It may be surprising to discover that the government of North Korea has a very clear-cut definition of mental health. In the words of the Korean Neuropsychiatric Association’s (KNA) study on the question “What is it to be mentally healthy from the North Korean refugee’s perspective?” the answer is very simple. The definition is loyalty. Loyalty to the state, absolute obedience to the government, subservience to North Korea’s deified leaders.

“A mentally healthy person in North Korea is someone who is faithful to Kim Il Sung and Kim Jong Il. Someone who is forever and ever faithful,” describes a North Korean defector in the KNA’s interviews.

Imagine then, the confusion of North Korean defectors arriving in South Korea, one of the most modern countries in the world. The South Korean government passed the Mental Health Act in 1995, a law that caused a five-fold increase in the number of facilities treating mental health from 2001 to 2015. Fleeing North Koreans arrive into a fast-paced world that does not only assess physical health, but mental and emotional well-being - entirely foreign concepts. The adjustment for North Koreans is far from simple, especially due the abuses they endured at the hands of their own government. 

According to research conducted by the KNA in 2017, “a longer amount of time in North Korea may be associated with greater instances of various types of trauma, such as political brainwashing, imprisonment, torture, and long-term famine, thus exacerbating the experience of mental illness.” The struggle of North Koreans with mental health and emotional well-being is unsurprising. According to Crossing Borders’ own surveys with medical experts, 100% of the North Korean refugees in Crossing Borders’ network in China suffer from post-traumatic stress disorder (PTSD). 

Recent research conducted in the population of North Koreans in South Korea suggests that there is a high correlation of PTSD with clinical depression and severe anxiety. There are various reasons for this phenomenon. Approximately 49.3 percent of defectors arriving from North Korea describe witnessing or undergoing traumatic events including but not limited to physical abuse, capture and arrest, or witnessing death. Fleeing North Koreans over the age of 20 have escaped one of the most devastating famines in recent history, a famine that is estimated to have claimed the lives of up to three million North Koreans. This is also a famine that was largely unrecognized by North Korea’s communist government, which relentlessly brainwashed its population with false history, propaganda and reasons for mistrust.

Defectors, specifically, have also risked imprisonment, abuse, torture and execution at the hands of authorities. Chronic feelings of helplessness can be compounded by the trauma of leaving or abandoning family members, as well as the constant anxiety of being spied upon or arrested by persecutors in police states like North Korea and China. In the population of over 33,000 North Korean defectors in South Korea, up to 49 percent of the population may suffer from depression without clinical aid.

The International Journal of Mental Health Systems assessed the condition of South Korea’s mental health support at the community level in 2018. Their conclusions, while supportive of the Korean mental health structure, make a number of critical comments on the weaknesses of South Korea’s current mental health model. While South Korea’s number of mental health facilities has expanded dramatically in the last 15 years, the number of in-patients in mental hospitals are ten times those of people accommodated in mental health facilities aimed toward rehabilitation. This focus on hospitalizing individuals has led to 1449 mental health hospitals which account for approximately 68 percent of all mental health institutions. Community-level facilities that can effectively respond to everyday services and help individuals without in-patient care are largely unavailable, a critical issue. “As a result, many patients become long-term residents at these facilities and lose their will to return to their own communities. The provision of mental health services also is neither sufficient nor well organized at the community level for the entire population,” writes the International Journal of Mental Health Systems.

It should be noted that hospitalization in mental health facilities has a particular connotation for North Koreans. Psychiatric hospitals in North Korea are referred to as “Ward No. 49” and largely built in secluded, rural regions of the country. No information on in-patients is made available once they are committed. According to one North Korean refugee, “As far as I know, it is almost certain death when you go there. Almost everyone thinks that is the case. If you do not do as you are told, they beat and torture you.” North Koreans may be more wary of approaching mental health facilities that require them to be hospitalized.

The issue of mental health is particular to South Korea, which has the second largest suicide rate in the world and where only one in ten individuals will seek clinical help. But the problem is further complicated for North Korean defectors, whose adjustment to understanding and seeking help for mental health comes with monumental obstacles. According to The Journal of Preventive Medicine & Public Health, there is a substantial lack of literacy and knowledge regarding mental illnesses in the population of North Koreans in South Korea. While there are great improvements in their general understanding of mental health with re-education in Hanawon programs that help North Koreans resettle in South Korea, North Korean defectors do not have consistent follow-up in the information they are provided. According to researchers, more education and assistance is needed. Surveys conducted with North Koreans in South Korea indicate that 70 percent of North Korean defectors do not recognize the purpose behind of counseling centers or psychological counselors. Approximately 58 percent of them do not know the role of psychiatrists in their community.

Crossing Borders’ plan to open Elim House in 2020 is specifically to provide an answer to this ongoing mental health crisis in the North Korean population in South Korea. Embedded in the local community, Crossing Borders will staff a counselor to provide advice, information and clinical aid to North Korean defectors. The goal to establish a community of North Koreans who can share with one another and listen to one another is to respond to North Korean defectors’ present lack of social and emotional support. Crossing Borders hopes to be a resource of mental and emotional stability for this struggling population.

To learn more about Elim House or to support this project for North Koreans in South Korea, please visit

www.CrossingBordersNK.org/ElimHouse