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[Feature] Patients alienated as mental illness falls through cracks in system

Is it safe to live with people with mental disorders? This is the question many South Koreans are asking after a series of highly publicized crimes committed by people with psychological conditions.

In a country where mental illness has long been stigmatized and patients removed from the community, reports of traffic accidents and crimes committed by those with mental illness are viewed with great alarm.

But mental health groups and advocates question whether the mental health information is even relevant.

“When a person with diabetes is responsible for a traffic accident, we don’t point to diabetes as the reason for the accident. The same perspective should be applied to people with psychological disabilities,” Lee Jung-ha, the leader of Padoson, a human rights group advocating on behalf of people with psychological disorders, told The Korea Herald last week.

Lee, who has schizophrenia, is leading the efforts to eliminate prejudice, push for changes to the laws and implement diverse peer support programs.

Those changes include the recognition that people with mental illness are people with disabilities who need access to support.

A total of 120,000 people with mental illnesses were registered with the government as of last year, of whom 70,000 have been institutionalized, according to the National Health Insurance Service.

In Korea, people with mental disorders are required to register with their neighborhood community service centers. Using a calculation method employed in the US, however, the figure stands at around 500,000 people, which means approximately 1 percent of the total population is afflicted with a psychological condition, according to the National Human Rights Commission of Korea.

In terms of the number of crimes reported, of the 28,927 violent crimes reported in 2017, people with mental disorders were responsible for 813, according to data from the National Police Agency.

The idea that people with mental disorders are more likely to cause trouble is prejudiced, Lee emphasized.

“The vast majority of people with psychological disabilities do not hurt others. We grapple with social prejudices and mental abuses, and in turn, we end up hurting ourselves. This is evident in the high suicide rate, which clearly no one pays attention to,” Lee said.

In 2017, 12,463 people died by suicide, and 31.7 percent of those deaths were related to mental illness, according to data jointly released by the Ministry of Health and Welfare and the Korea Suicide Prevention Center earlier in the month.

The rate of suicide was eight times higher among people who had a mental illness than those who didn’t have one, according to the National Mental Health and Welfare Commission, citing data from 2016.

What is wrong?

“In Korean society, people with schizophrenia undergo long-term hospitalization, receive poor quality medical service and unilateral treatment programs. These lower (the capabilities of) of all people with mental disabilities, causing frequent relapses, failure to return to society and serious regression. Each disabled person is different, with different skill sets and academic degrees. This is not taken into consideration,” Lee said.


Echoing Lee Jung-ha, Lee Hang-kyu -- who has a family member struggling with a psychological disability – said, “Mental disability is not subject to cure, rather welfare.

“Unless we recognize mental disorders as a disability, there is no welfare available. This, coupled with biased social perception and poor treatment systems, we are faced with poor conditions,” Lee Hang-kyu told The Korea Herald in a phone interview.

Lee Hang-kyu is the chairperson of the southern Gyeonggi Province division of the Korea Family Association for the Mentally Disabled.

“Mental disorder is not completely curable because it is a disability. A comprehensive approach that involves a social worker, psychologist and job training is needed, among others. The ultimate goal is to help us find a job and live inclusively in the community,” Lee Hang-kyu added.

Patient advocates point to Article 15 of the Welfare of Disabled Persons Act -- which in effect disqualifies mental illnesses as a reason to access support from welfare facilities for people with disabilities.

Though many people suffering from mental illnesses and their families seek psychotherapy, it is out of reach for many due to high costs that are not covered by the National Health Insurance Service.

“For a stable mental health care system, psychiatrists, nurses, social workers and psychologists have to work as a team. But psychologists are excluded from treatment and South Korea is the only OECD member country that does not have government licensing for psychologists,” said Chey Jean-yung, a professor of psychology and neuroscience at the Department of Psychology of Seoul National University.

Institution-centered funding

In 2017, the government spent 5.3 trillion won ($4.56 billion) on mental health, of which 4.8 trillion won went to hospitals and mental health welfare centers that are classified as medical institutions. A mere 200 billion won was channeled into community-based mental health care programs.

“It’s a vicious circle. Funding for mental health is mostly spent on institutions, when it should be used for the people. This is why we are prescribed excessive amount of medication and undergo extensive hospitalization,” said Lee Hang-kyu.

A schizophrenia patient is hospitalized an average of 303 days a year in Korea, six times the 2016 OECD average of 50 days, according to the National Human Rights Commission of Korea.

“I was involuntarily hospitalized for six months about 10 years ago but I was lucky to have met a good doctor,” Shin Suk-chull, the head of a peer support center for people with mental illnesses, told The Korea Herald in an interview last week.

“I was locked up in a room, more like a cell, for seven days. I had to shout to be allowed out to use the bathroom,” Shin recalled.

“Treatment for this (mental illness) should be individualized for each patient. Right now, people are hospitalized for way too long, and it (treatment) is centered on the doctors rather than the patients,” he added.

Lack of manpower, budget

Professionals working at mental health welfare centers say that a shortage of workers makes it difficult to pay close attention to each patient they are assigned.

These centers are the only government-run facilities where people can receive treatment and services for mental illnesses after leaving the hospital.

About 1,737 workers at these centers are responsible for taking care of some 75,000 registered members, which comes to 44 members per worker. Some 43 percent of the workers leave the centers within two years due to work overload.

Psychiatrists agree on the need for individually tailored treatments, which can only be realized when there is sufficient manpower.

“In the case of the UK and Australia, when they introduce comprehensive plans on mental health, they include a mid- to long-term supply and demand outlook along with plans for education and a (mental health) system,” said psychiatrist Lee Sang-hoon, who works at the National Center for Mental Health.

He added that plans in many developed countries include not only psychiatrists but also patients, their families, peer supporters and family supporters.

“Most developed countries allocate about 5 percent of their welfare budget to mental health. In Korea, it stands at 1.5 percent. It will be difficult to secure the equivalent level of budget all at once, but we can expect budget increases in many areas starting next year. We plan to expand successful integrative models and increase manpower,” said Kwon Joon-wook, the director of Health Policy at the Ministry of Health and Welfare.

While acknowledging the need for increased spending, Lee Jung-ha of Padoson said increased awareness about psychological disabilities should precede budget expansion.

She emphasized that people with mental illnesses who try to be economically independent are more prone to relapses due to the increased stress involved in finding employment and getting used to a new environment.

“Our society should change to one where we (mentally ill people) do not feel ashamed of our disorders and we are not blamed for them. Instead of heavily relying on drug treatments, we need psychological treatment and vocational training. But most importantly, we need an environment where it is OK to be sick,” Lee said. (