1. Changing Mental Health Policy in Korea Dong-Won Chang, M.D., Ph.D. Director, Seoul National Hospital

2. CONTENTS  Introduction  History of Mental Health Policy  Pre-Mental Health Act Era  Post-Mental Health Act Era  Future Plan

3. 3 Mental Health Issues in Korea  Stigma  Inadequate infrastructure of mental health system  Unmet needs of major psychiatric problems  Increases in suicidal mortality  Rapid Aging  Mental health after unification

4. 4 Prevalence of Mental Disorders in Korea Source: Seoul National Hospital. et al., The Epidemiological Survey of Psychiatric Illness in Korea, 2001

5. 5 Treatment Rate of Mental Disorders in Korea(2001) (%) All MD (except for nicotine) Mood Disorder Psychotic Disorder Alcohol use Disorder Source: Seoul National Hospital. et al., The Epidemiological Survey of Psychiatric Illness in Korea, 2001

6. History of Mental Health Policy

7. 7 Pre-Mental Health Act Era ( ~ 1995)  Before 1970 Burdens of mental disorder Absorbed by extended family in agricultural society Were not social issues Absence of mental health policy in national level Paucity of public mental health facilities (‘ Seoul National Mental Hospital’, 360 beds in 1962) No responsible office in government Pharmaco-/psychotherapy began in Univ. Hospitals

8. 8 Pre-Mental Health Act Era  From 1970 to early 1980’s Rapid industrialization & urbanization Rapidly growing nuclear families didn’t take charge of family burdens of mental disorders Increase in homeless patients in cities Deficiency in mental health service Increased demand for public mental health facilities Increase in illegal, non-medical mental health facilities (religious asylums) Nonscientific treatment based on traditional shamanism

9. 9 Pre-Mental Health Act Era  From 1983 to early 1990’s First nationwide mental health awareness Mass media raises issue on illegal asylum (“60 minutes”) Mental disorder became social issue The first governmental action for national mental health policy Focused on changing religious asylums into non- psychiatric nursing homes with minimum service for treatment & human rights Expanding national mental hospitals to 5 regions Expanding psychiatric beds, mainly in private sector Oriented toward cost saving long-term institutionalization, with limited insurance coverage

10. 10 Post-Mental Health Act Era  Enactment of Mental Health Act (1995) Human right oriented legal system Protection from inhumane institutionalization or illegal involuntary admission Focused on optimal process of hospitalization More humane institutional/hospital environment Basic conditions for community mental health system development Establishment of mental health department in Ministry of Health & Welfare Enforcement for mental health administration in local government Proliferation of community based psychiatric rehabilitation facilities Legal support for community mental health project

11. 11 Post-Mental Health Act Era  Revision of Disability Act Socioeconomic support for mentally ill patients in the community  Efforts in long-term mental health policy development Health Plan 2010(2002-2010)

12. 12 Development of Community-based Mental Health Facilities

13. 13 Changes in the Rate of Psychiatric Beds OECD Nations(1980 – 2000) Unit : beds/1,000 Source: OECD, OECD Health System: Facts and Trends. 2002

14. 14 Future Mental Health Policy in Korea  Health Plan 2010  Sectorization  Organization of KNIMH

15. 15 Health Plan 2010 : Major Objectives 1.Exercise 2.Nutrition 3.Cigarette smoking 4.Alcohol drinking & drug use 5.Stress 6.CVD 7.Cancer 8.Diabetes 9.Injury 10.Arthritis 11.Mental health 12.Oral health

16. 16 Focus areaPresent(‘95~’98)Goal of 2010 Health Promotion Amount of alcohol consumption/person 8.7 ℓ7 ℓ Prevalence of alcohol drinking in adolescence 21.0 %5.0 % Disease Prevention Prevalence of mental disorders (including alcohol) 14.4 %10 % Treatment prevalence of mental disorders 2.7 %3.2 % Prevalence of stress experience (per 1,000) 36.732.7 Suicidal death (per 10 5 ) 19.915.9 Health Plan 2010 : Mental Health Index

17. 17 Mental Health Plan 2010  Development of Community Mental Health System  Expansion of Social Rehabilitation Facilities  Expansion of Alcohol Centers  Expansion of Mass Education & Prevention Project  Prevention of Suicide  Prevention of Accidents/Crimes by Mentally Ill Patients  Improving Human Rights and Encouraging Participation of Mentally Ill Patients

18. 18 Sectorization  5 sectors of national mental health system Based on 5 National Mental Hospitals  National Mental Health Promotion Center National & Regional Mental Health Support Board Regional Mental Health Promotion Center To establish the leadership for community mental health system in each sector To support mental health worker to put policy into practice To resolve local challenges in developing mental health To connect mental health research, development, delivery, monitoring and review

19. 19 Organization 0f KNIMH  Mission/Goal To improve quality of life for all mentally ill, and reduce the burden of mental and behavioral disorders through research on mind, brain, and behavior To generate research that will transform prevention of and recovery from mental disorders  Major objectives Epidemiological study Mental health services development and intervention research Mass education and prevention research Sociocultural research

20. Seoul National Hospital www.snmh.go.kr