For weeks after 158 people were crushed to death in a Seoul alleyway, Song Haejin searched for the right psychological care for her teenage son.
Lee Jaehyun, 16, was with his two best friends in the trendy district of Itaewon when their Halloween night out took a fatal turn.
They were caught in the terrible crush of people in the warren of narrow streets that sits at the heart of South Korea’s capital.
“One was behind him so he couldn’t see his last moment, but the other friend was right beside him, so he had the trauma of seeing his friend lose consciousness,” said Ms Song.
Jaehyun recovered quickly from his physical injuries, but the mental scars remained. Once “bright and outgoing,” he stopped talking and could not sleep.
He tried to return to normal by attending school, counselling sessions, and even the gym, but ultimately died by suicide seven weeks after the disaster, becoming the 159th victim of South Korea’s worst ever crowd crush.
Jaehyun’s death and the traumatic aftermath of the Itaewon Halloween tragedy have thrown a fresh spotlight on the pressing need for mental health care in a country with the highest suicide rate in the developed world.
Twenty-six out of every 100,000 people – some 13,300 Koreans – took their own lives in 2021, a 0.3 increase on the year before, according to data from the national statistics office last September.
In February, new data showed South Korea, despite its technologically advanced society, to have one of the lowest life satisfaction rates among the 38 members of the Organisation for Economic Co-operation and Development, ranking at 36th.
Loneliness, rising household debt and a lack of leisure time have all been cited as factors that have lowered Korea’s so-called “happiness score” to 5.9, well below the OECD average of 6.7.
A society ‘not generous’ to people’s mistakes
South Korea’s mental health crisis has also been attributed to high-pressure environments at school and work, unemployment, a lack of a social safety net for the elderly, and the prevalence of cultural values that stigmatise poor mental health.
Dr HeaKyung Kwon, a Korean-American psychotherapist based in New York and founder of an online counselling service, said depression was particularly stark among younger and older people who did not feel empowered.
“Especially among young people there is a huge pressure to do well,” she said, citing the fierce competition to get into a tiny number of elite South Korean universities and parents’ intense investment in their education.
“They tell their children, ‘we are spending this money so you need to become this’, so they are under pressure and at a certain point they feel they cannot do it [and] meet everybody’s expectations,” she said.
Life is also tough for Korea’s ageing population. As well as having to contend with crippling isolation – in 2021, 1.6 million senior citizens lived alone – the nation lacks a strong welfare system to support society’s elderly, Dr Kwon said.
As a result, many elderly cannot retire and struggle to get by on low-paying service jobs, such as garbage collection, perpetuating exhaustion and depression.
Some of the factors behind the nation’s mental health struggles are also rooted in those uniquely Korean values which survived the nation’s rapid modernisation in the late 20th century.
These range from South Korea’s strong patriarchal undercurrents, which are present in all walks of life and can leave women feeling undervalued and unsafe, to long-standing concepts of “shame,” “saving face,” and conformity, says Dr Kwon.
“Our society is not generous to people making mistakes,” she added.
The intensity of Korea’s growing suicide crisis has focused minds on the urgent need for better mental health support.
In a statement to the Telegraph this week, the Ministry of Health and Welfare (MOHW) acknowledged that political support to help curb the problem was “desperately needed,” adding that it had stepped up its suicide prevention programme in April.
Large-scale national tragedies, including Itaewon, which largely claimed the lives of young people in their 20s and 30s, and the 2014 Sewol ferry sinking, which killed 306 people, including 250 high school students, have raised public awareness about mental health.
“The Sewol ferry incident was the first one where people really saw the impact of trauma. It was huge because the whole country was grieving,” said Dr Kwon.
But victims and experts say there is still a nationwide shortfall in psychological support services. There was a missing link connecting people who needed it most to the available resources, said Dr Kwon.
Mental health remains ‘taboo’
A paper last year in the Harvard International Review outlined the struggle of mental health care delivery despite “staggering” rates of stress and depression in South Korea.
It declared a “hidden crisis on the Han River,” which runs through Seoul, reporting that in 2017, nearly one in four South Koreans suffered from a mental disorder, but only one in ten received treatment, citing a mindset that still considered the topic as “taboo.”
Ms Song said she did not know where to turn for help for Jaehyun, despite government promises of support for anyone impacted by the crush.
When asked, the MOHW did not address specific individual concerns, but said that a combination of private and public sector support had been offered, including face-to-face and phone counselling or in-depth consultations with private experts. A mental health crisis hotline was also available.
As of March 10, psychological help had been provided for 514 people, including 275 bereaved families and the injured, it said, and further assistance like group counselling and education had been provided to 6,274 people, including the emergency services.
Since the disaster, the ministry said it had boosted its disaster support personnel and programmes, and expanded its national trauma centres.
But Ms Song said she had been left in the dark after an official helpline offered no specific advice.
“There are programmes and policies but the first problem is the victims have to find out about those programmes for themselves even though they are in a panic,” she said. “And the quality and level of the programme is really low.”
In desperation, she found a hospital counselling service but it could only offer Jaehyun a 20-minute consultation every ten days while she looked for more robust specialist help. Many clinics with trauma services had waiting lists for weeks or months.
“He never missed an appointment with the hospital and was eager to go back to school because he wanted to go back to his normal life,” she said, adding that the overburdened state support system ultimately let him down.
On the day of Jaehyun’s funeral, cruel online comments about her parenting left Ms Song devastated.
Dr Paik Jongwoo, a professor of psychiatry at Kyung Hee University and director of the medical and psychological support volunteer group for bereaved Itaewon families, said the authorities “had struggled to deal with the scale of psychological assistance required”.
“We do have basic systems for those people but we do not have enough manpower,” he added. “Reforms are required and it’s still in progress.”
Beyond the acute needs created by disasters, South Korea’s social welfare programmes had struggled to keep pace with economic progress, Dr Paik said.
“Safety nets such as social communities and social welfare systems and mental health services have not been sufficient for [economic] improvements,” he said.
Experts also partly attribute the country’s “very serious” suicide rate to rapid industrialisation, which, they say, lifted the nation out of poverty following the Korean war but triggered a rise in individualism and the break down of traditional community ties.
“We had to build our country all over again. We have very limited resources so we have to compete with each other. There’s a huge pressure to be successful,” Dr Kwon said.
“Within a relatively short period of time our country really bloomed ... It was an amazing success story but now we are paying a high price because we didn’t pay attention to tradition.”
This shift away from community is reflected in the increasingly isolated composition of the nation’s population, which heightens people’s vulnerability to poor mental health.
Estimates from Statistics Korea show that, by 2050, two in every five South Koreans will be living alone. As of 2021, people living by themselves comprised about 7.2 million, or a third of all households – more than than any multiple-number family group.
An Young-sun, the mother of Kim Dong-gyu, another teenager who died in the Itaewon tragedy, blames herself for the loss of her son on that fateful night.
“Every day, I go over that day, wondering if I could have done things differently that could have helped him survive,” she said. “Every day is hell for the families.
“I thought I could not live a day without my son.”
Like others, Ms An has been consumed by grief and trauma – yet the psychological support she needs has yet to materialise.
She now spends her days reliving precious memories with Dong-gyu, who died aged 17.
“He was kind and generous. He used to say he wanted me to enjoy life and do something I love. If my favourite singer had a concert he would gift me a ticket. We would go out to interesting movies together.”
A suitable memorial – currently a source of conflict between families and the authorities – would at least go a little way towards easing the pain, she said.
“That memorial should not be the place to cry or to be sad but should serve as a reminder to stop this kind of disaster,” she said. “If this is forgotten then it will only be repeated.”
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