Document I

Second Operation Plan of the Miyagi Disaster
Mental Health Care Center (Summary version)
FY 2021–FY 2025

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Purpose of plan
The prefecture has indicated a policy of continuing mental health care even after FY 2021 andformulated the “Miyagi Prefecture Mental Health Care Initiative Policy for FY 2021 Onward” inAugust 2020. Based on this, the Center decided to formulate a second operation plan to clarify thebasic principles and policies of operation during the five-year period from FY 2021 to FY 2025.

Initiatives and issues to dateResident support
We offered victim support upon the request ofmunicipalities by sharing the role of support center
support staff and others who supported residents
requiring follow-up after health surveys. The
number of requests for support for older adults
living alone and cases with multiple problems, suchas alcohol-related problems, has increased, and weprovided support in cooperation with relatedorganizations in municipalities and communities.
These initiatives were indispensable for the early
detection and early support of various issues.
We conducted forum activities for apartment-type
rental housing residents, who tend to be isolated, incollaboration with municipalities and relatedorganizations. These initiatives were effective inpreventing isolation and deterioration of physicaland mental healthRelocation to public housing has progressed, andthe number of cases that lead to support from healthsurveys has decreased. Collaborations andrelationships of trust were established withmunicipalities and related organizations through theactivities. We have received more requests forsupervising and accompanying visits of difficult
cases, such as shut-ins

Support for supporters
Projects on alcohol-related problems and suicide
prevention measures have led to the effective
development of projects in line with community
mental health and welfare issues as a result ofcooperating with municipalities and health centers.
The Center adopted a secondment system from anearly stage to dispatch staff to municipalities upon
their request. These staff members responded tovarious issues that arose in the disaster area after thedisaster, such as overseeing mental health andwelfare projects and difficult cases, and they werehighly regarded by the municipalities.

Medicine at Tohoku University based on requests
from municipalities, and we provided individualconsultations. We have seen promising results, suchas increased awareness of the importance of mental
health measures in the workplace through thecontinuous provision of support.
We established staff member counseling service
booths with the cooperation of the Department ofPreventive Psychiatry of the Graduate School ofMedicine at Tohoku University based on requests
from municipalities, and we provided individualconsultations. We have seen promising results, suchas increased awareness of the importance of mental
health measures in the workplace through thecontinuous provision of support.

We established staff member counseling service
booths with the cooperation of the Departmentof Preventive Psychiatry of the Graduate School ofRaising public awareness.We cooperated with community residents’workshops held by municipalities. The use of picturestory shows and skits that made the topics feel morefamiliar to the residents was effective in improving
the mental health of the inhabitants.

This was effective in improving the physical andmental health of residents who tended to be isolated
after moving into public housing or relocating.
Moreover, we disseminated various information,such as the Center’s activity status and training, on
the homepage and workshops, which led to anunderstanding of mental health issues and alcoholrelated problems among residents.

We cooperated with municipalities and relatedorganizations to try to understand residents who
tended to be isolated, and we held forums and variousclasses.
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Children’s Mental Health Care
Community Base Project

Basic principle and basic policy

We responded to consultations from children and parents
through walk-ins and home visits. The number of handled cases
is increasing every year, and the content tends to be complicated.
For the professional dispatch project, which has the objective ofproviding professional advice to supporters, we provided Center
staff-based supervision upon the request of municipalities,
dispatched professionals (e.g., clinical psychologists andpsychiatric social workers), conducted case studies withmunicipal managers and others, and responded to consultations.
This was an opportunity for municipal managers to recognize
the usefulness of collaborating with external professionals.
We also invited instructors from outside of the prefecture toconduct training for educators and supporters. There was muchinterest from public health nurses, nursery teachers, school
teachers, and others, and there were many participants in eachsession.
We conducted the “Children’s Cohort Study” in threeprefectures in the Tohoku region (Iwate, Miyagi, Fukushima) toevaluate the transformation of children and families and clarify
efficient support. This is expected to offer valuable data, and itis thought that the project should continue into the future.

Human resource development
We took up a wide range of themes in response to requests
from related organizations and supported the mental healthpromotion of victims. Initially, we received many requests forcooperation in earthquake-related lectures and training, such as
stress and PTSD following the earthquake. Over the years, thetopics changed to alcohol-related problems, suicide prevention,
and workplace mental health.
We have conducted on-the-job training for alcohol-relatedproblems since the opening of the Center after being entrusted
by Tohokukai Hospital. We receive many requests every year.
Many community medical organizations and local government
officials have taken the course. However, although the numberof graduates is increasing every year, we have faced difficultyin raising the level of community supporters owing torelocations at the affiliated location. In the future, we may needto collaborate with municipalities and health centers to continue
studying the training content.

ResearchThe bulletin published every year and the official activity
record published in FY 2020 are also the result of a detailed
summary of the activities in the Center to date.
The Miyagi Mental Health Care Forum, which was started inFY 2017, was planned as a venue for sharing and understanding
the current situation of the disaster area as well as investigating
the reconstruction of community mental health and welfare in
the future. As support organizations continue to withdraw fromthe region every year, there have been fewer places for where
supporters can gather and exchange ideas. Visitors have noted
the necessity of these types of plans.

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Basic principle

Improvement of community mental
health welfare in disaster-affected areas

Basic policy Implement “seamless support for residents, fromchildren to adults.”
 Resident support involves mental health care
activities centering on outreach, based onaccompanying visits with related organizations,such as municipalities.
 Support for supporters involves implementing
activities that contribute to the improvement of theskills of supporters through case studies andconsultations. It should aim for support relating to
the mental health of supporters.
 Raising public awareness involves activities
relating to mental health for community residents
that prioritize preventive viewpoints to deepen
understanding and interest in the mental health ofresidents, delivered in cooperation withmunicipalities.
 Implementing activities must be with theperspective of handing down the experiencecultivated in past activities, such as summarizing
the ideal way of support to be utilized in the eventof a future disaster. The activities that the Centerhas overseen will be valuable knowledge of mental
health care activities in the event of a disaster.
 Activities must be conducted according to theactual circumstances of municipalities while
collaborating and cooperating with relatedorganizations, such as municipalities, to improve
community mental health and welfare activities.
The transition of various projects must be
systematically implemented in anticipation of theconclusion of activities in FY 2025.

Project plan
Resident support
 There is a need to focus on older adults living alone, isolated individuals, infants and schoolchildren, people
with alcohol-related problems, and those who have other problems, such as being a shut-in.
 Cases with multiple issues are increasing. We will conduct visits and consultations with municipal and healthcenter public health nurses to provide seamless support to residents, from children to adults. Furthermore, we
recognize the need to cooperate with medical and welfare-related organizations in the community and to shift
to community mental health and welfare activities while responding by teams.

Central issues to be addressed in the next fiveyears

Plan

We will collaborate with related organizations to conduct consultation support activities for community
residents who require mental health care, such as residents with psychological burdens after the disasteror residents who have become further isolated owing to changes in the community. We will seek toimprove community mental health.

Support for supporters

 Supporters who oversee support activities in disaster areas will continue to be important players inreconstruction, and follow-ups on supporters represent an important task. We will supervise individual caseswith an eye toward human resource development and provide technical support, such as accompanying visits,with an aim toward skill improvement of supporters. We will collaborate with health centers and mental healthwelfare centers depending on the local circumstances.

PlanWe will provide professional advice and accompanying visits for supporters to help them address a wide
range of mental health issues. We aim to further improve the skills and reduce the psychological burdensof supporters by providing opportunities for various professional training (including self-care).

Raising public awareness Activities for raising public awareness among residents, to improve the mental health of community residents
and preventing aggravation of any illnesses, will be conducted in collaboration with municipalities and healthcenters using various methods that we have cultivated. We will further establish the understanding and interestof residents toward mental health.
 Regarding places to gather, such as various forums with which the Center has been involved, there is a needfor continuously providing a place where residents can connect and be active, and for investigating the ideal
form of such activities in collaboration with municipalities and related organizations.
 The bulletin and its English translation, the official activity record compiled in the final fiscal year, and othermaterials are published on the homepage. The practice of the Center to date can be utilized for new disasters.
The keeping of various documents relating to raising public awareness issued by the Center, such asorganizing them by phase, is also an important issue to consider.

We will continue to disseminate information to further establish and deepen the retention of information on
mental health that has been spread in the wake of the earthquake. We will provide places where people canPlan casually gather. We will also deliver lectures to residents who work during the day, and we will use various
methods to provide necessary information to all community residents. Furthermore, we will collect theknowledge gained through long-term activities and disseminate the results to contribute to future disastercountermeasures.

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We will visit residents who require support upon the request ofmunicipalities. For difficult cases, we will collaborate withrelated organizations to strengthen the team-based support
system. We will promote the transition through these activities sothat we can respond as part of the community mental health andwelfare activities, where local governments, relatedorganizations, and community residents work together.

Supporter consultations
We provide professional advice
from the perspective of mental
health in response to requests
from supporters regarding thehandling of difficult cases andproject management.

Community resident exchange project
Regarding places to gather, such as various
salons with which the Center has been
involved, we will continuously provide
places where residents can connect and beactive. We will investigate the ideal formof such activities in the future, incollaboration with municipalities andrelated organizations.

Supporters’ mental health support
We will conduct training andinterviews for supporters at therequest of municipalities, withthe aim of self-care promotion
and skill improvement.

Mental health public awareness promotion
project
We will make efforts that utilize the various
methods we have cultivated to further establish
the understanding and interest of residents towardmental health. Furthermore, we will provide
information on mental health to elementary,junior high, and high school students in theprefecture. We will also disseminate professional
knowledge and skills to related parties at therequest of local governments.

Support for supporters involved inchildren’s mental health care
We will provide consultations andtraining for supporters throughcohort studies. We aim to provide
effective support for children’s
mental health care.

Dissemination of mental healthinformation
We will disseminate information
on mental health through public
relations magazines and thehomepage to deepen
understanding among residents.
Additionally, we will actively
disclose materials to utilize theknowledge that the center has
cultivated for new disasters.

Annual activity
report creation
project
We will summarize
the activities foreach year andprovide activity
reports to relatedorganizations.

Promotion of plan
① Progress management

After the end of the half term, manager-level
employees and above will confirm and evaluate theimplementation status of the operation plan. The
steering committee will also evaluate the status.

② Promotion system

The system will gradually shrink as we move toward theconclusion of activities in FY 2025. Meanwhile, outreach bymultiple occupations and support for supporters need to be
developed as an important project of the Center. We willsecure a personnel system according to the amount of workand promote this work.

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