On April 16th
, 2014, the Sewol ferry passenger ship sank in the sea of Jeollanam-do, a province in the southwest corner of South Korea. Three hundred and four of the 476 passengers on the ship either died or went missing.
Three hundred and thirty-nine of the passengers had been sophomore students and teachers of a high school, who were on a field trip. Accordingly, 261 students and teachers were killed in this tragedy. They were from Danwon High School in Ansan, Gyeonggi-do province, a city located southwest of Seoul.
Therefore, although the disaster occurred in Jeollanam-do, the deaths were concentrated in the population in Ansan. Moreover, the majority were students, meaning that the bereaved families mourned the deaths of their son or daughter.
The death of a child, a devastating tragedy, may have additional complexities in the current Korean context, culturally and historically, where the family often revolves around children rather than the couple, and children might be expected to achieve the happiness and success that the parent generation had never had access to in the decades of the post-Korean war aftermath.
Thus, psychologically, the tragedy not only involved those directly affected by the disaster but also deeply shook the community as a whole. The city of Ansan fell into collective shock and mourning, and psychological intervention in the region became very important.
A case management model was developed for the first time in Korea after this disaster. Internationally, there are many intervention models after large-scale trauma, but there are not many with a mid- to long-term intervention perspective that is based on the local community, so systematic and continuous development was needed to develop and monitor such a model. We describe the model and our mental health response efforts below.
From April 16th
to April 30th
, the Mental Health Centers of Gyeonggi-do and Ansan City cooperated to create a temporary organization called Gyeonggi-do – Ansan City Integrated Disaster Mental Health Support Group, which provided emergency psychological support for the mental shock and grief of the families of the dead and missing, as well as local residents. Grief support was also made available as outreach efforts at incense altars and funeral halls; high-risk groups were selected for interventions such as mental counseling and medical support; and a 24-hour hotline was established and operated.
A residents’ counseling center was operated for Ansan and Gyeonggi-do residents experiencing indirect trauma, and volunteers were educated and integrated into the system. Under the judgment that an organization offering continuous psychological support would be needed for smooth communication between the local society and the bereaved families in the long-term, rather than just temporary groups, the Ministry of Health and Welfare became the main supporting department of the new Ansan Mental Health and Trauma Center. Thirty-five people worked at this center, including four psychiatrists, clinical psychologists, mental health social workers, mental health nurses, and general social workers.
The Ansan Mental Health and Trauma Center focused on psychological intervention for the bereaved families. This center was established with the following purposes: 1) to ease pain through physical, social, and psychological support for the bereaved and indirect victims of this tragedy, and to aid adaptive grief reactions; 2) to play the role of a control tower for psychological support for the tragedy by supervising many local civil organizations; and 3) to improve awareness of disasters and trauma among Ansan residents and help the community recover from traumatic group reactions.
Psychological support focusing on trauma and grief of the local community, and psychological support for the bereaved adult family members of the deceased and missing were two of our primary objectives. The family psychology support team for bereaved adult family members had case managers for block family units, who contacted subjects through funeral halls, home visits, their places of activity, and trauma center visits to make available potential services.
Psychological counseling experts recruited externally were placed in class gatherings of the affected high school. Various programs were run, such as group therapy, yoga, healing composition, meditation, self-help gatherings, art programs, mind and body stabilization methods, biofeedback, and Eye Movement Desensitization and Reprocessing.
Oftentimes, people more readily complained of physical pain related to their mental pain, so physical methods for mind and body stabilization were mainly provided. Psychiatrists were always available for continuous evaluations and counseling, not just for the bereaved families, but also for all Ansan residents who wanted a psychiatric interview. Regular and continuous case management is being maintained to this date.
House visits, telephone management, and trauma center visits were provided as customized services that reflected individual needs, and active crisis intervention provided the bereaved families and local residents with a psychological support system. In addition, an expert service on grief-based case management was provided, and various resources were cultivated within the local society to provide related integrated services.
Since most of the deceased were students in their sophomore year in high school, many had brothers and sisters of school age. Thus, another primary objective of this endeavor was to provide psychological support for siblings of the deceased and missing. Experiencing the sudden loss of a brother or sister in adolescence can have a great effect on emotional and cognitive development growing up and, therefore, requires expert observation and support in many cases.
There were many instances where the subjects resisted individual counseling, so the approach of an artwork-making program was devised. The bereaved parents’ class program, in which the state of the surviving sibling was explained in detail to their parents through specific examples, was especially useful. The bereaved families who were experiencing hardships with complex reactions in relation to the surviving sibling and their reactions were able to express their emotions, share their knowledge, and understand the pain of the remaining children. Emotional expression and relationship improvements were attempted through various group programs, and not only with medical interventions. School psychology support for youth was conducted through parents’ and teachers’ education and close cooperation between schools.
Another main objective was the creation of a local social network for the healthy growth of the children and youth of the community. A disaster-related expert was recruited to educate parents and teachers of elementary, middle, and high schools in Ansan city on possible psychological issues.
The cooperation of the local society was crucial in the assessment as well as healing and recovery of the affected community. Various meetings were organized prior to deciding major financial directions and events so that negotiations and adjustments could be made. Local representatives from diverse groups, such as related organizations, religious leaders, experts, and schools, attended such meetings. A nutrition support project was created in connection with the Family Counteraction Committee, as the bereaved families had difficulties in daily life due to the sudden loss of a family member – in particular, in preparing and eating food. A capacity-strengthening project was created through which Ansan residents could overcome group trauma and achieve growth through residents’ classes, open seminars, local residents’ education, and healing concerts. In particular, a support network was established, where the center and local society could work together through cooperation with civil organizations.
The educational booklets listed below were issued to inform health care providers and the public:
- Medical and anthropological foundation research for 4/16 tragedy-related long-term psychological support
- Collection of moving stories from residents after 4/16 tragedy
- Open space for “open talks” for healing of Ansan residents after 4/16 tragedy
- Mid- to long-term support method for brothers and sisters of the deceased from 4/16 tragedy
- Mid- to long-term support method for adult bereaved family members of 4/16 tragedy
- Ansan residents’ healing therapist training program
- Grand seminar on mid- to long-term support method for healing and recovery from 4/16 tragedy
- Psychological trauma treatment method (basic, intensive)
- Finding healing and recovery power for group trauma and civil society
- Intensive mourning counseling and case management program for healing and recovery of Ansan residents
- International symposium proceedings for long-term tracking management advice regarding psychological 4/16 tragedy support
- Grief-based case management manual
All of these booklets and materials can be accessed by contacting Ansan Mental Health and Trauma Center, Room 207 Praum City 33 Dangok-ro Danwon-gu Ansan City, Gyeonggi-do, South Korea, www.ansanonmaum.net
Further, if professionals are interested in training in the methods discussed here, they can contact: Korean Society for Traumatic Stress Studies, Department of Psychiatry, Seoul St. Mary’s Hospital, The Catholic University of Korea, 222 Banpodaero, Seocho-gu, Seoul, Korea, email: firstname.lastname@example.org
About the Author
Jeong-Ho Chae, MD, PhD, is a professor and chairman of Department of Psychiatry, and director of The Catholic University of Korea, Seoul St. Mary’s Hospital, Seoul, Korea. Dr. Chae is the president of Korean Academy of Cognitive & Behavior Therapy and founding president of Korean Society of Traumatic Stress Studies. Dr. Chae specializes in research and practice on the anxiety disorders, depression, and PTSD.
Disaster Mental Health Committee of Korean Neuropsychiatric Association. (2015). Disaster and Mental Health. Hakjisa, Seoul.
Paik, J.W., Kim, H.S., Sim, M., Lee, H.K., Woo, Y.S., Chung, C., Lee, S.H., Seok, J.H., Jeon, H.J., Lee, S.M., Bang, S.Y., Na, K.S., Lee, B.C., Lee, M.S., Huh, H.J., & Chae, J. H. (2015). The Sewol Ferry accident and early mental health care response by volunteer activities of Korean Disaster Mental Health Committee and Members of Korean Neuropsychiatric Association. Journal of the Korean Neuropsychiatric Association, 54,