[Interview] "Adolescent Mental Health Must Be the Nation's Top Priority" [Invisible Children] ⑤

Kiseon Wan, Head of the Central Mental Health Welfare Project Support Group
Mental Health Already Deteriorating When Leaving School
Urgent Need for 'Integrated Governance' Among Ministries

"Adolescent mental health must become the nation’s top priority,"

Kiseon Wan, Head of the Central Mental Health Welfare Project Support Group, emphasized in an interview with The Asia Business Daily on January 25 that "we must no longer neglect the mental health issues of adolescents and make them the highest priority for the country." He explained that addressing these issues during adolescence can reduce the ongoing social costs and provide a foundation for young people to become independent as soon as possible.

Kiseon Wan commented on the recent increase in out-of-school youth, stating, "There is a need to establish integrated government governance to respond efficiently." The following is a Q&A.

Kiseon Wan, Head of the Central Mental Health Welfare Project Support Group

-In the past, delinquency or family circumstances were the main reasons for dropping out of school, but recently, psychological and emotional difficulties have rapidly emerged as the biggest reason for leaving school.

▲Even now, behind adolescents’ psychological and emotional difficulties, there are often economic hardship, parental conflict and divorce, excessive drinking or aggressive behavior by fathers, and inappropriate parenting methods. In many cases, there are also problems in the adolescent’s own developmental process or very sensitive peer relationships. Especially, misunderstandings among friends, gossip, group ostracism, or bullying have become major obstacles to adapting to school. This is because today’s adolescents are extremely sensitive to their peers’ opinions of them. Most adolescents who leave school already have deteriorating mental health and lack supportive resources. While at school, their condition could at least be monitored and extreme behaviors controlled, but after leaving, they are left unattended without any help or intervention, causing their condition to worsen rapidly.

-It seems like a vicious cycle where students drop out due to depression, then feel even more isolated, which deepens their depression. Statistics show that the suicide attempt rate among out-of-school youth is significantly higher than that of students.

▲Outside of school, they experience even greater isolation and emotional trauma. Our society is not at all friendly to adolescents of school age who try to adapt and find employment. They are easily ignored, exploited, or deceived, leading to deeper emotional wounds and economic hardship. Female adolescents may be exposed to sexual advances or harassment and may experience unwanted pregnancies. Their anger, hostility toward society, self-doubt, and inferiority complex grow, and they become engulfed in depression and despair. They have escaped school, only to fall into a hellish society.

-It seems that the time in school is a golden window for intervention. However, the involvement of school counselors or homeroom teachers seems to have clear limitations. What do you see as the fundamental reason that early signs of dropping out (such as absenteeism or maladjustment) do not lead to immediate medical intervention, but instead result in the choice to leave school?

▲More proactive and intensive multidisciplinary case management is needed; temporary counseling or simple admonishment is not enough. Economic support, professional psychological counseling or group therapy, parental involvement, and, if necessary, treatment for substance abuse, gambling, or gaming addiction, psychiatric care, and educational measures must all be provided in a comprehensive, personalized manner.

-How should we improve the screening system to proactively identify and assess the mental health status of youth who have left the school system?

▲We must find accessible points of contact. For example, before employment or part-time work, during physical exams for military enlistment, or through life-cycle health checkups provided by health insurance, we should identify accessible methods and provide support. Identifying and resolving problems during adolescence can significantly reduce future social costs.

-To what extent do you think the current medical laws and systems, which require guardian consent, act as a barrier?

▲There are cases where guardians do not acknowledge the adolescent’s problems and refuse treatment or even refuse to provide financial support for treatment. Of course, due to the social stigma surrounding mental illness, parents may find it difficult to make treatment decisions. Conversely, there are cases where guardians, acting unilaterally, ignore the adolescent’s wishes and forcibly admit them to psychiatric hospitals. Therefore, legal improvements are needed, and systems such as public guardianship or advance directives for treatment should be utilized. More efforts are also needed to improve awareness and provide education to reduce the stigma of mental illness.

-After leaving school (Ministry of Education), responsibility shifts to the Ministry of Gender Equality and Family (Dream Center), while mental health falls under the Ministry of Health and Welfare. There is only one child, but the responsible agencies are fragmented.

▲Fragmented and scattered governance is a major problem for adolescent mental health and addiction issues. The government must establish integrated governance for adolescent mental health, which is currently divided among the Ministry of Health and Welfare, Ministry of Education, and Ministry of Gender Equality and Family.

-While Dream Centers serve as hubs for out-of-school youth, there are criticisms that there is a severe lack of clinical psychologists or professional counselors at these centers.

▲Currently, the capabilities of local youth-related centers are very limited. However, if each center strengthens its capacity and builds networks and alliances within the community, it is possible. Youth centers need to work more closely and collaboratively with local mental health welfare centers.

-For the National Mind Investment Support Project to be effective for out-of-school youth, what needs to be done?

▲The National Mind Investment Support Project is not easily accessible to out-of-school youth. Most of them are not even aware that such programs exist. Typically, people with only minor issues and enough time for counseling tend to use these services, while those requiring biological treatment or children with severe difficulties are often brought in by their mothers. In some local governments, there is not a single institution that can provide counseling services. The target beneficiaries of the program must be clearly defined, and psychological counseling services need to be specialized and standardized.

-To what extent should the public sector intervene for youth in crisis?

▲Recently, laws and systems have been revised to allow for more active sharing of personal information to prevent suicide, even prioritizing this over personal information protection in cases of severe crises like self-harm or suicide. Since self-harm or suicide is not only an individual crisis but also a reflection of accumulated societal and community problems projected onto the individual, the public sector should intervene more actively, while still upholding individual rights as much as possible. Preventing the loss of life must be a top priority. Of course, decisions that restrict personal freedom, such as psychiatric hospitalization, must be made legally.

-What does true psychological recovery and independence look like for out-of-school youth?

▲Even if they have suffered significant emotional trauma in the past, face harsh realities, or have personal disabilities, it is important for them to set healthy and productive life goals and live meaningful and valuable daily lives. Through this process, they can regain self-esteem, do what they love, and learn to love others-that is independence.

-Among early intervention models for adolescent mental health in advanced countries, is there a system that should be urgently introduced in Korea?

▲Headspace is a comprehensive support platform for the mental health of Australian youth, providing free or low-cost mental health support to adolescents and young adults aged 12 to 25. It covers not only mental health issues but also physical health, academics and career, and substance abuse. It also offers various access methods, including online, phone, and in-person visits.

-If you have a message for society and policymakers to view out-of-school youth not as potential troublemakers but as sick children in need of treatment and protection, what would it be?

▲In a low birthrate, super-aged society like ours, expanding human capital is the most important national task, and even if it is not visible, adolescent mental health must become the nation’s top priority. Identifying and resolving problems during adolescence can reduce enormous ongoing social costs. Such efforts also help unify the nation and strengthen the community. Now is the time to act.

About Kiseon Wan, Head of the Central Mental Health Welfare Project Support Group

Kiseon Wan graduated from Yonsei University College of Medicine and obtained his medical specialty at Sinchon Severance Hospital, focusing primarily on treating patients with alcohol addiction in clinical practice. He has worked as a community mental health expert for over 30 years. He is currently a professor of psychiatry at International St. Mary’s Hospital, Catholic Kwandong University, and has served as Director of Mental Health at the Korean Neuropsychiatric Association, President of the Korean Academy of Addiction Psychiatry, Vice President of the Korean Society for Social Psychiatry, and President of the Korea Suicide Prevention Association. In recognition of his contributions to mental health, he received the National Medal of Honor in 2020. The Central Mental Health Welfare Project Support Group is a national advisory and support body for mental health policy, comprising private experts and the Ministry of Health and Welfare as the lead agency.