People & Society / East Asia

How is mental health a societal—not just a medical—issue?

by Zu Xiang Ng
Length 8 min

What do you understand of mental health? Often, as a society, we think about this through a biomedical lens: brain chemistry imbalance, genetics, and evolutionary biology are the terms we typically reach for when discussing mental health.
But our understanding of mental health has changed over the years. Critics have questioned the consequences of using a strictly biomedical approach as the only valid way to understand mental health.

Instead, a new approach has been recommended. Instead of asking patients, ‘What’s wrong with you?’, the psychosocial approach asks, ‘What happened to you?’. The difference between the two is that the former question tends to treat mental health as an individual issue rather than understanding how wider social and environmental factors lead to the conditions that cause poor mental health.

In societies like Asia’s—where, despite modernisation, traditions remain an important aspect of our social fabric—an understanding of the socio-environmental factors that lead to poor mental health is crucial. Adopting the psychosocial approach, rather than just the biomedical, can help us better understand some worrying mental health trends in our region.


Youth suicides in East Asia

One of the more concerning social issues in recent years is suicide amongst youths. Particularly in East Asian societies, where there are often deep-rooted traditions and a respect for academic acclaim, high-pressure educational systems are often blamed for the mental health issues that plague the young.

Take South Korea, for instance. For many students, their path in life is largely determined by one test—the Suneung college admissions examination. Students study for it as early as the start of high school, as the rewards for getting into any of South Korea’s elite universities cannot be overstated.

A documentary on South Korea’s ‘SKY’ elite universities, the combined acronym for Seoul National University, Korea University, and Yonsei University.

Aside from becoming a shoo-in candidate for most white-collar industries and South Korea’s chaebols (conglomerates), it is also a social marker that can help even one’s children find a job years down the road. With so much at stake, the pressure to perform can turn debilitating.

That is why so many South Korean youths see themselves as living in ‘Hell Joseon’, a term used to describe the malaise state of a Korean society where job opportunities are scarce, social mobility is low, and a sense of hopelessness pervades. And sometimes this hopelessness becomes too much to handle. According to a 2015 report by Statistica Korea, self-harm overtook transport accidents and cancer to become the leading cause of death amongst South Korean youths in 2013.

Sadly, a similar trend is reflected In Singapore. In 2018, suicide was the leading cause of death for youths (aged 10–29), at 94 deaths. Teenage (aged 10–19) male suicides, in particular, rose almost threefold between 2017 and 2018, from 7 to 19.

Even Hong Kong, where suicide rates amongst youths have been historically low compared to other age groups, saw a spike in youth suicides from 2014 to 2017.

Often, the specific causes of suicide are not known, and they may well be described as a complex mix of factors unique to each individual. That said, we start to observe some patterns that can help contextualise mental health issues among youth in these three East Asian societies, once we pull back to a broader view.


East Asia: Prosperous, but poor in mental health?

Branded East Asian Tigers, Hong Kong, Korea, and Singapore have wealthy, modern cities and societies. A reason often cited for their economic success is their quick and early investment in education. These societies also greatly value Confucian meritocratic values that prioritise individual merit over one’s socio-economic background, an ethos that then gets baked into their education systems. While the East Asian Tigers’ focus on educational meritocracy has helped produce skilled workers, it has also created high-pressure, exam-focused systems that take their toll on youths’ mental health.

In Hong Kong, South Korea, and Singapore, national examinations are treated with great severity. They are believed to be key to securing career prospects and are seen as important gatekeepers of an individual’s future opportunities. In Hong Kong, this stress begins in primary school and builds towards the Diploma of Secondary Education (DSE) exams. Similarly, in South Korea, students are drilled to perform well on the College Scholastic Ability Test (CSAT). South Koreans are taught to prepare for the CSAT from an early age, with many enrolled in ‘cram schools’ (private tuition classes) that have them studying up to a gruelling 16 hours each day.

High-stakes exams are also a mainstay of Singapore’s education system. The Primary School Leaving Examinations (PSLE), which separates students into different streams, has been criticised as a form of social stratification that prematurely determines a child’s life opportunities and creates a competitive, high-stakes environment. Faced with overwhelming stress, thousands of Singapore’s youths have been developing anxiety and depressive disorders.


The times are a changin’

The mental health toll on youths within these societies has not gone unnoticed. In fact, it has been the subject of hot debate and criticism, and education systems have started to change in response.

Since 2000, Hong Kong’s education system has undergone reforms, such as the introduction of liberal studies into the curriculum and the reduction of the number of national exams to just one in the DSE. Likewise, South Korea’s education ministry has abolished private high schools and increased the weight given to CSAT scores in university admissions since 2018. These changes make the education system more equitable—private high schools, which typically charge premium tuition fees, often run separate curricula designed to prepare students for the CSAT. Singapore too, has reduced the number of exams in schools and avoided streaming students in secondary schools.

But exactly how extensive are these changes, and do they make a significant difference? In Hong Kong, students remain banded into different secondary schools based on performance. Public opinion in Hong Kong still holds that education reforms have been slow to address mental health issues, despite these changes., For South Korea, critics say that the increased emphasis on CSAT scores encourages cramming, which only serves to exacerbate severe stress among students.

It remains to be seen if these changes across Hong Kong’s, Korea’s, and Singapore’s education systems can ease the high-pressure environments that have built up in their schools. Education systems are large, hulking machines, and any systemic change will likely require a long time to fully take hold.


Rays of hope

Still, mental health is increasingly recognised and addressed more openly in these societies, bringing students a sense of hope. In Hong Kong, the Committee on Prevention of Student Suicides emerged to enhance support for struggling students in schools, and students have begun showing one another support through social media. The Korean government has bolstered action against suicide, setting up a department and increasing available funds to tackle the issue.

Singapore, too, has sought to build positive school environments, improve mental-health education in primary and secondary schools, and enhance support for students. The Character and Citizenship Education curriculum in primary and secondary schools, for instance, now includes a focus on mental health, and student peer-support leaders are charged with helping to look after their peers.

These are encouraging signs that the mental health of East Asia’s youths is being looked after. More important, they suggest that these students’ struggles are finally being contextualised in high-pressure school cultures, opening the door to larger systemic change.