Mental health policy making in South Korea: structural and cultural influences

Abstract

This study focuses on the way in which rapid structural changes (such as economic development, urbanisation and other demographic factors, and the economic crisis of 1997) have raised issues that are seen to require a social policy response in the mental health care arena under Confucian governance in South Korea. These structural changes happened over a couple of hundred years in Western Europe but have taken place over only the past 40 years in Korea. The main thrust of the study is on the extent to which the decisions about policy responses to perceived social problems, especially the increasing number of people with mental health problems, are structurally driven or the extent to which they are informed and shaped by Korean politics and culture. The industrial and economic base of Korea grew dramatically until the late 1990s. This facilitated the development of social policies - particularly in areas such as education, health and housing, which support economic growth. However, although the structure of the family changed to be closer to its structure in the West, it could be argued that evidence pointing to a broader ‘Westernisation’ of Korean society was premature. Confucianism may have been a factor in Korea's development, but it may yet prove a hindrance to any further moves to modernity and equalisation of life chances amongst its citizens. Since the economic crisis of 1997, Korea has experienced a rapid expansion of social welfare provision following a series of reforms. These reforms have gone beyond the functional minima necessary to deal with social problems caused by the economic crisis. However, the government has tended to stress the greater role played by family members, particularly women, in providing care to their elderly relatives, and the desirability of multigenerational households over nuclear families. A similar emphasis on the caring roles of the family and community is also seen in the Korean state's renewed public emphasis on the country's Confucian cultural tradition. As a result of this, there has been a tension between the increased emphasis given to the role of the informal carer within mental health policy as the Korean government has introduced a community-based scheme which assumes that families want to care and those with mental health problems want to be cared for by their families. Accordingly, the main burden of care falls upon women. This still tends to be ignored by policy makers. Despite the country's rapid demographic, economic and social changes, there has been a widening gap between the population's expectations and needs and health and social service provision in the mental health arena. Neither long-term care services nor personal social services are well developed for those with long-term mental health problems. In addition there is a marked disparity between the acute services, which are predominantly provided by private sector organisations in a highly competitive market and broadly achieve high standards, and public primary care and rudimentary residential services in the mental health arena. In this context, it could be argued that Korean mental health policy is concerned with maintaining social order rather than care and treatment of those with mental health problems