By Suh Soo-yeon
Recently, the Ministry of Health and Welfare passed a new mental health bill to include cognitive-behavioral therapy (CBT) under the universal medical health insurance. CBT is a type of psychotherapy that has the strongest scientific evidence for being effective for a range of psychiatric illnesses, psychological problems and relationship issues. While this new mental health bill was a huge step forward in acknowledging that more forms of effective mental health care needs to be offered to the public than medical management in the country which ranks first among suicide rates, the new policy states that only psychiatrists and neurologists would be allowed to provide CBT, and excludes any other mental health professionals.
As a clinical psychologist who has studied and practiced CBT for the past 13 years, written a book about CBT, and teaches CBT to graduate students every semester, this new mental health bill came as a huge shock to me for a number of reasons. First, during the last year, there were more than 6.15 million individuals in Korea who were diagnosed with some form of psychiatric illness. Given that there are only roughly 6,500 psychiatrists and neurologists in Korea, it is highly likely that most of these people will not be able to receive CBT in hospitals (roughly 950 patients to 1 doctor). This new bill will therefore move Korea away from the worldwide trend of making more mental health professionals available to those who are suffering from psychiatric illnesses.
Second, individuals who have the government-issued “mental health clinical psychologist” license will no longer be able to provide CBT, and many of them will end up losing their jobs. The government legislated the Mental Health Promotion Act in 1995, and started recruiting and training mental health professionals consisting of nurses, social workers and clinical psychologists by establishing a national license called “mental health agents.” These mental health agents were expected to complement doctors in the medical field, and mental health clinical psychologists were expected to conduct psychological assessments and provide therapy, including CBT, as their main duties. Since 1997, mental health clinical psychologists have contributed to the mental health field with their expertise in clinical psychology. However, with this new change, they will no longer be able to provide CBT. Not only does this put many mental health clinical psychologists in jeopardy of losing their jobs, it also prevents any new mental health clinical psychologists from being trained in the future in CBT as a mandatory part of training in receiving the government-issued license. Basically, by passing this new policy, the government is unofficially announcing that they are discarding an important group of mental health professionals who have loyally served the mental health field, after having invested in them for the past 20 years.
Finally, CBT requires a level of professional training beyond a mere understanding about psychiatric illnesses. I recently went back and looked at my application when I was applying for licensure in California. I had acquired over 5,000 hours of clinical training, with most of those hours spent face-to-face with patients providing psychological services. Even after I acquired my doctorate, I still needed an extra 2,000 hours of clinical experience to acquire a license in California. This is consistent in many countries across the world such as Germany which requires psychiatrists have at least more than three years of psychotherapy experience beyond their medical degree. This is in stark contrast to Korea, as many psychiatrists and psychologists will either receive no psychotherapy training or attend a short workshop before trying to provide CBT to patients.
Koreans work hard every day to make a good life for themselves yet many of them are depressed, suicidal and tired. Koreans deserve good quality psychological services, and as far as therapy goes, quality is so much more important than quantity. I hope that the ministry reconsiders this decision so Koreans can finally find some respite from their daily lives.
Suh is an assistant professor at Sungshin Women's University, Dept. of Psychology. She can be reached at