[The action of Amagasaki City Health Center to the train derailment accident on the Japan Railway Fukuchiyama Line].

OBJECTIVES: To examine and describe the reactions of Amagasaki City Health Center to the train derailment accident that occurred on April 25th, 2005 on the Japan Railway (JR) Fukuchiyama Line in order to provide useful information for health centers to help them deal with such catastrophic disasters in the future. METHODS: Each day after the accident reactions and actions were examined and described. They included mental health care provided by the health center for the inhabitants of the condominium building into which the derailed train had crashed, as well as the volunteers who participated in the rescue work. Health checkups were also provided for the latter. RESULTS: Actions directly related to the rescue were continued by the health center for four days after the accident. The mainly consisted of the following. The health center asked hospitals to input information concerming their ability to respond to the emergency situation into the Hyogo Emergency Medical Information System. A relief party was organized by the health center staff and engaged in the rescue and on-site rescue triage. The health center slso coordinated the mortuary work. Two days after the accident, "postmortem triage," to insure that bodies were taken directly to a mortuary after death certification by a physician was needed on site after rescue triage was concluded. The health center confirmed all information for the passengers' safety. The rescue volunteers and the nearby inhabitants who were affected consulted with the person in charge of mental health care provided by the health center from immediately after the accicent for a period of five months to September 30. Health checkups for rescue volunteers were conducted for infections and post-traumatic stress disorder. CONCLUSIONS: This JR accident was characterized by many civilian volunteers engaged in rescue over the relatively long period of rescue of four days. Mental health care and health checkups were needed for civililian volunteers and were therefore provided by the health center. During the four days of rescue, triage was begun immediately after the accident and subsequent postmortem triage was also required.

[A questionnaire survey of mental health and welfare in city health centers prior to the partial amendment of the mental health and welfare law going into effect].

OBJECTIVE: The situation of mental health of health centers in cities prior to the partial amendment of the Mental Health and Welfare Law going into effect was investigated to provide data relevant to mental health and welfare in cities. METHOD: 81 health centers were recruited from designated, core, and ordinance-designated cities as well as the 23 sections of Tokyo City, and were supplied into questionnaires by mail. RESULTS: Less than 10 percent of the health centers had played a central role in establishing rehabilitation facilities. Regarding active support, small community-based workshops were most commonly subsidized. Only 13.3% of the health centers in Tokyo City provided support for daily life training facilities, while 60% had rehabilitation facilities. Seventy percent provided in-home services. More specifically, in contrast to the 64.7% of health centers in the designated cities which provided home-helper services, the figure was only 10.0% in ordinance-designated cities. Regarding the 2000 social adaptation training program, this was put into effect by less than half of the health centers in Tokyo City. No patients were admitted to rehabilitation facilities through 28.6% of the health centers, or underwent the consultation for rehabilitation facilities at 37.1%. Participation in care manager training sessions was low in Tokyo City but high in the other areas. Applicants for the health and welfare handbook and medical expense assistance for people with mental disorders were interviewed in 40.0% of Tokyo City's health centers and in over 70% of the others. There were problems with counter application in 50% of health centers in the core cities but not many in the remainder. More than 70% of health centers in the designated cities and Tokyo put the transfer system based on Article 34 of the law into effect but the percentages were lower for core and ordinance-designated cities. Patients were transferred at 34.2% of the health centers where the transfer system was enacted. Most of the designated cities and Tokyo established a council for mental health and welfare. However, this was the case for only 21.4% of the core cities and many of the ordinance-designated cities did not even consider this matter. Many health centers answered that welfare policy had advanced with the partial amendment. CONCLUSION: The study revealed major gaps among health centers and specific problems with different background types.

[A questionnaire survey of mental health in cities, towns and villages for the partial amendment of the law on mental health and welfare for people with mental disorders].

OBJECTIVE: In accordance with the partial amendment of the Law on Mental Health and Welfare for People with Mental Disorders, some mental health and welfare work has been performed under the jurisdiction of cities, towns and villages instead of prefectures since April, 2002. What is the role of prefectural health centres in supporting cities, towns and villages under the partial amendment? To consider this question in the light of transfer of responsibilities from prefectures to the municipalities, we investigated the situation in municipalities in October, 2001. METHODS: A total of 500 municipalities with populations less than 100,000 were recruited and questionnaire survey was carried out to study the mental health and welfare work, the department in charge and other relevant data. RESULTS: A total of 359 municipalities responded to the questionnaire (the response rate was 71.8%). Mental health and welfare work came under the jurisdiction of 58.5% of the municipalities. The persons in charge were mainly public health nurses and officers and few municipalities had specialists. About 64% of the municipalities had designated a department in charge of the transferred work, but only 16% had designated the number of persons in charge. Although municipalities must provide services for patients living at home as of April, 2002, under the partial amendment, 24.2% of municipalities had already been providing such service previously. About 60% of municipalities had staff who planned to participate in training for care management. For the office work related to the delivery of the health and welfare note for people with mental disorders and public expenditure for hospital expenses, 16.2% of municipalities had designated specialists as persons in charge and 24.2% of municipalities had secured space for privacy. Almost all (98.6%) municipalities pointed to problems in the transfer, which included the shortage of specialists and requested health centres to provide specific information. CONCLUSIONS: Although mental health and welfare work comes under the jurisdiction of over half of the municipalities, few have specialists for this purpose. Support services for patients living at home were often provided by the municipalities prior to the partial amendment of the Law going into effect. As municipalities stressed the shortage of specialists and requested specific information, health centres need to support municipalities from the standpoint of their specialized abilities.

[The actions of health centres in realising the partial amendment of the law on mental health and welfare for people with mental disorders. A questionnaire survey of prefectural health centres].

OBJECTIVE: In accordance with the partial amendment of the Law on Mental Health and Welfare for People with Mental Disorders, some mental health and welfare work is now under the jurisdiction of cities, towns and villages instead of prefecture. What is the role of prefectural health centres in realizing the change? To assess the smoothness of the transfer of the work from prefectures to the municipalities, we investigated the situation in the latter and the actual support provided by health centres. METHODS: A total of 103 health centres in the administrative divisions were recruited. A questionnaire survey was carried out to study the mental health and welfare work, the department in change and other data for cities, towns, and villages in the administrative division of each prefectural health centre. The actions of health centres were also investigated and analyzed. In addition, Japan was divided into 6 blocks of health centres, and comparisons among the 6 blocks were made based on the answers to survey questions. RESULTS: A total of 83 health centres responded to the questionnaire (the response rate was 80.6%), with 683 cities, towns and villages included in their territories about 60% of the municipalities had designated a person in charge of the transferred mental health and welfare services, the responsible department was decided in less than 40% of cases. There were differences among the 6 blocks in Japan in the rates of actions on mental health and welfare, and in the designation of the department in charge in municipalities. Over 95% of the health centres provided educational courses related this transfer of work for municipalities. About 80% of the health centres evaluated the merit of the partial amendment for promotion of mental health and welfare, and 60% were anxious about retrogressive policies for people with mental disorders. CONCLUSIONS: Educational courses supported the smooth transfer of services. The department in charge of the transfer of service in the cities, towns and villages was designated in less than 60% of municipalities.