The Making of the Mental Health System in South Korea, 1960s–1980s: The Rise of Institutionalization and the Unfulfilled Promise of Community Mental Health

In recent years, growing attention to the social integration of persons with psychosocial disabilities into their local communities has intensified calls to shift Korea’s hospital-centered mental health system toward a community-based model. Historically, the Korean mental health system has often been framed through the narrative of a “delayed transition,” which suggests that the country is belatedly undergoing the deinstitutionalization experienced in Western societies during the 1960s and 1970s. However, this linear account fails to explain a crucial divergence: during the very decades when deinstitutionalization was being debated and implemented in several Western countries, Korea was rapidly expanding its psychiatric institutions and hospital beds, entrenching a long-term institutional regime. This article reexamines the 1960s through the 1980s as a critical juncture in the formation of Korea’s mental health system by tracing the debates and strategic interactions among the state, the psychiatric profession, and civil society surrounding the enactment of the Mental Health Act. During the 1960s and 1970s, authoritarian regimes adopted a social defense framework that cast people with mental illness as potential threats, thereby legitimizing a system of confinement. The 1983 “prayer house” (gidowon) scandal, however, publicly exposed the realities of institutionalization and briefly opened a window for communitybased alternatives within the psychiatric profession. The Korean Neuropsychiatric Association adopted community mental health as its official orientation, and in the mid-1980s a community mental health project was carried out on Ganghwa Island. Yet this opening was foreclosed by a convergence of countervailing forces: As the legislative process leading to the 1985 Mental Health Act became structured around a dichotomy between psychiatric nursing homes and hospitals, the psychiatric profession pursued a strategy of transition “from facilities to hospitals,” thereby consolidating an admission-centered system. This strategy aligned with state interests in expanding hospital beds for purposes of social defense while simultaneously curtailing public welfare expenditure. At the same time, the expansion of health insurance and medical aid programs in the 1980s increased service utilization, creating economic incentives for further growth in psychiatric beds. Meanwhile, civil society’s human rights discourse emerged as an extension of resistance to the authoritarian regime and focused on procedural safeguards against involuntary hospitalization; however, it did not lead to a fundamental reconfiguration of the confinement-centered system itself. Rather than reducing the formation of the Korean mental health system to a problem of developmental delay—often framed as a “fifty-year gap with the West”—this study highlights the multiple possibilities and alternative trajectories embedded in its history and invites a historically grounded rethinking of the current Korean mental health system.