world : ‘Absolutely Insufficient’: How Data Restrictions and Funding Constraints Hamper South Korea’s Suicide Prevention Efforts

Thursday 13 June 2024 02:45 AM

Nafeza 2 world - If you or someone you know may be experiencing a mental-health crisis or contemplating suicide, call or text 988. In emergencies, call 911, or seek care from a local hospital or mental health provider. For international resources, click here.


On the sixth floor of an office building in the heart of Seoul, eight students strolled into their workplace in a well-ordered procession. After dutifully removing their shoes in the narrow entryway, they trod across the room, then crowded together on a few stone-gray couches. A semi-gloss poster taped to the wall behind their heads proclaimed: “Mental Health Matters.”

These students, all of whom have experienced their own mental health challenges, are peer specialists at Mental Health Korea, a nonprofit network of over 300 high school and university students across South Korea. After completing a training program, peer specialists connect at-risk youth to crisis resources, mentor peers experiencing similar challenges, draw up mental health awareness-raising initiatives, and advocate for policy changes.

“We get a lot of messages from people who say they’re struggling,” Jeongbin Park, a 17-year-old peer specialist, told TIME, adding that in South Korea, talk of mental health is typically met with backlash. “We’re trying to change that.”

That change can’t come soon enough.

From left, Moon Dana, Yeon Gahyeon, Jeongbin Park, Aiden Won Kim, Chang Eun-ha, Derrick Park, Choi Yunu, and Lee Jaehyun—student peer specialists as well as the president of Mental Health Korea—cross a road in Gangnam, Seoul, in April.
Mental Health Korea peer specialists and president Choi Yunu, second from back, cross a road in Gangnam on April 14, 2024.Lim Beom-Sik—Reviere Pictures
From left, peer specialists Yeon Gahyeon, Derrick Park, Moon Dana, Jeongbin Park, Aiden Won Kim, Lee Jaehyun in Gangnam.
From left, peer specialists Yeon Gahyeon, Derrick Park, Moon Dana, Jeongbin Park, Aiden Won Kim, and Lee Jaehyun.Lim Beom-Sik—Reviere Pictures

South Korea records the world’s fourth highest suicide rate, according to the World Health Organization, and the highest suicide rate among OECD member states. Suicide deaths have upended the country’s entertainment industry, disrupted local and national politics, sparked a nationwide protest movement, and forced c-suite resignations. The elderly are at the highest risk of suicide, but deaths by suicide among the country’s teens are rising: Suicide caused more than half of all deaths among South Koreans in their 20s in 2022, and it is the leading cause of death among those in their teens, 20s, and 30s, according to the country’s statistics agency.

In 2011, then-South Korean President Lee Myung-bak signed the suicide prevention act into law, creating a nationwide patchwork of local mental health centers that oversee suicide prevention efforts within their jurisdictions. These government centers provide counseling to suicidal individuals and check in on those at high risk, such as loss survivors. They dispatch first responders to the scene of an anticipated suicide, craft local suicide prevention policies, and train so-called suicide “gatekeepers”—such as school teachers and paramedics—in suicide prevention best practices.

The law also requires South Korea’s Ministry of Health and Welfare to release a suicide prevention “master plan” every five years. The latest installment, released last year, promises to ramp up mental health care check-ups, broaden national insurance coverage, and train additional suicide gatekeepers. Many of the plan’s “5 major strategies, 15 agendas, and 92 implementation tasks” must be implemented by South Korea’s suicide prevention and mental health welfare centers, which the Health Ministry says are expected to reduce suicide deaths by 30% by 2027.

TIME’s reporting casts doubt on that forecast.

For this report, TIME spoke with senior officials from six local suicide prevention and mental health welfare centers. Most allege the central government is withholding key suicide-related data from their centers to shield districts, cities, and provinces with high rates of suicide from reputational damage. Taken together, the officials say a data blockade limits their understanding of local suicide trends, obstructing their efforts to enact policies that would meet the needs of their communities and, ultimately, save lives.

Separately, 10 suicide prevention centers, as well as the Health Ministry’s suicide special corporation, declined TIME’s repeated interview requests. An additional two local suicide prevention centers abruptly canceled previously scheduled interviews, citing fears of government reprisal. In one such instance, after TIME scheduled an interview with an official at a suicide prevention center in Incheon, a city just west of Seoul, local government officials apparently intervened and forced a cancellation.

“The city said it would be better to ignore your [interview] request,” the official told TIME. The Incheon Metropolitan City government did not reply to a request for comment.

TIME also interviewed South Korean medical experts, first responders, university researchers, and current and former public health officials. They, along with the prevention center officials, said the Health Ministry’s suicide reduction goal is impossible to achieve absent a dramatic change of policy, pointing to slim government spending, overwhelmed prevention centers, and a brain drain of government suicide experts.

Dr. Kim Hyun-soo, Director of Seoul Suicide Prevention Center, at his workplace on April 9, 2024.
Dr. Kim Hyun-soo, director of Seoul’s Suicide Prevention Center, poses for a portrait at his workplace on April 9, 2024.Lim Beom-Sik—Reviere Pictures

Kim Hyun-soo, the director of Seoul’s Suicide Prevention Center, told TIME the ministry’s public master plan to curb suicide deaths amounts to “political theatre.” His center is tasked with identifying high-risk groups among Seoul’s roughly 9.8 million residents. But, he said, they cannot access the central government’s latest suicide-related data, and the limited data they do receive are out-of-date, hampering their efforts to spot suicide-related trends.

“For example, we can’t see how many people visited an emergency room in Seoul after a suicide attempt or the latest ‘psychological autopsy’ findings,” he said, referring to investigations that determine an individual’s “psychological” cause of death.

“We need data to understand trends—the reality—around suicide to create effective policies, but the Ministry of Health and Welfare does not share such data,” Kim said. “Unless the ministry shares its data and the National Assembly allocates additional funds, our ability to save lives will remain limited.”

A spokesperson for the Ministry of Health and Welfare declined to respond to questions related to data sharing.

Jeongbin told TIME that Mental Health Korea’s 300 volunteer peer specialists, who are neither clinicians nor lawmakers, are seeking to fill the critical support gap that the government has left. “It’s so difficult to actually find support other than just calling the hotline or visiting a hospital,” which can require parental consent, she said. “I know our work is really needed right now.”

From war to wealth

“It wasn’t always like this,” said Peter Jongho Na, an assistant professor at the Yale University School of Medicine. The suicide rate first spiked among the elderly in the aftermath of the 1997 Asian financial crisis, he said, plunging South Korea’s rapidly growing economy into recession.

After a 1953 armistice split the Korean Peninsula in two, both South and North lived in mutual poverty, recording two of the world’s lowest per-capita GDPs. Then, in 1961, Park Chung-hee, a military general, ousted South Korea’s post-war government in a coup d'état. Park, himself born into poverty, vowed to grow South Korea’s fledgling economy at all costs, including to his people’s civil liberties. He jailed dissidents, mandated propaganda screenings, enforced curfews, and imposed draconian labor laws. South Korea’s economy grew, and the country eventually democratized, but its “miracle” ballet from war to wealth exacted an extraordinary toll on its people.

Paik Jong-woo, former director of the Health Ministry’s central suicide prevention center, said that rapid economic growth caused the demise of South Korea’s “nuclear family,” where aging parents lived with their adult child, but no social safety net had emerged to fill that support gap. In 2011, after years of haphazard policymaking, South Korea’s National Assembly passed the suicide prevention act. “That was generally good news,” Paik said. The law did enhance overall suicide prevention efforts, but existing government programs and spending are “still not enough” to meet the population’s needs, he said.

Today, South Korea’s suicide rate is down from its peak in 2009, but it remains—by a sizable margin—the highest among OECD member states. Experts who spoke to TIME pointed to the country’s hyper-competitive education system, high rate of school violence, long working hours, social isolation, and legal and social barriers for minors seeking mental health care, among other factors.

Na, the Yale professor, said the stigma associated with mental health also dissuades many from seeking support in moments of need. South Korea’s rate of antidepressant prescriptions ranks third lowest among OECD member states, even though the projected depression rate is among the highest, he said.

The result, Na said, is “a real discrepancy between what they suffer from and the amount of help they get.”

Blocked 

About an hour south of Seoul, Yoon Mi-kyung’s cadre of doctors, psychiatric nurses, welfare workers, and clinical counselors are working “tirelessly” to curb suicide deaths.

Yoon, a doctor of nursing science, is the director of Gyeonggi Province’s combined Mental Health Welfare and Suicide Prevention Center. The government center oversees suicide and mental health-related efforts across Gyeonggi’s 31 districts, home to roughly 13 million people, but she told TIME that they are given “absolutely insufficient” resources or government support.

“Our budget is really small. We are short-staffed. Our infrastructure is insufficient,” Yoon said. The central government’s blockade on suicide-related data doesn’t help, she added.

Yoon Mi-kyung, Director of Gyeonggi Province’s combined Mental Health Welfare and Suicide Prevention Center, at her workplace on April 9, 2024.
Yoon Mi-kyung, director of Gyeonggi Province’s Mental Health Welfare Center and Center for Suicide Prevention, at her workplace on April 9.Lim Beom-Sik—Reviere Pictures

Local suicide prevention center officials told TIME they cannot access current data from the National Police Agency, which falls under the interior ministry; Statistics Korea, which operates under the finance ministry; or the Korea Foundation for Suicide Prevention, a special corporation under the Ministry of Health and Welfare. Most of the suicide data the centers can access are included in an annual “causes of death” report, but those figures are out-of-date and nonspecific, Yoon said.

TIME reviewed a copy of Statistics Korea’s annual “Causes of Death Statistics” report. The agency published its latest edition in September 2023, but that report only contains data from the previous year, 2022. The report lists the basic demographics of those who died by suicide—such as their age, occupation, and gender—as well as a tally of the “causes” of suicide deaths, such as financial hardship or mental illness, but most of the data are mixed with other causes of death, such as accidents and heart attacks. The next report, which will contain suicide data from 2023, is scheduled for release in September 2024.

“That’s more than a one-year gap,” Yoon noted. “Local suicide prevention centers need access to the latest raw data to work effectively.”

For its part, the Health Ministry releases a 275-page suicide prevention handbook at the beginning of each calendar year. Most of the handbook, which TIME reviewed in full, lists the year’s forthcoming suicide prevention projects, but a one-page chart tucked in its appendix names the central government agencies tasked with collecting and sharing suicide-related data. The chart says data on mental health-related emergency room visits, the causes of death report, and a “complete survey” of suicide-related police records are all released once a year, though “organizations performing regional suicide prevention projects” can request to receive police data on a bimonthly basis. Suicide prevention workers, however, tell TIME that data is limited.

Kim, the Seoul director, said the police data and annual reports—as well as DataZoom, a limited Health Ministry database of provisional suicide data—are not enough to inform his team’s work. The Seoul Suicide Prevention Center needs direct access to the latest central government data to tailor suicide prevention programs to his city’s needs, particularly findings from psychological autopsies, he added.

Like a coroner attributing a death to a heart attack, psychological autopsies endeavor to piece together the deceased’s mental state in the weeks preceding their suicide. Investigators pore through all available information on the deceased: They comb through medical records, visit the site of the death, and conduct grueling hours-long interviews with the deceased’s consenting friends, family, medical team, and/or coworkers. The result pinpoints specific circumstances that likely contributed to an individual suicide, while a collection of these findings helps public health officials spot risk factors associated with suicide, which ultimately inform suicide prevention policies.

For example, imagine a city conducts 40 psychological autopsies in a month, and 30 of them find the deceased was consuming a large amount of alcohol in the weeks preceding their death. In response, a suicide prevention center could create alcohol-specific awareness-raising initiatives and partner with alcohol-related advocacy groups, tailoring their outreach to those the data identifies as high-risk groups.

That hypothetical is grounded in decades of research. “LIVE LIFE,” the W.H.O.’s suicide prevention handbook, notes that quality public health policy can help reduce suicide deaths, similar to policies that address other health conditions such as obesity or heart disease. Suicide, the guide says, is fundamentally a question of public health, not individual character or behavior, and up-to-date data on suicide deaths and suicide attempts are “essential in informing LIVE LIFE pillars and interventions” that can help save lives.

Tens of thousands of teachers shout slogans during rally in front of National Assembly on Sept. 4, 2023 in Seoul. The teachers held a huge rally to mourn the recent suicide deaths of fellow teachers.
Thousands participate in a rally to mourn the recent suicide deaths of teachers in front of the National Assembly in Seoul on Sept. 4, 2023.Chris Jung—NurPhoto/Shutterstock

In response to a list of questions on psychological autopsies, a Health Ministry spokesperson said suicide prevention centers can access an annual psychological autopsy report released to the public. While Health Ministry officials perform psychological autopsies, the spokesperson said local governments are free to conduct their own.

Kim said local governments find it “difficult” to carry out their own psychological autopsies, pointing to “limited budgets and manpower.” Kim and his colleagues’ pleas to the ministry to share their latest autopsy findings are ignored, he said. “Lots of suicide-related information and data are not shared with prevention centers,” said Kim, who pointed to data from the National Emergency Department Information System.

Shortly after attempting suicide, individuals are often rushed to a hospital emergency room, and NEDIS collects data—including a patient’s reason for their visit—from over 150 ERs across South Korea. Suicide prevention centers receive some NEDIS data in an annual report, but they cannot view the data that hospitals transmit to NEDIS in real time, Kim said.

“The Ministry of Health and Welfare has the data, but they do not share the data with suicide prevention centers,” he added.

The Ministry of Health and Welfare has the data, but they do not share the data with suicide prevention centers.”

- Kim Hyun-soo, director of Seoul’s Suicide Prevention Center

Baek Min-jeong, executive manager of social work at the Suwon Center for Suicide Prevention, tells TIME her center needs access to Statistics Korea’s city- and district-specific trends—or “macrodata”—as well as “individual data,” including from the Health Ministry’s psychological autopsies. “Our [data] access is extremely limited,” she said.

Without the latest central government data, the Suwon Center conducts its own research to identify local suicide causes and risk factors, but it lacks the resources or expertise needed to replicate the central government’s data, Baek said. Combining the latest psychological autopsy findings with Suwon Center’s research could help them pinpoint “socio-cultural factors contributing to suicide” in their city, she added.

Some experts tell TIME that other data sources could better inform suicide prevention policy: Paik, the former center director, argued a sharp increase in psychological autopsies would be prohibitively expensive. Instead, health authorities could conduct a limited number of psychological autopsies while also identifying suicide-related trends in police reports. He said that approach could yield similar, even if more limited, insights into suicide risk factors at a fraction of the cost of psychological autopsies.

But suicide prevention centers cannot access the latest national police data either, Paik said.

The National Police Agency and Statistics Korea did not respond to requests for comment. The Korea Foundation for Suicide Prevention declined to comment. A spokesperson for the Ministry of Health and Welfare declined to respond to questions related to data sharing.

Read More: Why Some Countries Are Decriminalizing Suicide

Most suicide prevention workers who spoke with TIME alleged the central government is withholding its data to shield districts, cities, and provinces with high suicide rates from reputational damage, pointing to parallels with Japan as a case study.

Japan, like South Korea, saw a sharp increase in suicide deaths in the aftermath of the Asian financial crisis, but its suicide rate peaked a year later, in 1998, according to OECD data. Today, Japan’s Ministry of Health, Labour and Welfare shares much of its suicide-related data with local governments each month—but things weren’t always that way.

Paik said the Japanese Health Ministry once withheld timely suicide-related data from local governments. “It was quite similar to South Korea,” he said. The Japanese government had “their own set of excuses” to justify the blockade, but they feared that sharing localized data could impede on individual rights to privacy—particularly in rural areas—and harm specific cities’ reputations, causing a collapse in housing prices. After sustained internal dissent, the central government eventually capitulated: Local governments now receive monthly, rather than yearly, suicide data—and housing prices did not tumble, Paik said.

South Korea could save more lives if it follows Japan’s lead, Paik said. Until then, “South Korea cannot fully utilize its suicide surveillance system.”

Asked to respond to what Paik told TIME, the Health Ministry spokesperson declined to comment.

‘Politicians bear a lot of responsibility’
South Korea's President Yoon Suk Yeol speaks during a meeting about an expanded mental health care program aimed at helping curb the country's high suicide rate, at the Blue House in Seoul on Dec. 5, 2023.
South Korean President Yoon Suk-yeol announces a mental health care program aimed at curbing the country’s high suicide rate, at the Blue House in Seoul on Dec. 5, 2023. Yonhap/EPA-EFE/Shutterstock

Even if the central government began sharing its data in real-time, the Health Ministry’s suicide reduction forecast would remain out-of-reach, current and former public health officials told TIME, citing comparatively slim government spending on mental health programs, widespread stigma, and overly centralized policies.

Yoon, the Gyeonggi director, said her province’s annual mental health-related budget is less than eight U.S. dollars per capita, far lower than most local population-adjusted budgets in Japan, though she said South Korea’s Health Ministry is overwhelmed as well. Yoon and her colleagues are pushing for a new funding model that would see other government agencies, such as the presidential office, contribute to suicide prevention efforts, but that has yet to materialize.

“Increasing the budget is a prerequisite for decreasing the suicide rate,” Yoon said.

Baek, the Suwon director, said suicide prevention centers receive a mix of subsidies from the local and central government, though the allotted amount is “consistently insufficient,” creating poor working conditions for staff and soiling efforts to attract and retain qualified professionals. Baek surmised her center needs annually about 200 billion Korean Won—roughly $150 million—to support her city’s 1.2 million residents.

“And how much did you receive last year?” TIME asked.

“Less than 800 million won,” or under $600,000, she said.

Baek added that money alone cannot fix an already broken structure. Italy operates one suicide prevention center per 70,000 residents, she noted, but in Suwon, just the one center is responsible for more than 17 times as many.

“They expect us to oversee everything, like a department store,” Baek said. “One center should not be responsible for all suicide prevention efforts.”

Our suicide prevention policies have failed.”

- Central government researcher who spoke to TIME anonymously

Ha Sung-hun, the director of LifeLine Korea, a nonprofit crisis hotline, echoed Baek’s points, calling for a “whole-of-society” approach to suicide prevention policy.

“Suicide prevention should not only be a matter for the Ministry of Health and Welfare,” Ha said. “Other government ministries, like the Ministry of Employment and Labor, should get more involved, too.” He said the central government should enlist additional support from nonprofits and private corporations, noting that LifeLine Korea began collaborating with Samsung on a mental health awareness program for teenagers in 2022.

“LifeLine helped Samsung develop and operate that program,” said Ha. “Samsung funded 100% of it.”

A central government researcher on suicide-related projects, who spoke on condition of anonymity for fear of employment repercussions because they are not authorized to speak to the press, told TIME that the stigma associated with suicide silences internal discussion of suicide-related projects within the Health Ministry.

The researcher, pointing to low wages and high turnover, alleged that staffers contributing to suicide-related projects experience low morale. “Nobody wants to be the researcher on a suicide project,” they said. Most ministry officials who manage existing suicide-related projects are “not comfortable discussing suicide projects in the workplace,” the researcher alleged, adding that suicide-related work is rarely subject to internal scrutiny. Internal dialogue on how to improve existing policies is rare, they alleged, ultimately resulting in ineffective projects and policies.

“Our suicide prevention policies have failed,” they said. “This is the atmosphere we are working in.”

A Health Ministry spokesperson told TIME, without substantiation, that the researcher’s claims “lack evidence” and “differ from the truth.”

Kim, the Seoul director, said that most lawmakers he’s met with express “little interest” in discussing suicide and that politicians are free to neglect suicide prevention policy because it comes at little cost to their political legitimacy. Celebrity suicide deaths might be top-of-mind in South Korea, but the broader suicide and mental health crisis is not, said Kim, who attributed this to a common misconception—fueled by stigma—that suicide is a matter of individual responsibility, rather than a question of public health.

“Politicians bear a lot of responsibility for our current suicide crisis,” Kim said, adding that increased public scrutiny could compel them to act.

‘There is another way’
Student peer specialist Derrick Park
Mental Health Korea peer specialist Derrick Park.Lim Beom-Sik—Reviere Pictures
Peer specialist Jeongbin Park
Mental Health Korea peer specialist Jeongbin Park.Lim Beom-Sik—Reviere Pictures
From left, Vice Director of Mental Health Korea Chang Eun-ha, and the Director, Choi Yunu, on April 14, 2024.
Mental Health Korea vice president Chang Eun-ha, left, and founder and president Choi Yunu, right, in Seoul on April 14.Lim Beom-Sik—Reviere Pictures
Peer specialist Moon Dana
Mental Health Korea peer specialist Moon Dana.Lim Beom-Sik—Reviere Pictures
Peer specialist Aiden Won Kim
Mental Health Korea peer specialist Aiden Won Kim.Lim Beom-Sik—Reviere Pictures

With rampant stigma and limited public health capacity, it can be easy for many to feel hopeless: Just a few days before TIME spoke to Derrick Park, a 16-year-old peer specialist at Mental Health Korea, in March, one of his close friends experienced a mental health crisis.

In Park’s telling, his friend had just earned a “really bad grade” in his strongest subject. His teacher, apparently dissatisfied with his performance, shamed him in front of the class, castigating the student for falling short of the promise purportedly shown by his peers. Once a local prodigy synonymous with academic honors, Park’s friend now “felt like he lost his strength and he wasn’t himself anymore,” said Park.

A few days later, he attempted suicide.

His friend is now recovering, but Park described it as a single drop in an ocean of preventable tragedy. He said cutthroat competition, widespread stigma, and limited mental health resources in schools fuel a misconception that nobody will offer support in moments of crisis. “That’s the turning point,” Park said. “You just feel alone.”

Read More: Why South Korea’s Crackdown on Private Tutoring Is Just a ‘Band-Aid’ on a Much Larger Problem

But stigma is a status quo Park and his peers at Mental Health Korea say they aren’t willing to accept.

Aiden Won Kim, another peer specialist, said acknowledging one’s mental health is typically seen as a weakness in Korea, but he’s using social media platforms, like TikTok and Instagram, “to help teenagers like us speak up.”

“I’ve been working with this organization to try to break the stigma,” the 16-year-old said.

Choi Yunu, the group’s adult founder, said Mental Health Korea is “the first organization where people with lived experience actually come out and speak out about their mental health.” The use of the term coming out is no accident, he said, likening speaking out about one’s mental health to ‘coming out’ as LGBTQ in South Korea. “The stigma for those experiencing mental health challenges is very similar,” he told TIME. (National law provides no protection from discrimination based on sexual orientation or gender identity.)

What if people in difficult situations knew of other options?”

- Moon Dana, peer specialist at Mental Health Korea

Moon Dana, a 20-year-old peer specialist, said pervasive stigma pushes too many of her peers to feel they are at a false crossroads.

“We have created a climate where people are made to think they have two choices: live with the pain or die,” Moon said. Even if one’s family and social circle exhibit the emotional intelligence of a rock, “that doesn’t mean they must choose pain or death,” she said. “There is another way.”

Mental Health Korea calls it the “social prescription”: a novel support philosophy that includes in-house support groups, mentorship from peer specialists, and community-building events. Here, sharing one’s struggles is a celebrated act of strength, not a weakness to exploit. Here, teens support each other with a mix of mutual empathy and lived experience. Here, teens find an empowering community, something most of the country’s adults decline to provide, Moon said.

TIME asked the young peer specialists at Mental Health Korea what policy changes could help ease the country’s mental health crisis. Like the rest, Moon listed many ideas, including developing classroom suicide prevention curricula based on “reality.” But she once again emphasized the illusory dichotomy: endure or die.

“What if people in difficult situations knew of other options?” asked Moon. “What if they could find a social network that would support them? What if they knew that they could still live well tomorrow, even if they are in pain today?” she said, her voice nearing a measured crescendo. “What if everyone knew where to find the support they need, like social prescriptions at Mental Health Korea?”

“If they knew, they could hold on to hope,” said Moon. “Hope saves lives.”

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