While issues surrounding the mental health of North Korean refugees is more generally discussed in the academic literature, the state of care for people with mental health problems inside North Korea is a more difficult topic to cover so receives scant attention. This hides some major issues that should concern us all.
In a country like North Korea, where providing access to aid for those most in need is always difficult, mental health will likely be put on the ‘way too hard’ pile. For many NGOs, even providing ‘basic’ humanitarian support, such as ensuring the nutrition of mothers and children, is already seen as too difficult. A major obstacle is the stringent rules and regulations for humanitarian operations that are imposed by the DPRK authorities.
In other Communist countries, and in war-torn and developing nations, the mentally ill and those with learning disabilities are usually the least supported and thus are often kept in appalling conditions. There are also many examples of political dissenters being placed in psychiatric institutions as a punishment.
Understanding how aid actors can help those in North Korea suffering from mental illness and learning disabilities should be key in any preparations to assist the North Korean population in the medium and long term. If aid organisations become involved in these areas of health, they must be prepared to provide immediate intervention as well as longer term support and training of staff at all levels. Preparing for such eventualities will also be key to understanding if psychiatric institutions are being used as a tool by the state to control its population.
These are topics that NKhumanitarian hopes to cover in more detail in future postings and it invites comment and contributions. Some insights into the level of psychiatric understanding in North Korea has been provided by a relatively recent (2012) paper by SJ Kim et al. The authors interviewed a number of North Korean medical doctors now living in the South. They describe a health system where psychiatric illnesses are dealt with as physiological or biological conditions, ignoring or being unaware of the psychosocial aspects to mental health. Furthermore, only those with severe psychotic symptoms received psychiatric treatment, which was in any case outdated, and that psychiatric illness, as in many other countries, attracted high levels of stigma.
Some sense of the scale of possible problems likely to be encountered in North Korea can be glimpsed in the situation revealed in post-Ceausescu Romania. Here there were many institutions filled with children with learning disabilities, the children often physically restrained and sometimes two or three sharing a cot. While the situation in North Korea is very different to that of Romania at the time (which had a policy of encouraging women to have large families), the inability of Ceausescu’s regime to properly care for these children and young adults provides many difficult lessons and warnings. Not the least of these lessons is that, when dealing with such institutionalised and neglected children, deprived of any experience of normal family life, even with the best care in later life the early damage they suffer can be impossible to reverse.
Mass overseas adoption of institutionalised children with mental health issues and learning difficulties is not an answer – many of the Romanian children taken in by foreign families ended up in institutions in their country of adoption, their adoptive families simply unable to cope with the complex and demanding needs of these children. Nor does this care route provide answers for the many adults and adolescents with mental illness.
Obtaining better information about mental health care in North Korea will not be an easy task, but it currently does not appear on the agenda of any aid agency working in that country. We recognise the competing priorities that confront aid organisation working in the DPRK, but some of the most vulnerable and neglected in North Korea should not be ignored simply because they are too difficult or ‘unattractive’ as a problem for the aid community to engage with.
 Kim SJ, Park YS, Lee H, Park SM. (2012). “Current Situation of Psychiatry in North Korea: From the Viewpoint of North Korean Medical Doctors.” Korean Journal of Psychosomatic Medicine 20(1): 32-39. [Abstract in English].