another thing is the support for alcohol
issues. Although we have already met withmany individuals who are clearly alcohol
dependent, based on the city’s data analysis I
think in the future we must also approach
those who have been identified as being at risk
for alcoholism even if they are not yet at thestage of full dependency and stage earlyintervention through education and awarenessinitiatives.

In the beginning, there were only about
3 attendees, but now the monthly numbers
exceed regularly exceed 20. The name“Ojikoro” is an abbreviation of “Ojisan
Exchange at Karakoro Station.” Participants
are referred through home visits, no different
from other organizations. We first build
rapport during home visits, inviting them withthe assurance that familiar supervising staff
would also be there. There are times when themen will be put off by the number of people
after one visit, in which case we try andencourage them to try again. For those who
still will not go, we then try and focus on othermethods of support rather than pushing them.

I transferred to the Disability Welfare
Department back in April, and I think it would
be good to continue such initiatives incollaboration with health departments whooversee health exams.
Hoshi: In Watari, our support center has
already closed. Although its services haveended, we continue to carry out victim support
liaison meetings. In the morning, we discussed

Matsumoto: Thank you for the detailed
explanation. It’s wonderful that focused efforts
on engagement were able to bring the numbers
up from just 3 to over 20. I think it could beconsidered a successful example of how─ 29 ─

2017 Reportproblems with mental health and psychiatry.
I think mental health care services up to now
have operated on the framework of specialists
seeing patients that come to them, where
seeking counsel on hikikomori at a hospital was
not possible without the person in question
making the appeal themselves. The disaster has
demonstrated the need for direct outreach topersons of concern and the importance ofbuilding rapport. I think there’s been a change
to a new attitude of, “Rather than wait for themto come to us, we will go to them.”

three of these meetings, and it is work I would
like to continue in the future.
Conferences especially are an opportunity
for specialists to consider the direction of
support work together and receive advice on
approaches to support and other challenges.
Akasaka: I think the role of the prefecture
will be to support municipalities, but cities andtowns will be burdened with new
responsibilities and it would be good toprovide whatever support is possible as wetransition to regular work, for instance in antialcoholism measures during health exams andsuch. Also, in a shared role with the prefecture
and municipalities, the public health centerscancontinue
toprovideat-homepsychoeducation and specialist consultation on
alcoholism or hikikomori, etc.

I think it’d be a great waste to think ofthese changes in the field as applicable only tothe disaster, and such preventive andcommunity-based approaches should become
the norm of mental health care. Ideally, there
should be no need for mental health careclinics or hospitals, and our goal should
instead be a decrease in the number of
inpatients. I think preventive outreach toward
community members will build better, moresustainable communities, and that is the future
we should be aiming at.

Additionally, as a charge of themunicipality, the public health center currently
attends municipal meetings once a month,which we would like to be an opportunity tomeet and discuss issues related to thetransition to regular work and other things to
consider for the future.

Matsumoto: Dr. Kato, if you have anything
to add?

Shoji: Regarding what Dr. Kato was saying
about research ethics, I think that is something
we are sure to keep in mind as we continue to
conduct survey research. In fact, when we
asked the Social Welfare Council to carry out
a survey, we asked when they expected to beable to do it and were told by a supervisor thatthey would need 4 months’ notice due to thepress of business. That was very difficult tohear, and I had conflicting feelings about
whether we were in fact inducing more stressthrough our work.

Kato: We have focused quite a bit on alcoholrelated problems today, but I think there issomething else we also must not forget, andthat is just the sheer impact of trauma that
follows a disaster like an earthquake. PTSD is
not something that has come up much today,
but it is core to many of the problems
discussed. In my experience as someone who
was affected by the Hanshin Earthquake,looking at the reports following the Tohoku
Earthquake, I am sure there are many people
suffering serious cases of PTSD. Although
they may be able to ignore many problems by
developing coping mechanisms to get by insociety, symptoms are likely to take hold when
the problems can no longer be avoided.
Looking at various counseling cases, it does
seem the number of cases of PTSD are
relatively few, but we must not forget that for
those few, it is a very grave issue that they are
constantly coping with in their lives. I hopethat in seven or ten years, Miyagi Prefecture
will be able to have the infrastructure to
support and treat PTSD.

As Dr. Kato mentioned earlier, along withreminding everyone involved in research of
the importance of research ethics, today’s
event was a good opportunity to communicate
the importance of preparation, where we moreclearly articulate what we need from surveys
sent out to organizations, public offices,
schools, etc.
Fukuchi: I think I speak for mental healthcare centers in general when I say we will
respond to whatever orders come our way inearnest to the extent that we can within thebudget.

Another issue is grieving. Many people in
the area have lost their families, yet the subjectof grief does not come up much in the data.
Often, it is only after the fact that the large
numbers of people dealing with grief are

At the same time, as a health carepractitioner I am very conscious of Japan’s─ 30 ─

2017 Programming Review

realized. Thus, I think we need to make sure to
give adequate consideration to grief support aspart of our system of mental health carepractice, which we have not spoken on somuch today.
Matsumoto: Thank you everyone for yoursustained participation from the morning, anda special thanks to our guest speakers who
have taken the time out of their schedules topresent their valuable experiences andthoughts to us.
Today we have focused more on Miyagi
Prefecture’s southern areas, but there remain
many other disaster-affected areas in theprefecture that I hope can be the subject offurther discussion. I hope we can continue thiscycle of reflecting back on past approaches toimprove future ones so as to continue
providing better support.
I also hope that after this, people willcontinue to connect with each other and share
their ideas and opinions with each other.
Thank you everyone for your participation
today.
Thank you to Dr. Kato and all the speakers
who presented their practical reports.

─ 31 ─

2017 Report

Symposium Summary
The symposium brought forth many different perspectives in the form of reports related to survey
research. The discussion following facilitated deeper discussion of issues presented in the practicalreports, which are outlined as follows.
1. The importance of unifying health surveys with municipal surveys on general citizen
circumstances according to the specific needs of the area and connecting survey results withpractical implementation of support services
2. The importance of health surveys in clarifying issues in a community and standardizing theirrole in acting as a window for disaster relief support
3. The need to coordinate survey efforts immediately following a disaster so as not to burden
locals with undue stress and responsibilities arising from a large volume of surveys
4. The importance of workplace mental health is becoming more apparent as an extension of
support for supporters
5. Addiction issues, focusing on alcohol problems in particular
6. Children’s issues
7. Ways of encouraging community engagement in isolated seniors and middle-aged men
8. Difficulties providing continuous care as disaster relief services come to an end and services
transition into regular support services
9. How to maintain the outreach services provided as a part of disaster relief services in generalmental health welfare services
10. Continuing the inter-occupational collaborative approach (case studies, care conferences, etc.)
developed as disaster relief support as a part of training in the regular system
11. PTSD and grief support
Points 1 to 3 were previously mentioned topics that were elaborated on further in the discussion, while
points 4 to 11 were new topics brought up as important points that should be discussed further atfuture symposiums or other events.

─ 32 ─

Regional Children’s Mental Health Care Projects

Child Mental Health Care Projects
Naru Fukuchi – Director, Doctor
Tetsuro Higuchi, Manager, Psychiatric Social Worker
Planning and Research and Planning Division, Stem Center, MDMHCC

Introduction
Miyagi Prefecture has announced a policy to provide “continuous mental health care fromchildhood to adulthood” for children affected by the disaster. Thus, in April 2016 Miyagi Disaster
Mental Health Care Center (MDMHCC, or the Center) took charge of the “Children’s Mental
Health Care Project,” which continues to operate to this day.
Based on contract specifications, the following report summarizes the regional children’s
mental health care projects in the Center’s charge for counseling cases with minors under the ageof 20 in 2017.

1. Results(1) Counseling
The MDMHCC provides counseling services to children affected by the disaster throughmunicipal agencies, educational institutions, nursery schools, and so on. Many cases involve thedispatch of specialist workers to city-run infant health examinations, counseling help desks, andhealth centers where staff and family members seek counsel on dealing with children’s mental
health care. There has also been an increase in the cases of those coming directly to the Center for
help.
Counseling cases numbered 281 in total, involving 118 persons. Table 1 shows the number ofcases by age group and counseling point of contact, while Table 2 shows the number of cases by
age group and residence.
Among the counseling cases, in the under-6 age group, behavioral cases such as those involving
delayed development, lack of participation in group activities at school or daycare, and so on are
particularly prominent, as well as cases having to do with mothers’ anxieties over childcare. Cases
where we connected with mothers mainly came to us via referral from municipal public healthnurses or daycare teachers. In the 7-to-15 age group, cases with developmental or family problems
in the background were most prominent. Finally, in the 16-to-19 age group, truancy cases related tohousehold problems were common, with more cases of individuals seeking counsel desiring further,
continuous counseling than in the previous year.
(Table 1) (Table 2)
Table 1: Cases by age group and point of contact(Total: 281, Actual: 118)

Total
(by
point ofcontact)
Actualno.

Self
Family
Other
Total

6 and
under

7 to
15

0
52
1
53

61
37
3
101

16
to
19
100
22
5
127

51

37

30

─ 33 ─

Total
161
111
9
281
118

2017 Report

Table 2: Cases by age group and residence
6 and
under

7 to
15

Sendai
Shiogama
Natori
IwanumaWatari
Yamamoto

2
0
22
0
1
2

8
0
14
0
3
1

16
to
19
1
1
24
1
0
8

Residence

Stem
CenterTotal (byresidence)

Total
11
1
60
1
4
11

Matsushima

0

1

0

1

Ishinomaki
RegionCenterIshinomaki

4

7

2

13

Higasimatsushima

9

13

17

39

Kesennuma
RegionCenterKesennuma
Tome

2
0

51
1

70
1

123
2

Minamisanriku

0

1

2

3

Anonymous

11

1

0

12

Total

53

101

127

281

(Table 3)
Table 3: Dispatched staff by occupation and host institution
Prefecture

Municipality

Nursery,
DaycareElementary
School

Psychiatrist

0

9

39

15

1

3

67

Clinical
Psychologist

1

85

5

0

0

10

101

Psychiatric Social
Worker

0

14

0

0

1

2

17

Public Health
Nurse
Other
Total

0
0
1

75
0
183

1
5
50

0
0
15

0
0
2

0
0
15

76
5
266

Occupation

Location

MiddleSchool

Other

Total

(Table 4)
Table 4: Dispatched staff by host institution and location (city, township)

Location

Prefecture

Municipality

Nursery,
DaycareElementary
SchoolMiddleSchool

Other

Total

Sendai

0

3

0

3

0

10

16

Shiogama

0

3

0

0

0

0

3

Natori

1

65

4

0

0

0

70

Tagajo

0

1

0

0

0

0

1

Iwanuma

0

15

15

0

0

0

30

Watari

0

23

7

0

0

0

30

Yamamoto

0

6

4

0

0

0

10

Matsushima

0

2

0

0

0

0

2

Ishinomaki

0

59

7

0

0

0

66

Higashimatsushima

0

2

13

4

0

1

20

Onakawa

0

1

0

0

0

0

1

Host Inst.

Stem Center

Ishinomaki Region
Center─ 34 ─

Regional Children’s Mental Health Care Projects

Kesennuma Region
CenterKesennuma

0

Tome

0

3

1

183

Total

0

0

8

2

3

0

0

0

1

4

50

15

2

15

266

(2) Specialist Dispatch Services
In 2017, we dispatched specialists such as pediatric psychiatrists and clinical psychologists to a
total of 266 institutions, including municipal health centers, nurseries and daycares, and elementary
schools, to provide consultation services. Table 3 shows the breakdown by host institution type andoccupation, while Table 4 shows the breakdown by host institution type and location (city,
township).
Of all host institutions, municipalities made up the greatest number of consultations at 183 cases.
Among these, there were 124 cases seeking counsel on difficult cases, 69 cases seeking counsel on
difficult cases at local children’s aid councils, and 31 cases of public health nurses seeking counsel
regarding infant health examinations. As for consultation requests from nursery schools or daycares,
there were cases of how to engage with difficult-to-approach parents of children suspected to beabused or who have developmental disorders.
(3) Workshops
There were 51 cases in 2017 where the Center held workshops or otherwise sent speakers toother events. Table 5 shows the types of specialists involved in these events and the municipality
they were held at. All the events are listed in Table 6.
The workshop events held by the Center itself include the “Parent-Child Bonds and Children’s
Emotional Development” event in Ishinomaki (230 attendees), the “Building Mental Health forHigh Schoolers Visiting Lecture” in Minamisanriku (85 attendees), and the “Children’s Mental
Health Symposium: Supporting Childcare in Disaster-Affected Regions” in Sendai (48 attendees).
Ishinomaki was the most popular region for events, followed by Sendai and Natori.
In addition, 3 training workshops in PFA (Psychological First Aid – a technique forpsychological support immediately following a disaster) were held under the title of “Children’s
PFA Training” as the importance of connecting with children affected by disaster or other accidents
is being emphasized in training manuals. MDMHCC plans to continue to play an active role inproviding children’s PFA training at educational institutions across the prefecture.
Table 5: Workshop events
Event location
occupation

SendaiNatoriStem Center

Kurihara
Watari
Yamamoto
ShikamaIshinomaki
RegionCenterKesennuma
RegionCenter

Psychiatrist

Clinical
Psychologist

6
1
0
0
0
0
7

5
2
1
0
0
1
2

PsychiatricSocialWorker
0
4
0
0
0
0
0

5
1
1
1

0
0
2
0

22

13

Speaker

Ishinomaki
Higashimatsushima
Kesennuma
TomeMinamisanriku

Total‘Other’ includes clinical developmental psychologists and nurses.

─ 35 ─

PublicHealth
Nurse

Other

Total

0
0
0
0
1
0
2

0
2
1
1
0
0
1

11
9
2
1
1
1
12

0
2
0
1

0
0
0
0

0
1
0
0

5
4
3
2

7

3

6

51

13

2017 Report
Table 6: Workshops and training events
Location

Topic(s)Date12017/05/09

Sendai

Attachment andattachment disordersNGO

5

Clinical
psychologist

2

2017/05/18

Tome

How to conduct casestudies

Administrative
officials

3

Clinical
psychologist

3

2017/05/22

NatoriDevelopment
assessment, sociality,
attachment

Child welfare officials

15

Clinicaldevelopmental
psychologist

4

2017/05/23

Sendai

Fostering change

NGO

6

Clinical
psychologist

5

2017/05/25

HigashimatsushimaConnecting withabused childrenChild welfare officials

35

Psychiatrist

6

2017/06/07

Ishinomaki

Ishinomaki Region
Center’s children’s
mental health careprojects

Health care workers

19

Public health
nurse

7

2017/06/23

Minamisanriku

Building mental
health for highschoolers visiting
lectureHigh school students

85

Psychiatricsocial worker

8

2017/07/11

Natori

Responding todifficult caregivers

Administrative
officials

11

Psychiatricsocial worker

9

2017/07/11

NatoriDevelopmental
disorders andtreatment

Education officials

100

Psychiatrist

10

2017/07/21

Ishinomaki

Causes andapproaches to child
maladaptation

Ishinomaki
elementary schools

20

Psychiatrist

11

2017/07/27

Shikama

Agency collaborationin preventing childabuse

District welfare
officials, etc.

45

Clinical
psychologist

12

2017/07/28

Sendai

Responding tochildren with mental
health problems

Education officials

130

Psychiatrist

13

2017/08/02

Kesennuma

Responding tochildren with diverse
issuesKesennuma Omose
Middle School

30

Psychiatrist

14

2017/08/09

SendaiChildren’s day camp
sub-leader workshop

Middle schoolers

2

Psychiatrist

15

2017/08/10

Ishinomaki

Understanding
difficult children

Sakura Nursery

4

Clinical
psychologist

16

2017/08/21

Ishinomaki

Attachment
disorders

Ishinomaki Sumiyoshi
Elementary School

14

Clinical
psychologist

17

2017/08/22

IshinomakiChildren’sdevelopment
assessments from anunderstanding pointof view

Kawakita District
public health nurses
and early childhood
educators

19

Clinicaldevelopmental
psychologist

18

2017/08/22

Ishinomaki

Understanding
children’s behavioral

Education officials

70

Psychiatrist

─ 36 ─

Primary Participant(s)No. ofAttendeesNo.

Speaker TypeRegional Children’s Mental Health Care Projects

disorders and how to
respond19

2017/08/23

KuriharaChildren with
developmental
disorders, theircaregivers, andproviding support

Education officials

32

Clinicaldevelopmental
psychologist

20

2017/08/31

IshinomakiChildren’s mental
health in Ishinomaki:
What we’re seeing 5
years after theearthquake

Administrative
officials

53

Psychiatrist

21

2017/09/07

NatoriChild abuse andcommunity
involvement

Education officials

80

Clinical
psychologist

22

2017/09/22

Ishinomaki

Parent-childattachment andchildren’s mental
development

Children’s welfare,
etc.

230

Psychiatrist

23

2017/09/26

Kesennnuma

Children’s PFA
training workshop

Administrative
officials, etc.

14

Psychiatricsocial worker

24

2017/09/27

Natori

How to proceed withindividual caseconferences

Natori public healthnurses, etc.

11

Psychiatricsocial worker

25

2017/10/02

SendaiSocial care

Short-term university
students

112

Clinical
psychologist

26

2017/10/13

Minamisanriku

Understanding andresponding totruancy

Education officials

30

Psychiatrist

27

2017/10/13

Watari

Staff mental healthcare

Okuma Nursery

20

Clinicaldevelopmental
psychologist

28

2017/10/24

Natori

Responding todifficult caregivers

Public healthadvocates, etc.

32

Psychiatricsocial worker

29

2017/10/26

Ishinomaki

Ishinomaki mental
support work
support conference:“How to support
survivors”

Education officials

10

Psychiatrist

30

2017/10/31

Kesennuma

Communication

Omose Middle School
second-year students

70

Psychiatricsocial worker

31

2017/10/31

Higashimatsushima

Higashimatsushima
Child Protection
Regional Council
workshop:“Supporting Parents
and Children in
Families with Mental
Illness”

Education officials,
etc.

30

Psychiatrist

32

2017/11/09

Higashimatsushima

Mental health forparents and children
from abusive families

Higashimatsushima
Child Protection
Regional Council

40

Psychiatrist

33

2017/11/13

IshinomakiLong-term
psychological

Ishinomaki Shiritsu

20

Psychiatrist

─ 37 ─

2017 Report

support for students
following the disaster

Oshika Middle School34

2017/11/14

SendaiCase study meetingNGO

7

Clinical
psychologist

35

2017/11/17

SendaiChildren’s PFA
training workshop

Administrative
officials, etc.

19

Psychiatrist36

2017/11/30

Kurihara

Looking at childabuse throughproblematic behavior
in adolescence

District welfare
officials, etc.

140

Clinical
psychologist

37

2017/12/06

Higashimatsushima

Higashimatsushima
Child Protection
Regional Council
workshopHigashimatsushima
Child Protection
Regional Council

40

Psychiatrist

38

2017/12/17

Kesennuma

Breathing exercises
using blowpipe toys

Ishigu District
Children’s Society

50

Nurses39

2017/12/19

SendaiChildren’s mental
health symposium:“Supporting children
in damaged areas”

Administrative
officials, etc.

48

Psychiatrist

40

2017/12/21

IshinomakiChild development
and appropriate
approaches to careChildcare support
center8

Public health
nurse

41

2018/01/09

Tome

Organizational
collaboration whenworking with difficult
cases

Administrative
officials, etc.

12

Clinical
psychologist

42

2018/01/23

IshinomakiChildren’s PFA
training workshop

NGO

14

Psychiatrist

43

2018/01/25

NatoriFun childcare tips

Masuda Nursery
public health nurses

30

Clinicaldevelopmental
psychologist

44

2018/01/29

NatoriCase study

Administrative
officials, etc.

13

Psychiatricsocial worker

45

2018/02/08

Yamamoto

Supporter mental
health care andchildren’s
perspectives

Administrative
officials, etc.

8

Public health
nurse

46

2018/02/09

Sendai

Raising children
through communitybased support

NGOs, etc.

35

Psychiatrist

47

2018/02/13

Sendai

Fostering Change
workshopNGO

7

Clinical
psychologist

48

2018/02/21

SendaiThe Social Impact of
the 3.11 Disaster on
the JapaneseCommunity

Tohoku University
international
students

30

Psychiatrist49

2018/03/08

Higashimatsushima

Understanding
children with mental
health issues

After-school club
activity support
workers40

Psychiatrist

─ 38 ─

Regional Children’s Mental Health Care Projects

50

2018/03/16

Tome

Early detection ofdevelopmental
disorders during the
18 months healthexam and childcare
supportAdministrative
officials

20

Psychiatrist51

2018/03/22

NatoriCase study

Administrative
officials, etc.

6

Clinical
psychologist(4) Public Awarenessi. Pamphlets on post-disaster children’s mental health care, such as “Understanding &Responding to Children’s Mental Health,” were distributed at events to promote publicawareness and understanding.
ii. Along with the projects like the “Miyagi Mental Health Care Report” or educational
information on the home page communicating the importance of post-disaster children’s mental
health care, the MDMHCC worked to promote the “Regional Children’s Mental Health Care
Projects.” There were also efforts to promote mental health care among children themselves,
with 100 sets of a dozen pencils with empowering messages aimed at children printed on them
(4 kinds) distributed to workshop attendees and institutions participating in our surveys.
iii. There were also 2 public awareness and education events related to mental health conducted incollaboration with children’s school cafeterias and childcare centers.
(5) Research
The following survey research was conducted in 2017.
i. Longitudinal Support Study of Children Born after the Hanshin Earthquake and their Families“2017 Regional Children’s Mental Health Care Project, Research Report 1: Longitudinal
Support Study on Children Born after the Hanshin Earthquake and their Families” – Miyagi
Prefecture baseline survey results report
ii. Children’s Day Camp“2017 Regional Children’s Mental Health Care Project, Research Report 2: Survey Research ofCamp Projects aimed at Parents and Children of Affected Areas”
2. Discussion
Compared to 2016, the number of counseling programs, professional dispatch programs, andworkshops have all increased in 2017. Counseling programs saw a rise in the number of support
cases from 230 in 2016 to 281 in 2017, with the actual numbers (of persons concerned) rising from89 to 118. Instances of professional dispatch also rose from 234 in 2016 to 266 in 2017, and thenumber of workshops increased from 43 to 51.
This is the second year running these programs, and it appears that communities’ needs havebroadened, which could be attributed to the fact that the respective agencies and organizations havebecome increasingly aware of them. Particularly as the number of counseling cases involving under20s has continuously increased in the past three years (according to the 2017 report on projects andactivities), we must continue to oversee the development of these projects.
3. Summary
It has now been two years since the Regional Children’s Mental Health Care Projects firstbegan in 2016. Of the total of 280 counseling cases this year, problems pertaining to childdevelopment, problems in the household, and truancy were particularly prominent. In workshops
and consultations as well, support workers brought up their concerns about dealing with
developmental disorders, abuse, and difficult caregivers or guardians of children. Although the high─ 39 ─

2017 Report

rate of truancy in Miyagi Prefecture has been noted before, the earthquake is thought to have had agreat influence on the school environment.
In terms of our human resource development and training programs, our children’s PFA
training workshops have seen great engagement, which will spread awareness of psychological first
response techniques following a disaster, and we hope to continue offering this type ofprogramming to the respective agencies and organizations into the future. There were also many
attendees at the conferences and symposiums held in Ishinomaki and Sendai. These events continue
to play an important role in providing opportunities for exchanging and sharing the most recent andrelevant information pertaining to children’s mental health care. Children’s mental health care must
be understood as connected to various social factors and not just the earthquake, and it is crucial tocontinue to develop relevant programming with the cooperation of various agencies andorganizations.

─ 40 ─