title: Developing a Consensus-based Definition of "Kokoro-no Care" or Mental Health Services and Psychosocial Support: Drawing from Experiences of Mental Health Professionals Who Responded to the Great East Japan Earthquake.
abstract: OBJECTIVE
  In this survey, we aimed to build consensus and gather opinions on 'Kokoro-no care' or mental health services and psychosocial support (MHSPSS) after a disaster, among mental health professionals who engaged in care after the Great East Japan Earthquake.
  
  
  METHODS
  We recruited mental health professionals who engaged in support activities after the Great East Japan Earthquake, which included local health professionals in the affected areas and members of mental health care teams dispatched from outside (n = 131). Adopting the Delphi process, we proposed a definition of 'Kokoro-no care', and asked the participants to rate the appropriateness on a 5-point Likert scale. We also solicited free comments based on the participants' experiences during the disaster. After Round 1, we presented the summary statistics and comments, and asked the participants to re-rate the definition that had been modified based on their comments. This process was repeated twice, until the consensus criterion of ≥ 80% of the participants scoring ≥ 4 on the statement was fulfilled.
  
  
  RESULTS
  In Round 1, 68.7% of the respondents rated the proposed definition ≥ 4 for its appropriateness, and 88.4% did so in Round 2. The comments were grouped into categories (and subcategories) based on those related to the definition in general (Appropriate, Continuum of MHSPSS, Cautions in operation, Alternative categorisation of care components, Whether the care component should be categorised according to the professional involved, Ambiguous use of psychology, and Others), to mental health services (Appropriate, More specification within mental health services, More explicit remarks on mental health services, and Others), and to psychosocial support (Whether the care component should be categorised according to the professional involved, Raising concerns about the terms, and Others), and others.
  
  
  CONCLUSIONS
  We achieved a consensus on the definition of 'Kokoro-no care', and systematically obtained suggestions on the concept, and practical advice on operation, based on the participants' experiences from the Great East Japan Earthquake. This collective knowledge will serve as reference to prepare and respond to future disasters.
authors: Department of Adult Mental Health, National Center of Neurology and Psychiatry, National Institute of Mental Health, Kodaira, Tokyo, Japan.
authors: Yuriko
authors: Y
authors: Suzuki
authors: Department of Adult Mental Health, National Center of Neurology and Psychiatry, National Institute of Mental Health, Kodaira, Tokyo, Japan.
authors: Maiko
authors: M
authors: Fukasawa
authors: Department of Adult Mental Health, National Center of Neurology and Psychiatry, National Institute of Mental Health, Kodaira, Tokyo, Japan.
authors: Satomi
authors: S
authors: Nakajima
authors: Translational Medical Center, National Center of Neurology and Psychiatry, National Institute of Mental Health, Kodaira, Tokyo, Japan.
authors: Tomomi
authors: T
authors: Narisawa
authors: Graduate School of Musashino University, Koto, Tokyo, Japan.
authors: Asano
authors: A
authors: Keiko
authors: Department of Adult Mental Health, National Center of Neurology and Psychiatry, National Institute of Mental Health, Kodaira, Tokyo, Japan.
authors: Yoshiharu
authors: Y
authors: Kim