A panel of 33 mental health multidisciplinary professionals across psychology, psychiatry, the arts council, the ministry of education, voluntary work organisations and academicians with expertise predominantly within the Asian region gathered at the inaugural Round Table discussion at NUHS Tower Block on 22 November 2017. The enthusiastic response to invitations allude that Hikikomori as a phenomenon has been identified as a mental health issue that warrants attention and congregation of empirically driven evidence for future steps on conclusive profiling and intervention.

MSC welcomed an exciting series of speakers representing various regions or jurisdictions their research expertise is nested within. They include A/Prof Kato Takahiro (Kyushu University), Prof Lo Tit Wing (City University of Hong Kong), Dr Gloria Chan (Caritas Institute of Higher Education), A/Prof Paul Wong Wai Ching (Hong Kong University), Dr Jungup Lee (National University of Singapore), Mr Ray Chua (REACH West), Dr Teng Jia Ying (National University Hospital), Dr Shao Yang (Shanghai Mental Health Center), Mr Shem Yao (Touch Community Services) and Ms Jennie Wan (MeToYou).

The Hikikomori Round Table Discussants at NUHS.

The Round Table serves as the first inter-regional exchange of academic findings, to collate an integrated, multi-dimensional understanding of Hikikomori. The various features of the condition include problem definition, risk factors, country reports addressed in the first half, followed by interventions and organization of social services in the second half. This provided structure to the discussion, where A/Prof Paul Wong and A/Prof John Wong, the Lin Jo Yan and Yeo Boon Khim Professor in Mental Health and Neuroscience, moderated the first segment, while A/Prof Tan Chay Hoon and Dr Tian Cheong Sing moderated the second segment. Five general discussions at various intervals throughout the discussion assisted in enhancing clarify of content and for local Singaporean mental health colleagues to provide their own input and feedback on how Hikikomori should be addressed in the local context.

Dr Jungup Lee presenting the regional report on Socially Withdrawn Youths in Korea.

A/Prof Kato and Prof Lo and opened the topic for discussion by raising functional and operational definitions for diagnosis of Hikikomori, based on the duration of three versus six months in various regions, exclusions such as mental illness diagnosis, and five stages of social withdrawal. A/Prof John Wong then differentiated Primary and Secondary Hikikomori, and various psychiatric and psychosocial comorbidities that occur in a portion of Hikikomori individuals such as gaming or device addiction, psychosis, anxiety, depression, personality and developmental disorders.

Mr Shem Yao presenting on VWO Touch Community Services.

After a brief tea break, A/Prof Kato, Prof Lo and Mr Chua shared presenting case reports of Hikikomori as well as cultural factors that influence several characteristics of Hikikomori in different geographic locations of Japan, Hong Kong and Singapore. After lunch, Dr Lee and Dr Shao also supplemented the regional report with depictions the Hikikomori phenomenon in South Korea and China. Across the different locales, respective incidence rate, organization of existing interventions, challenges faced in screening, assessment and treatment, and identified service and provision gaps were addressed.

Thereafter, interventions were discussed at the Biological, Psychological and Social level by A/Prof Kato, A/Prof Paul Wong and Dr Chan respectively. In particular, they introduced several novel approaches including psychodynamic therapy and family education programs by A/Prof Kato. A/Prof Paul Wong revealed the efficacy of Regain Momentum network of programs focusing on interpersonal relationships and improved employability, as well as animal-assisted dog therapy. Dr Chan drew attention to the use of online gaming platforms as a more effective method of reaching out to youths, in contrast with traditional home visits. Dr Teng concluded with the impact on the system, society, family and individual, by drawing parallels between individual and family level issues, and the cumulative exhaustive effects on parents of Hikikomori individuals that may face mental health challenges of their own. The positive and negative impact on youth economic consumerism trends are also briefly discussed.

A/Prof Tan and Dr Tian moderating the discussion on interventions

Lastly, after a brief tea break, voluntary work organizations Touch Community Services and MeToYou in Singapore were represented by Mr Yao and Ms Wan. Their approach and framework mainly target cyber wellness to address social withdrawal in youths, and both articulate the interest to measure efficacy of their interventions, which are currently not empirically driven or proven in entirety, despite positive response and case reports observed.

A/Prof John Wong summarizing the Round Table discussion at the close of the event.

In conclusion, the problem definition comprises of operational definition of the Hikikomori population and other modern issues seen in youths such as Not in Education, Employment or Training, and internet addiction. Therefore, a multidimensional approach is necessary to target the three types of withdrawn youths; overdependent, maladaptive interdependent, and counterdependent. Hikikomori is a mult-faceted phenomenon, above whether it should be addressed as a social ill or disease. Regional similarities and differences can provide insight on the various cultural and demographic factors, unique and personal trajectories of the Hikikomori individuals, and the different gatekeepers to detect and increase early accessibility to resources. Existing challenges include identifying whether the youths, family, mental health professionals or society is distressed or perceiving Hikikomori as a problem, and provide therapeutic, social and educational intervention where necessary. The impact of Hikikomori in the socioecological model affects the individual, family and society, alluding to the necessity for cross-sectional approaches for longitudinal efficacy.

In sum, mental health wellbeing and resilience against Hikikomori is determined by a composite of sociodemographic and psychiatric risk factors, clinical and operational problem definition, regional similarities and differences, multidisciplinary biopsychosocial approach, standardized assessment tools, which ultimately influence Government and municipal policies.