FY2019 Bulletin Vol. 8

FY2019 Miyagi Mental Care Forum Implementation Report
Miyagi Disaster Mental Health Care Center
Stem Center – Planning and Research Division
Chief, Psychiatric Social Worker Tetsuro Higuchi

Introduction
The Miyagi Mental Care Forum is sponsored by the Miyagi Disaster Mental Health Care Centerand has been held since FY2017 with the backing of Miyagi Prefecture and Sendai city. We planned tohost four sessions by FY2020, and we hosted the third forum in FY2019. The Planning and Research
Division was in charge of the administrative office, and the Community Support Division and the Planning and Research Division cooperated in the selection of practical reporters. Responsibilities for operations on the day of the forum were shared among the Stem Center staff.
1. Implementation Outline(1) Purpose of event
The forum was hosted with the objective of exploring the future of community mental health andwelfare from a prefectural/wide-area perspective. We share the current status of mental care in the wakeof the Great East Japan Earthquake through practical reports from local government officials and othersupporters. We also deepen knowledge about future efforts via talks by external lecturers.
(2) Date and time: 13:00−17:00, November 22 (Fri.), 2019(3) Location:
TKP Garden City Sendai Hall 21CD (Aer 21st Floor, 1-3-1 Chuo, Aoba-ku, Sendai,
Miyagi)(4) Target:
supporters such as local government and related organization staff involved in victim support(5) Theme:“Thinking about the future of mental care, eight years since the Great East Japan
Earthquake ⎯ How to take over post-earthquake disaster efforts in the community"(6) Program◎ Part 1〇 Keynote speech: 13:00−14:00“Thinking about a comprehensive community care system based on the experience ofcommunity support in Okayama Prefecture”
Lecturer: Masayuki Noguchi (Director, Doctor – Okayama Prefectural Mental Health and Welfare Center)◎ Part 2〇Practice report: 14:10−16:30
Reporters
. Kaori Ono (Public Health Nurse), Aya Uesugi (Psychiatric Social Worker)
Minamisanriku Health and Welfare Division, Health Promotion Section
. Naomi Abe (Psychiatric Social Worker/Social Worker)
Higashimatsushima Health and Welfare Department, Health Promotion Division
. Manami Abe (Public Health Nurse)
Shiogama Health Center, Iwanuma Branch, Community Health Group
. Kazunori Matsumoto (Doctor)
Tohoku University Graduate School of Medicine, Endowed Department of Preventive
Psychiatry- 22 -

FY2019 Miyagi Mental Care Forum Implementation Report〇 Discussion“Prospects from support in an affected area to a comprehensive community care system ⎯ How to take over post-earthquake disaster efforts in the community"•
Discussions by lecturers and practice reporters
Moderator: Sakiko Okamoto, Miyagi Disaster Mental Health Care Center (Community Support Department Manager)〇 Summary: 16:30−16:50
Masayuki Noguchi (Director, Okayama Prefectural Mental Health and Welfare Center)◎ Panel exhibition: 13:00−17:00
2. Implementation content(1) Keynote speech
Dr. Masayuki Noguchi, who is the director of the Okayama Prefectural Mental Health and Welfare
Center, spoke on the theme of “Thinking about a comprehensive community care system based on theexperience of community support in Okayama Prefecture.”(2) Practice report and discussion
. Practice report
Kaori Ono and Aya Uesugi from Minamisanriku reported on practices when working with residents on alcohol problems that manifested after the earthquake disaster as part of “Public awareness dissemination using picture-story shows.” Naomi Abe from Higashimatsushima reported onpractical secondary preventive measures targeting people with health problems as part of the city’s
own health survey in “Independent initiatives to address alcohol-related problems.” Manami Abefrom the Shiogama Health Center, Iwanuma branch shared the importance of sobriety support in
the area following the earthquake disaster in “Initiatives of sobriety support” and how this led tothe promotion of effective projects. Kazunori Matsumoto of the Tohoku University Preventive
Course reported on the effectiveness of preventive interventions through university outreach andthe importance of human resource development as part of “Initiatives to date by the Preventive
Psychiatry Endowed Course.”
. Discussion
Participants asked questions related to the sub-theme of “How to take over post-earthquake
disaster efforts in the community.” The members spoke on each of their responded and shared theirthoughts for the future. Please refer to the “Discussion Record” for details.
. Summary
Masayuki Noguchi’s comments on comprehensive community care included the following:“Instead of top-down, bottom-up,” “Alcohol-related practices can be expected to have a ripple effect on other problems,” and “Human resource development is important for raising the level of
support.”
3. Participant questionnaire results
The participant questionnaires had a 48% response rate, and approximately 80% of the participants
responded with “very good” or “good” for both Parts 1 and 2. “Administrative” was the largest affiliation
among the participants, and there were multiple instances where participants thought that “the forum served
as a useful venue for thinking about the roles demanded by each local government following the conclusionof the Mental Health Care Center” and where “the forum served as an opportunity to think about the future
as an administration.” Other frequent comments included “There were many specific innovations, and it
served as a useful reference”; “I was able to gain perspective on what to develop and continue, and who todo this with”; and “Cooperation with multiple occupations was impressive.”- 23 -

FY2019 Bulletin Vol. 8
4. Summary
We believe that this forum served as an opportunity to deepen the understanding of the “reconstructionof community mental health and welfare based on comprehensive community care,” while keeping thetheme of “how to take over post-earthquake disaster efforts in the community” in mind. It is thought thatfurther discussion is needed in order to determine how to apply the initiatives that have been conducted todate by each local government and university, as well as support organizations, in the future.
In the next forum, using the ten-year anniversary as a benchmark, we would like to reflect on theCenter’s activities and provide opportunities for the active exchange of opinions between participants. We
would like to propose hosting the forum in collaboration with the Miyagi Prefecture Mental Health andWelfare Association (which is the Center’s parent body) and proceed with planning.

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FY2019 Miyagi Mental Care Forum Implementation Report

Part 2 Discussion
Okamoto: I would now like to begin the discussion. I would like to receive questions and opinions from Dr. Noguchi and everyone who received the practice report. Thank you for yourtime. Today, we have received practice reports
from four individuals. Of these, three have talked
about preventive efforts for alcohol abuse. Alcohol-related problems manifested themselves after
the earthquake disaster, and we imagine that thishas been a serious problem for individuals, families, and supporters. As the phase begins to shift,
we are receiving reports on these efforts that reflect the importance of prevention. Dr. Matsumoto talked about the importance of preventive
intervention through the outreach efforts of professional groups in the university in the preventive psychiatry course. We would now like to receive questions and opinions from everybody inthe audience, so please do not hesitate to ask
speak up.
Kodaka: Thank you very much for your time,
Dr. Noguchi. Thank you to all the panelists aswell. I would imagine that this applies to every
site, so I would like to ask Dr. Noguchi a question. I imagine that various projects are being
conducted at the Psychiatric Social Welfare
Center, but I also imagine that there was a strategy specific to the Center there, such as specializing in outreach. Did you feel that there was acertain significance in the cross-sectional effort?
I think that this aspect is important in terms of
how to organize and focus our efforts in our areas of activity, so I would appreciate you elaborating on this.
Noguchi: Thank you for your question. I was ultimately thinking of this as a generalization, but
this is as you mentioned. I would imagine that
this is the case for municipalities as well, but thePsychiatric Social Welfare Center has been facing a wide array of issues, one after the other.
Today, we must address regional migration, addiction, withdrawal, suicide, and others, as wellas other psychiatric review boards. These are divided disparately and cross-sectionally. It is notnecessarily the case thatthese are passed down in a planned manner.
However, when we once again consider these issues ⎯ and this is also the case for outreach ⎯we understand that these share the common issue of how to approach those individuals who
struggle to connect with treatment, those who
struggle to begin treatment, and those who struggle to get support. We have conducted each project with this in mind. Furthermore, outreach isa point of emphasis at our Center; as an example,
withdrawal and outreach are highly continuous
processes. Another example is that for addicts,
we provide on-site lectures and preventative
measures, and we liaison and coordinate with alcohol-related organizations. Basically, we are
maintaining continuity and commonality withother projects to some extent by making the mostof the skeleton of municipal support, focusing on
cooperation with health centers. Therefore, weare conducting each project disparately while
maintaining the basic structure of local governments’ multi-layered support, with comprehensive community mental care in mind. However,despite not quite knowing what we are doing as
a whole, at the very least, we are slowly organizing this by providing support to people who
struggle to connect with support. Does this answer your question?
Okamoto: Thank you, Dr. Noguchi. Does anybody else have any questions or opinions?
Oba: My name is Oba from the Miyagi Disaster Mental Health Care Center, Stem Center. I
have a question for Ms. Abe from Higashimatsushima. Thank you for creating tables every
year, continuing investigations with everybody,and explaining them in an easy-to-understandmanner when conducting the home visits withmultiple occupations. I would like to ask you
about any innovations you implemented wheninvestigating with multiple occupations.

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FY2019 Bulletin Vol. 8
Naomi Abe: Thank you for your question. First,
there was a story about how public health nurses
and psychiatric social workers conducted home
visits together, but when a dietitian intervened,
there were times when we felt that it would be
difficult if our project objectives and the dietitian’s project objectives were not aligned. Dr.
Noguchi also mentioned that multiple meetings
were held when conducting these, with multiple
occupations, but I believe that one effort, if not
an innovation, of ours was to conduct multiple
discussions to ensure that we were progressing
on the same trajectory. ***Okamoto: I also have a question for Ms. Abe asa follow-up. As Dr. Noguchi mentioned earlier,when it comes to which project to devote limited
manpower to, did you have any innovations or
considerations regarding where to focus prevention and allocate the amount of work in each city,
town, or health center, including Higashimatsushima, as the workload increased?
Naomi Abe: In my three years of working on
this project, I feel that this was the most difficult
aspect. This unfortunately becomes a lower priority in terms of work. In that context, when it
comes to sobriety, I wanted to reduce the number of people with alcohol dependencies and severe cases of this as much as possible. This was
also the case at the Mental Health Care Center,but I have listened to a wide range of opinions.
There were many things that I remembered
when creating this material. Despite these challenges, I like to think that these three years werefilled with hard work.
Okamoto: Thank you very much. Now, I would
like to move on to Dr. Obara.
Obara: Thank you all very much for today. My
name is Obara from the Miyagi Prefecture Mental Health and Welfare Center. First, I would liketo ask a question about Higashimatsushima. I
want to ask whether you were able to identify
who to collaborate with next after having developed the project year

by year. I would also like to ask about
Minamisanriku, the health centers, and Dr.
Matsumoto’s preventative endowed course regarding who you would like to pass the torch to
and what you would like to entrust to them,even if it is just as an idea or on a conceptual
level.
Okamoto: In that case, can we start with
Minamisanriku? In what area would you wantto pass the torch? Who would you want to cooperate with?
Ono: It is in the presentation, but concerning
Minamisanriku, I would like to work with thetown’s residents.
Obara: To further clarify, in order to work withthe residents, is there anyone who you want toinclude as part of the support team? Are there
others, like related institutions, that you would
like to include at the supporter level? Have you
thought about who to cooperate with in order toincorporate the residents?
Ono: When it comes to public awareness targeting children, this would involve people likeschoolteachers.
Uesugi: In addition to key people in the community, such as the health promotion team andthe people I introduced earlier, there is also agroup of people who want to volunteer called
the Hot Bank, and there are quite a few ambitious residents. Therefore, I would like to workwith these residents using easily accessible materials. I have some experience working with
the LSA, which has overseen public housing,so I would like to cooperate with highly motivated people among the residents.
Okamoto: Next, I would like to pose the question to Ms. Abe of Higashimatsushima.

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FY2019 Miyagi Mental Care Forum Implementation Report

Naomi Abe: As for people I would like to collaborate with, Dr. Noguchi mentioned this earlier, but I believe that social withdrawal and suicide, in addition to alcohol, lead to all projects.
I would like to utilize more of residents’ power
through today’s talks. I think another aspect is tohave residents disseminate public awarenessabout alcohol and talk about it as well. Additionally, how to conduct project evaluations is a difficult aspect. I think that it would be helpful tohave people who could help conduct evaluations.
Okamoto: Thank you. Next, I would like to posethe question to Ms. Abe of the Iwanuma branch.
Manami Abe: I spoke about this in the presentation, but the health center has focused on addiction support thus far. The HAPPY program
tools presented earlier and sobriety support wereeasy to use since they were packaged, and they
have been widely used due to the large numberof subjects. I think that collaboration with healthcare and workplaces is important. There werealso stories of how it linked to suicide countermeasures, but given that the percentage of suicides among those in their 40s and 50s is high,there does seem to be data showing that excessive alcohol consumption seems to be a problem
here as well, so I think that interventions in collaboration with mental health are necessary. Ultimately, I think that conducting these actions in
a comprehensive and multi-occupational manner is important. I was not able to introduce thisin the presentation, but every year, a gatekeeper
class is offered by the Japan Beauty General Incorporated Association and National Association of Grooming and Hygiene Associations involving talks about health education, such as thedissemination of alcoholic drinks. I feel that it isimportant to have interventions in a variety ofplaces.
Matsumoto: The preventive course was executed during a limited time to begin with, sowhat we wanted to focus on the most was humanresource development. Human resources remainin the community, so the philosophy was to develop human resources in the community so thatthey would remain even when the preventive
course had been completed. We therefore focused our energy on this aspect. We studied cognitive behavioral

approaches, trauma issues, early intervention in
workplaces, and education with highly motivatedpeople in the community. We built a networkwith these people — the “pay-it-forward” methodthat was mentioned earlier. Our ideal vision wasthat it would continue to self-propagate throughlearning about these topics together.
Obara: Thank you.
Okamoto: Thank you. I think a number of important keywords were mentioned there. This is
the “fostering of social capital” mentioned in Dr.
Noguchi’s lecture, and the issue here is how to
expand the project while thinking about how toutilize residents’ power. I would like to ask Dr.
Noguchi: I am personally of the belief that
health centers and psychiatric social welfare
centers are the institutions that conduct project
evaluations in Higashimatsushima, but is thisthe case?
Noguchi: It is not like we have been able to do
this sufficiently either, but it is true that theseroles will need to be taken on in the future. However, it is not necessarily the case that the Psychiatric Social Welfare Center can conduct all ofthese specialized tasks alone. I think that the university has a large presence in this aspect. Okayama University is in our region, and we also
have connections with Okayama University andthe epidemiology classroom. The university has
many evaluation tools, so I think that an ideal
path forward is to have on-site municipalities
and health centers investigate how to use thesetools, with us joining them in these investigations.
The social capital surveys were conducted inthis way as well, and we faced many difficulties
in making adjustments when it was just municipalities, health centers, and the university. I
think that the Center acted as a cushion in thisregard. Ultimately, I think it is important to conduct these together. I think that this would leadto an easy-to-use, valid, and versatile evaluation
scale. Even for us, this is still an issue.
Okamoto: Thank you. I would like to open thefloor up to others.

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FY2019 Bulletin Vol. 8
Kaneda: I am the chief priest of Tsudaiji temple
in Kurihara and the vice-chairman of the Society
for Interfaith Chaplaincy in Japan. At around thesame time as Dr. Matsumoto’s course, a coursewith the objective of providing mental healthcare in affected areas called the “Practical Religious Studies Endowed Course” was establishedat Tohoku University. This project developped
and became a national-level initiative.
I would like to ask Dr. Matsumoto how persons with a psychiatrist’s perspective address
various problems rooted in Japanese culture,such as grief due to bereavement and the whereabouts of the dead.
We have also created various ethical codesand conducted workshops so that we can collaborate, while keeping in mind the politico-religious separation that has existed until now.
While repeatedly conducting these activities, we
actually were informed by DPAT that approximately 80% of the psychiatric field should be in
the field of religious figures, the remaining 20%
should be overseen by DPAT, and that they werevery much interested in cooperation.
I did not hear about cooperation with religious figures from any of the six speakers today,
but I would like to hear opinions on this aspect.
I believe that this is an opportunity for us religious figures.
When speaking with the former mayor of
Iwanuma the other day, he mentioned that hewished that he had recognized this aspect earlier.
I feel that the work we do often crosses into thefield of psychiatry. Of course, there are many
types of religious figures, but I am of the belief
that we could cooperate in these types of grayareas.
In fact, I went to Ishinomaki yesterday, and I
believe that very long-term mental health care isneeded. Instead of eliminating one symptom at atime, to properly clear out the problem from theroot — I acknowledged, once again, yesterdaythat it would be a very long time before thesepeople can function while carrying such burdens.
I would like to hear each of your opinions on this,incorporate this into the clinical life and deathstudies course, and collaborate together.

Okamoto: What does everyone think about
this? Does anyone have any experience collaborating with religion? Dr. Matsumoto, how aboutyou?
Matsumoto: When we discuss the biopsychosocial model, it is often said that the spiritualmodel is more integrated. However, in reality,
the majority are still stuck in the biopsychosocial
model. When looking comprehensively at humans in psychiatry, there are models that incorporate spirituality in a broad sense.
Meanwhile, in the so-called medical model,
when the framework is such that the spirit is handled on the basis of medicine, there is the inevitable problem of the range of boundaries, of how
religion can do science, and how science can enter religion. It is actually difficult to collaborate,
but in contrast, at the field level, there are many
aspects that the individuals at DPAT mentioned,
that is, aspects that do not fit into the current
medical model.
I think that it is important to gradually segregate, or sort out, the gaps between religion andscience, with regard to the respective boundaries
of religion and psychiatry.
I have known about the activities for a longtime, and I believe that they are very valuable
activities, but I also think that collaborating inthis manner is more on an individual basis. I am
not sure if I have answered the question, but I
have spoken a bit on the model.
Okamoto: Dr. Noguchi, your response?
Noguchi: There was talk about what to do tocare for those who lost their families in WesternJapan, and the Disaster Mortuary Operational
Response Team (DMORT) was established at
the Japanese Red Cross Society. Nurses were at
the center of the team, and their primary role wasattentive listening. In that sense, I feel that there
were parts that were heavily linked to religion
here, in that there was no medical aspect and thefocus was to listen to individuals’ stories. However, they could not collaborate on specific experiences, so I think that having such a form
would be ideal. Furthermore, with regard to suicide countermeasure workshops, I think that it
would be ideal to work together with Christian- 28 -

FY2019 Miyagi Mental Care Forum Implementation Reportgroups, and consider and act on various ways torespond to community needs. Unfortunately,
there were no Buddhist groups there, but perhaps
in the future this would be ideal.
In fact, there are many active religions in addition to Christianity overseas. I think that thepsychiatric role that religious figures play has
been intensely discussed, particularly in the fieldof multicultural psychiatry. I hope to see moreof it in the future.
Matsumoto: One other thing I would like to add
is the concept of personalized medicine in psychiatry, wherein treatment is individualized foreach person. Scientific reproducibility is sought
at a group level by taking the average of groups
composed of several hundreds of patients. However, when it comes to views on life and death,
this becomes an individual issue. I think that thisis an area in which science is very weak. Individualization is becoming a very rapidly growing need, so I think that there may be an avenue
for religion to enter the picture through this individualization aspect.
Okamoto: Thank you. Does anybody else haveany other questions or opinions? We would liketo hear them.
Kayama: My name is Kayama from Tohoku
Bunka Gakuen University. Dr. Matsumoto summarized how to increase the number of instructors in the prefecture and how to disseminate
them, but I would like to hear what the people
who participated in the workshops for professionals think about how many people should bein which field and what the next generation of
instructors should be like. I am curious to hear
what they think is needed in order to create a system that can contribute to the improved qualityof the various staff of Miyagi Prefecture.
Matsumoto: Thank you for the question. For
example, there are workshops for general supporters. These are workshops that target beginners, and there is a wide range of people, such as
public health nurses, occupational therapists,
psychiatric social workers, and persons at nonprofit organizations (NPOs) in the field of support who have no professional

qualifications. These kinds of training needs arelikely present everywhere. I think that this will
be at a level where all occupations should havebasic skills.
There are also higher levels of training, suchas workshops where cognitive behavioral therapy is continuously conducted. There are also
workshops that address individual problems,such as problems related to trauma. We conduct
trauma workshops that target child psychiatrichospitals, child guidance centers, and professionals who work with those children, and we
also have workshops that impart skills to professionals who deal with children so that they can
go one step further in terms of developing theirskills. In this way, we are engaged in human resource development. I think that it would begood to have an image like this for the content
of each training program.
I think that the issue is thinking about wanting to develop these kinds of human resources orwhether we should develop these other kinds ofhuman resources for the entire prefecture. Thereis also the aspect of strengthening health centersor identifying problems in municipalities or onsite, premised on wanting to support them as
well, based on needs, as Dr. Noguchi mentioned.
I think that what is important is to think about
what human resources need to be developed, andwhat the needs are, and then developing them ina planned manner. Furthermore, setting up strategies on a step-by-step basis and doing the workto achieve the set goals is important. The ideal
form for this is not to do this on a one-off basis,but to continuously plan for it over several years.
Kayama: Thank you. I think that the previous
story about project evaluations and needs would
qualify as Dr. Matsumoto’s example. With thattogether as well, I was wondering whether thiswould integrate with the needs of municipalities,
such as through human resource dispatches ortraining projects, and I am interested in the answer. Thank you.
Okamoto: Thank you. Ultimately, it is important to develop human resources on a daily
basis, and we have begun to see in stories thattraining in various forms that meet on-site needs- 29 -

FY2019 Bulletin Vol. 8
is important. Does anybody have any other questions?
In that case, today’s theme is thinking about
mental health care in the future, so the issue is
how to develop post-earthquake disaster efforts inthe community. I would also like to hear about
how to start new efforts; for example, aspects thatwould serve as a reference for those in the cities,
towns, and health centers. In Part 1 of Dr. Noguchi’s talk, there was a discussion on a cycle thatis born from preventive activities, and how an extremely positive effect can arise from residents’perspective in terms of cost as well, but if there
are additional things that you urgently feel theneed to communicate, or if there are things you
would like more people to know, then I would
like the people who reported today to speak, starting with Minamisanriku.
Uesugi: This may be slightly off topic, but Dr.
Noguchi’s talk mentioned the need to have serious conversations about when to transition to municipalities. I have been seconded to
Minamisanriku from April of this year, but prior
to this, I was working at the Kesennuma Regional
Center, and then I was seconded from the regional
center to Minamisanriku. I had a very positive experience, since I was able to see a variety ofthings after going into the town. I have gotten
closer to the public health nurses, and being able
to exchange opinions with them has also been apositive experience. I was able to communicate
the thoughts and intentions of the Kesennuma Regional Center, and I was also able to communicate the public health nurses’ concerns along withmy wishes to help them to the regional center, so
I felt that this role was extremely important. I
have considered these points with regard to thetheme of how that region should transition.
Okamoto: Thank you. I would like Dr. Noguchi
to provide some summarizing advice at the end.
Ms. Abe from Higashimatsushima, do you have
any remarks?
Naomi Abe: What I would like to communicate,at the very least, is as follows. What left a major
impression on me was that regardless of problem
cases or anything else, I could not do anythingalone: this project was able to succeed to thispoint through various people’s cooperation. For
this reason, I have reached out to many people
asking for help, and those people helped me, so
I am very grateful to them. I think that I will ask
for their help again in the future, but I hope thateverybody will do so in the future. Thank youvery much.
Okamoto: Thank you. Ms. Abe from the Iwanuma branch, do you have any remarks?
Manami Abe: This might overlap somewhat,
but when advancing the health center’s projects
on a daily basis, and while advancing separate
problematic cases, I have felt that collaboration
with municipal officials was indeed extremely
important, and I am extremely grateful for their
help. Yamamoto town also collaborated with me
on individual cases. It was extremely easy to introduce sobriety support in Yamamoto town,
and I have also felt that these daily connections
were extremely important when entering Natori
as well, so I look forward to continuing to workwith them in the future.
Okamoto: Thank you. Dr. Matsumoto. If you
would please share some remarks?
Matsumoto: After listening to each practice report and Dr. Noguchi’s presentation, I am
simply impressed by the work that has been discussed today. New individual attempts are being
made in the community, and ultimately, alcohol
problems emerged as a community need, so efforts to combat alcohol problems were begun,and further efforts to address emerging problems
have been initiated. When something good happens in Kesennuma, let us also try it in
Minamisanriku; if something good is happening
at the national level, then let us try it over here
— new efforts are actually being made in affected areas, outcomes are being recorded indata, and they are being verified to see whether
they are useful. I feel that these practice reports
themselves are incredible.
Meanwhile, since these are affected areas,
places like the Mental Health Care Center andour preventive course are receiving funds andcreating a budget. The utilization of this budget
is ultimately serving as the catalyst. I think that
we have been able to connect with professionals- 30 -

FY2019 Miyagi Mental Care Forum Implementation Reportnationwide; the community has been making
connections within itself, and these connections
have been activated. I think that it is possible thatthe budget will be used to strengthen cooperation in many ways. Therefore, one concern isthat the budget, the disaster reconstruction
budget, will be continuously cut in the future. I
think that one of the aims of this forum is to think
about how to ensure that what has shown a meteoric rise until now does not get carved awaywith future budget cuts.
Therefore, I am amazed at the work being
done, and at the same time, I think that there is aneed to contemplate what needs to be done tocontinue and develop these projects, and also foreveryone to make more appeals to collect money
instead of operating on the premise that themoney will disappear. The budget will inevitably decrease. More developed countries tend to
spend their budget on prevention. Countries withless money tend to pump more and more money
into the problems that are right in front of them,but I think that Japan needs to spend moremoney on both health and prevention. It is just afeeling of mine that we as a country need to advance in that direction in the future. Thank youvery much.
Okamoto: Thank you very much. I appreciate the important remarks you have madethat will guide us into the future.

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