Chizine

Preface Mental health is a pervasive issue which ails everyone. No one is immune to its impacts, as inconspicuous as they could be, and it is plain to see that there is a need to combat the plight that is mental illness. In recent years, there have been

an increasing number of initiatives to promote understanding of mental health, yet statistics show that mental health issues of Hong Kong are not improving.

“There is no health without mental health.� This is often emphasised by the

WHO, and parroted by the Hong Kong government. That being said, many

question the effectiveness of the efforts headed by the government to the end of promoting mental health in Hong Kong.

With that in mind, Chi-zine’s goal is to gather and retell Hong Kong centric

mental health experiences and investigate the underlying problems of the mental healthcare system, in an effort to find possible outs that we have in this dire situation.

2

Table of Contents Introduction

4-9

A Wounded Healer

10-11

Price of $100000 - Is It Worth It?

12-13

Solace in Understanding

14-15

Pride Built on Psychiatrists’ Sweat and Blood

16-17

An “Accidental” Psychiatrist Au Yeung Kwok Leung

18-19

Support in Society

20-23

Hong Kong’s Healthcare System – Time For a Reform?

24-26

Acknowledgements

27

3

What is the mental health situation in Hong Kong?

Who is having mental health issue here?

4

Introduction In one of the most densely populated cities in the world, with many people working long hours, and even experiencing the coronavirus pandemic alongside the fragile

political climate, it is not surprising that mental health issues are still commonplace in Hong Kong.

Anyone in the city could suffer from mental issues.

5

Hong Kong Citizen Mental Health Index 60

56.3

59.8

50.2

46.4

44.5

45.1

40

57.8

50

2015

2016

2017

2018

2019

Early 2020

Mid 2020

Data: Mental Health Month

In 2020, the mental health issue in Hong Kong is more prevalent than ever

recorded. Experiencing the social unrest and the coronavirus pandemic, the average mental health index of Hongkongers has dropped to a new low of 45

this year. Over 60% of interviewees’ mental health is at “unsatisfactory/failed� state.

6

Prevalenece in Hong Kong No. of Recorded Psychiatric Patients 2016-17

240900

2017-18

251200

Estimated no. of psychiatric patients

2018-19

1.1-1.8

258700

MILLION

Psychiatrist : Population Ratio

1 : 21000

Data: Hospital Authority

One out of seven Hongkongers will experience mental

behind the increasing numbers is the unhealthy work

mixed anxiety and depressive disorder (MADD), followed

longest working hours around the world exacerbates the

health issues in their life, with the most common being by anxiety disorders.

culture which led to workplace stress. Having one of the issue.

The estimated number of people with mental disorders is

As for the youth, the exam oriented study culture resulted

Serious mental illness cases also amount to a concerning

states that over half of the secondary school students have

1.1 to 1.8 million, with a majority of them not seeking help. estimation between 70,000-220,000.

Mind HK’s research suggests that the major contributor

in poor mental health. The Food and Health Bureau’s report depression symptoms and a quarter of them demonstrate clinically-high levels of anxiety.

7

Lack of support?

No. of Psychiatrists in the Public Sector

344

15-16

349

16-17

Average Waiting Time of Public Psychiatric Services Priority 1 (Urgent) <1 to 1 week Priority 2 (Semi-urgent)

347

17-18

351

18-19

Priority 3 (Stable)

368

19-20

14-105 weeks (~3.5 months- ~2 years)

3-6 weeks

Data: Hospital Authority

Currently, the average waiting time for visiting a psychiatrist

The shortage of mental health professionals is a main cause

as â&#x20AC;&#x153;stableâ&#x20AC;?, which is the lowest in the triage system.

sector has to handle 3000-5000 psychiatric patients. The

in public hospitals is almost 2 years if the case is regarded

Despite the long waiting time, many citizens still opt for the

public service due to the high cost of private mental health services. Those who are not able to afford can only wait,

when their problems might worsen. On the bright side, some mild cases do recover during the waiting period, according to psychiatrist Dr. Au Yeung Kwok Leung.

8

of the long waiting time. Every psychiatrist in the public

psychiatrist to population ratio in Hong Kong is 1:21000, far behind the 1:11500 average in high income countries.

Hong Kong only has half the number of psychiatrists recommended by the World Health Organisation. Shortage

of psychiatrists in the public sector is also caused by the high turnover rate, as more psychiatrists choose to work in the private sector.

Patientsâ&#x20AC;&#x2122; Story There are many forms of mental illnesses, and everyoneâ&#x20AC;&#x2122;s stories are unique in

their own right. Hopefully, sharing these experiences will be a small step towards destigmatisation of mental illnesses.

9

A wounded healer

“Everyone has emotions.”

Sometimes it is forgotten that this applies to psychiatric professionals as well.

As an occupational therapist, Gloria’s job is to help mental illness patients rehabilitate and rejoin the society. However, due to her line of work, Gloria

herself has fallen ill with depression, and faced discrimination from mental illness centric NGOs when she sought employment as an occupational

therapist after her recovery. Despite that, Gloria firmly believes that “[her] medical history does not define her capabilities”.

When Gloria was diagnosed with

therapists, and art therapists, in

as

but to no avail. At the time, Gloria

depression, she was still working an

occupational

specializing

in

therapist,

rehabilitation

for

mental illness patients. Since her

senior was replaced with another, her workload has grown excessively heavy, to the point where it is nearly

refused to visit a psychiatrist, as “[she] did not want to bear the label

of a mental health patient as an occupational therapist.”

double her coworkers’.The heavy

Gloria’s fear of labelling is not

her took a heavy toll on her

profession is truly helpful to those

down at work, sobbing while hiding

to her being even more worried

workload and her senior mistreating

baseless. She believes that her

emotions, which led to her breaking

who seek her aid, which leads

in the bathroom.

about losing her job because of

She has not gone a day without

backed into a corner when none of

breaking down into tears during her

two years of work when diagnosed with depression. She approached clinical 10

hopes of improving her condition,

psychologists,

hypnosis

her condition. She was eventually

the non-psychiatrist options worked for her, and visited a psychiatrist, who diagnosed her depression.

The psychiatrist suggested Gloria

to request a lighter workload from

her senior, however, this request

can tell from their despising eyes that they are not convinced.”

was ignored by her senior even

Though

her

job

seeking

has

the psychiatrist. A year later, she

her medical history, Gloria does

her work was solely based on her

this information to her potential

depression, which led to a negative

claims to help mental health patients

Consequently, she was coerced to

mental illness, then it is pointless for

when presented with a note from

been hampered by her revealing

found that her senior’s appraisal of

not

performance after the onset of her

employers. “After all, if a NGO that

review of her work performance.

can’t even accept my history with

resign.

me to work there.” Gloria believes

On

top

of

her

struggle

with

depression, she also had to take care of a family member with dementia.

The overwhelming pressure further

unstabilized her condition, which

led to her turning to self harm on an occasion. Fortunately, her condition eventually stabilized through the combined effort of her psychiatrist and

herself.

Her

psychiatrist

believed that she was well enough to seek employment, and encouraged her to do so. However, she has not

heard back from any NGOs where she sought employment from past

the first round interviews, and she

that

regret

proactively

though

many

revealing

NGOs

state

their mission to be helping those with mental health needs, they still discriminate

against

those

with

mental health issues. She believes

that NGO seniors should be more in

touch

with

emotions

and

their

employees’

make

suitable

led

interviews, to

which

interviewers

invariably

questioning

her capability to deal with work.

Gloria believes her history with mental illness to be a boon rather than a bane in this line of work, as to

her

experience

understand

what

allows

her

psychiatry

services are lacking. Despite Gloria

emphasising that she has already

recovered from her illness, “[one]

through

mediation.

Gloria

believes that even if the mediation was

successful,

her

workplace

experience would not be improved

by any meaningful degree. Her experiences has led her to create the

Facebook

page

“Wounded

Healer”, where she employs her professional knowledge and shares

her personal experiences to the

end of helping those in need with their rehabilitation, and ultimately change

the

many

negative,

stereotypical assumptions that the public have about those with mental health issues.

understand everyone has emotions, but even one with mental illness can be capable of working.”

the right to lodge a complaint

her

case

utmost importance that “employers

Gloria

her history of mental illness during

and would prefer to solve the

all else, Gloria thinks that it is of

by

reveal

intend to seek aid from the EOC,

employers in other fields. Above

recovered from mental illnesses. proactively

Gloria states that she does not

as necessary to set an example to

As of now, mental health patients

would

Knowing that,

workplace adjustments and support

believes that to be NGOs not being

able to accept those who have

her mental history.

are protected from discrimination the

Disability

Discrimination

Ordinance, which ensures them

when facing discrimination based on their mental health issues. Chi-

zine requested advice from the Equal Opportunities Commission (EOC)

regarding

Gloria’s

case.

According to the EOC’s response, Gloria’s

case

actionable

as

may her

be

legally

experiences

during her job seeking may hint at suspected discrimination against

Gloria by the employers based on misconceived assumptions about

11

Price of $100000 is it worth it?

Even

though

people

with

mental

health

require

formal medical care, informal care such as comfort,

understanding and support from family and friends are often important to patients on their road to recovery.

One of the largest obstacles in a mental health patient’s

path to recovery is often monetary costs of treatment, Jonathan Law has spent nearly $100,000 in the past two

years to finance his treatment for his depression. Even if

the sessions are very pricey, Jonathan still believes that seeking professional psychiatric aid is the fastest way to returning to a healthy mental state.

Depression originated from schoolwork Born in the late 90s, Jonathan Law is still in his academic

pursuit. Studying in one of the most prestigious law schools in the UK - the London School of Economics

and Political Science, the competition amongst the elite is intense even though the peers are friendly and supportive.

As Law

is a competitive person, he pushed himself

extremely hard during his first year as the freshman year results are important for gaining future career opportunities.

“I was a little bit depressed at times but it was still

manageable. Not until when exams approached, which was when I had a mental breakdown.”

After the mental breakdown, he was diagnosed with

depression after seeing a counselling psychologist in Hong Kong.

“(We) can’t wait, especially for mental illness. It takes a

long time to wait for a public psychiatrist in Hong Kong, even if you have a referral.”

The first professional he reached out to was a counselling

Besides being unhappy, people with depression like Law

psychologist, who mainly talked to him and did exercises

short attention span, mood swings and self-harm

behavioural therapy allowed him to change his behaviours

have symptoms such as attention deficit, procrastination,

with him to understand his own thoughts. The cognitive

thoughts, especially at night.

through altering his thought patterns.

Effectiveness vs affordability

Each session lasts for 45 minutes, and occasionally two to

When it came to treatment options, Law had no options

more effective as it allowed him to feel significantly better

but to opt for private services. He had sought help from both a counselling psychologist and a psychiatrist.

12

three hours if the condition is serious. Law found therapy

in just several weeks. However, it was the price which made him think twice - a steep 3000-4000 HKD weekly.

Soon after he consulted a counselling psychologist, he

Importance of support network

medication for him, but it took a long time to find the

Apart from the formal medical treatment, Law thinks that

him, which had to be evaluated every month, and each

His family and friends were supportive, which aided his

was referred to a psychiatrist. The psychiatrist prescribed

correct dosage and the medicine most compatible with

a good support network was essential to his recovery.

meeting only lasts around five to ten minutes. Also, the

recovery.

and constipation, and it’s a long-term treatment.

“My parents gave me a lot of space and showed presence

“It took one year to improve the situation from two to three

Even the minimal things were very helpful.”

that effective in the first few months.”

He regarded this as his privilege as some individuals

The upside is that psychiatrists are more affordable

have to seek support elsewhere on top of the extra family

chose to continue with the psychiatric treatment but not

through acceptance and listening to depression patients.

medication has notable side effects such as tiredness

marks to six to seven marks out of 10 marks, but it isn’t

and their love to me, like saying “we love you very much”.

have bad family relationships, in which case they would

- 2000 to 3000 HKD per month. This is also why Law counselling.

burden. Good comfort can already be provided simply

Law thinks it would be tough for him without a support

network, as he could only rely on himself for mental

adjustment aside from professionals if a support network

Price Treatment Meeting time Effectiveness

Therapist

Psychiatrist

3000-4000

2000-3000

weekly

Counselling, exercise

monthly

Medication

45 minutes

5-10 minutes

Effective after

Effective after a

weeks

was absent. Moreover, people around them can provide

more immediate support and have good bonding in the long term.

“Professionals don’t really participate in your life, they are just there to make it less worse. Friends and family are more impactful.”

long time

13

Solace in understanding A large portion of Hong Kong’s youth experience mental health issues. Unfortunately, those are often students, who do not have time to work. The public sector’s psychiatry team is overloaded with cases. This poses a question: Does the Hong Kong youth really have a choice when it comes to seeking mental health aid?

Among one of those youths, is Sabrina Yu, who is diagnosed with depression, generalized anxiety disorder, panic disorder, and mild OCD.

“It’s all in your head?”

Helping hands

When asked to describe a panic attack, this is what Yu said.

Yu tended to hide her panic attack from her friends when she

“You start to shake uncontrollably, stutter, feel faint, nauseous,

was experiencing one

and an intense sense of fear overcomes you, and you lose

“When I have a panic attack, I kind of revert back into a child,

surroundings.”

understand.” Yu recalls an episode where she had a panic

all sense of time as your mind is so loud it overrides your

While mental illnesses are issues of a psychiatric nature, the

symptoms can often manifest on a physical level. After an accident at the gym that led to head trauma a year ago, Yu experiences panic attacks up to 5 times a day.

Onset and development Yu’s onset of her panic disorder was when she was around 8,

which was when her first dog passed away. Since then, Yu has experienced panic attacks which would occur around once

a year. Stepping into adolescence, Yu started to experience symptoms of depression, losing interest in everything.

“I was the model child back then, top grades, obedient - things you would expect from your kid. High school came around, along with conflicts, internal conflict with myself, as well as with my friends. Eventually I lost my interest in everything, I just didn’t see the point in school, and didn’t care about myself.”

For an extended period of time, Yu barely attended school. Due to her deteriorating academic performance, and attendance

issues, the principal and her head of year asked for an explanation of her situation. The principal asked Yu “What is your

plan for the future?” “I don’t wanna study, I just wanna f**k off, I

wanna be a piece of s**t” was the blunt and heartfelt response she delivered at the time.

14

like I would grab and cling onto my mother and she would

attack while visiting the dentist, where she shook intensely and

the dentist had to stop and check if something was wrong with the procedure. Yu’s mother helped calm her down by patting her and verbally reassuring her until the attack subsided.

“I feel very isolated and desensitized to external stimulus, my fight

or flight response takes over, and my usual coping mechanisms such as writing as a method of catharsis are not helpful at all,

as I can barely write legible words when the panic attack takes over.” Yu also notes that common methods suggested to control

panic attacks, such as 4-7-8 breathing, are not helpful at all to her.

“I guess there’s something that helps everyone, even though

something works for others, it might not work for me. For me,

and many others I know, rescue pastilles are helpful. Personally, I tend to cling to something, or play with my dog. I would instinctively reach out for a hug if someone close to me is nearby so they could stop the shaking. Creating a calming environment,

such as brewing some ginger tea, also helps in relieving the attack.”

Above all, Yu believes that finding someone who experienced similar symptoms was very helpful, as she found comfort in

knowing that someone truly understands what her experiences are like.

Treatment

to that, she is hesitant regarding taking medication, as she is

“I haven’t experienced psychiatrist services in Hong Kong’s

about.

public hospitals yet, but if I had to make a guess, I would

worried about the possible side effects the medication can bring

estimate a session to last around one to one and a half hours?”

As an alternative solution, she visits a mental health coach, an

Contrary to Yu’s expectations, due to the lack of manpower

such as journaling, inner child meditation which helped her

in Hong Kong’s mental healthcare system, the reality is that sessions with a psychiatrist in Hong Kong’s public hospitals last

who helps her through leading her through different exercises, reconstruct and assist in dealing with her childhood trauma.

around three minutes.

However, Yu is in two minds with regards to whether she should

Despite how troubling her conditions are, Yu has not sought

rather financially taxing. Costing around 200 USD for four one-

help from a psychiatrist, and the reasons are multifold. Negative

reviews of psychiatrists from Yu’s friend, monetary factor, and a doubt of the severity of her case.

“Sometimes I feel like maybe my case doesn’t warrant visiting a psychiatrist. I am worried that I might be wasting the psychiatrists

time if I visited, when their time could be spent treating someone in dire need.”

Yu says that an important reason is that she is unable to commit

to a psychiatrist’s treatment as she is currently studying in Canada. In the near future, she foresees herself going back and forth between Canada and Hong Kong, which makes regular

continue her sessions with her mental health coach, as it is hour sessions, the sessions are not affordable in the long run for

a college student, even though she feels that the sessions are helping with her condition.

According to the most recent Mental Health Review Report

by the Food and Health Bureau, the caseload of the child and adolescent psychiatric team has shown a sharp increasing trend, revealing a need of mental health resources for the younger age group, yet, those who are younger are often unable to acquire

the money necessary for private treatment, nor are the public resources sufficient to provide ideal treatment for the younger population, such as ones like Yu.

appointments to the same psychiatrist difficult. In addition 15

Pride built on psychiatrists’ sweat and blood Hong Kong has always been known as having the most efficient mental healthcare system, yet to Dr. Au Yeung, a psychiatrist in Hong Kong, “I feel no pride, only misery”. He explained that to satisfy the psychiatric needs of Hong Kong with this amount of people implies that the psychiatrists have to be “worked to the bones”.

How do we fare?

This may appear to be a rather curious sentence. However,

“Actually, I would consider Hong Kong’s mental healthcare

that efficiency is basically the ratio of results delivered to

system to be superior to ones of foreign countries such as the UK” said Au Yeung.

While Hong Kong’s system certainly has its problems –

it is not as odd as it seems once Dr. Au Yeung explained the resources spent.

such as long queue times resulting from a low number of

“Basically, efficiency can be translated to the

the system of UK, which would see patients directed to a

to the bone.”

staff – particularly in public service – it is still better than

doctors in public health services being worked

general practitioner, who may or may not be capable of treating mental health patients effectively.

Brain drain from public sector

Dr. Au Yeung described the working conditions for

psychiatrists in public services as undesirable, and that many felt that the Hospital Authority did not care much for

their staff, drawing many psychiatrists towards running “Did you know we are the most efficient

their own private clinic instead, where work conditions are

systems? Yet I feel no pride, only misery.”

income.

internationally in terms of mental healthcare

16

more controllable, as well as generating a more lucrative

Escaping the current predicament

Currently, no country in the world runs an effective triage system for mental healthcare. General practitioners’ eyes

are not sufficiently trained to determine what kind of “Rather

than

saying

there

aren’t

enough

psychiatrists in Hong Kong, you should say there aren’t enough people practicing medicine in general.”

treatment a mental illness patient needs. “One problem

of Hongkongers seeking mental health aid is that there are too many choices – which patients often choose from without being well informed.”

Dr. Au Yeung recalls a case of an eight year old child he treated. The child’s family had a history of depression, and

Contrary to popular belief, psychiatry is among the more popular choices for Medicine students, however, human resources have to be allocated to best fit the needs of the

society. “There aren’t enough doctors in internal medicine too, that is plain for anyone to see. It’s really difficult to request increased resources allocated to psychiatry too, since cases are rarely lethal.”

Mental healthcare reimagined

“It is basically impossible to increase the

number of psychiatrists to any amount that would result in significant changes with regards

to accommodating patients. What we need is a triage system.”

the child herself also showed symptoms of depression

at the young age, without warning. Her parents had her qualms putting her child on medication, and thus looked

towards social workers for counselling – which did not help despite an extensive period of time working towards that end.

Eventually, the child’s parents turned to Dr. Au Yeung

for help. After taking serotonin for a mere four days, the child’s vim and vigor returned to her.

“People get information from many sources nowadays, lacking the knowledge to judge whether someone else’s solution also applies to

them, they blindly follow that information, which essentially leaves their treatment to chance.”

17

An “Accidental” Psychiatrist Au Yeung Kwok Leung A psychiatrist since 2001, Dr. Au Yeung Kwok Leung has

plenty of experience in the field from his work at Castle Peak Hospital and his recently established private clinic.

where his eloquence would play a much greater role in his line of work than he thought.

He has a fair share of encounters of eccentric conditions,

Though in Chinese there is a saying that says that

guessed that his career as a psychiatrist started as an

Yeung maintains that counselling is not a replacement for

and successfully dealt with many. No one would have

“emotional problems require emotional solutions”, Au

“accident”.

medication. Rather, receiving both is the most beneficial

Au Yeung recalls his internship experiences at various

explanation of the medication itself can lead to greatly

departments in hospitals after graduating from the MBChB

programme. Students had to make a choice between

to the patient. “Medication is one thing, but the doctor’s varying results in the efficacy of the treatment.”

some 40 options. Putting optometry as a first choice, and

Au Yeung illustrates the situation as follows: Assume that

led to him being a psychiatrist anyway. He earned himself

of one to ten. However, if the patient does not understand,

performance at the interview. Yet the same eloquence led

the effectiveness may drop to a measly two to three.

at the time.

with emotional problems, which sometimes goes beyond

“I may be the last student who was forced into psychiatry,”

psychiatrists should aim to gain the patient’s trust, in order

psychiatry at a last, “fate worked in mysterious ways” and it

the medication is rated a seven in effectiveness on a scale

a place as an optometrist intern owing to his eloquent

or even fear the effects of the medication they are given,

to him being placed into a profession which surprised him

Hence it is important for psychiatrists to help their patients

said Au Yeung as he laughed. His career plan was to proceed as an optometrist, which led to his shock when

explaining the effects of their medication. Ultimately, for the treatment to be effective.

receiving the employment notice which reads: Psychiatrist.

However, most psychiatry consultation sessions in Hong

anyone can be this talkative!’” Through a series of

poses the question: How is it possible for these patients to

“The interviewer probably thought, ‘wow, I can’t believe

Kong’s public hospitals last around three minutes, which

“accidents”, Au Yeung ended up in the psychiatry ward,

undergo this ideal sort of treatment?

Support in society Apart from the public and private hospital services, the social community actually has different support available for individuals with mental health

support. The government, NGOs and even individuals in society attempted to

provide assistance towards people with mental health problems. At the same time, they tried to raise the public awareness and educate the general public about the issue.

Government - Shall We Talk With a $50 million funding, “Shall We

not be hard to come across posters

is among the proposed solutions.

off by the government in July 2020.

holding a string telephone, or have

inception

Talk” is a campaign recently kicked In need of raising social awareness of the public towards mental health

problems, the programme targets

on education and destigmatisation.

While the public has yet to see the

effectiveness of this programme, the

predecessor programme “Joyful @

HK” launched in 2016 had similar objectives, yet what it has actually achieved came under question.

In the past few months, it should

of well-known singer Eason Chan watched a mental health programme on RTHK. It is indeed part of the

promotion strategies of the “Shall We

where

solutions

development.

Shall We Talk is a successor to

Health (ACMH) and the Department

HK, which was alleged to have

committee aimed to advise and

towards the public. Tracing back,

mental health policies and measures

launched in 2016, under the “Review

Kong. The “Shall We Talk” scheme

by the Government in May 2013. The

by the Advisory Committee on Mental

a

of Health in November 2017. The

low effectiveness and little reach

assist the Government on developing

“Joyful@HK” was a three-year-plan

to enhance the services in Hong

Committee on Mental Health” formed

Aim: Review Policy & help gov map out future policy direction

20

stage,

are in the process of research and

Talk” programme , launched jointly

Review Committee on Mental Health Established

2013

Yet, as of 2020, they are still in the

previous

programme,

Joyful@

Joyful@HK launched (3-year programme)

2016

aim of the Committee was again to review Hong Kong’s mental health

policy and help the Government map out future policy direction. Not only

do it have similar aims and objectives with the “Shall We Talk” programme,

its promotion strategies were also more or less the same.

The “Joyful@HK” programme had invited the celebrity Sammi Cheng

as the campaign ambassador and launched a website “joyfulathk.hk”

and Facebook page as well. Four

years have passed since then, the

campaign Facebook page has only 16 likes. On top of that, its website’s “My Pledge” session, which encourages

people to promise walking one step

closer towards healthier lives had included over a hundred replies, even

from Chief Executive Carrie Lam and Secretary for Food and Health, Sopia

Chan, yet most of them had the exact same wordings.

“If I had $50 million, I would rather

invest in new technology that could directly help the patients.” said Jim, co-founder of Mentalok – an

application that allows people with

mental health issues to chat one-onone anonymously. Jim explained that new technologies could be built upon Google Glass technology or even the Siri function, in which mental health patients or their peers could get

instant guidelines on how to handle sudden emotional breakdown or

related issues. “Though that may sound unrealistic, I believe that

having it spend directly on helping

Mental Health Review Report announced

the patients is way more optimal

the role instead. “Actual support and

doing.”

need right now”, Dr. Au Yeung further

than what “Shall We Talk” is actually

Dr. Au Yeung, a psychiatrist, had similar views towards the scheme

as well. He believed that education

on mental health in Hong Kong

explained that many NGOs have indeed launched many programmes

in promoting the awareness of mental health in Hong Kong.

should always be encouraged and promoted, yet NGOs could take up

Advisory Committee on Mental Health Established Aim: Advise & Assist gov to develop policy

2017

services are the patients’ most urgent

Joyful@HK concluded ; “Shall We Talk” launched

2020

21

NGO - Mind HK Not only do NGOs attempt to promote mental health in society just like the government, they are also playing a key role in bridging the citizens and the resources and services available to them.

Mind HK, a local mental health charity in Hong Kong, aims to make sure no one has to face mental health problems alone.

The organisation offers low cost or free healthcare services to the public, which includes online resources, training, and outreach campaigns.

Mind HK agrees that there is a lack of resources allocated to mental health patients in need. Hence, the organisation attempts to put much effort into mental health education as they believe that early intervention through self-help materials or low-intensity psychological therapies can alleviate the strain on both the private and public sector to focus on more severe cases.

Mind HK’s survey shows that 60% of Hong Kong adults do not know where to seek help outside of hospitals, implying that the public are not well informed on the means of seeking help. Despite their effort to promote awareness, Mind HK admits that “a gap remains between knowing and applying the said knowledge to improve the current situation”.

Mentalok “A

lot

of

people

have

mental

disorders, and usually other people struggle to understand them,”

who is looking for technological for

the

mental

people with mental disorders best understand their peers, therefore

said Jim, the co-founder of Mentalok, solutions

issues in society. He believes that

health

informal community care allows them to chat and comfort one another more

effectively than a social worker may be capable of.

Matchmaking process

Users are asked to report their own mental health problem and rate their mood. The system will pair up the individuals accordingly.

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Origin of the app Since the beginning of the social movement in 2019, more adolescents have used Telegram as a platform to talk about their own thoughts, and a lot of them have mental health problems. Jim discovered that they feel more relieved and relaxed after chatting with the “treeholes”.

When the negative thoughts appear, they usually want to look for immediate support. However, they may not want to disclose their thoughts with their family and friends.

“It’s hard to find people to talk to at night, it is difficult to find the same entrusted person over a hundred times. They may feel annoyed. You may want to look for a new person to talk to, perhaps someone with different values.”

As a result, Jim and his team developed the platform for people with mental health issues to seek comfort among understanding peers.

App features “Teens and adolescents nowadays aren’t good at talking to people over phones and hotlines, they prefer typing more.”

Jim suggested that texting is a more comfortable and convenient way for people to express their own thoughts. Especially when it is a one-on-one conversation, users can ensure someone is really communicating with them. Situations like one’s text getting ignored in a group chat can be avoided.

Also, the registration process is easy, only requiring a phone number, username and sex. Before the matchmaking process, users are asked to report their own mental health problem during the first trial, and rate their mood every time.

Afterwards, the system will pair up the individuals accordingly.

“Surprisingly, even the person who wishes to seek comfort at first will try to comfort the other person with more serious mental health problems when they are matched, and both of them successfully alleviated themselves from their negative thoughts.”

Regarding personal safety concerns, artificial intelligence is employed to analyse and filter conversations to ensure they aren’t too negative in nature. The system has a hidden score of negativity based on the choice of words and sentences, and will issue warnings to the users that their matching will be terminated if negativity continues to increase. The feature aims to filter thoughts such as “committing suicide together” to protect the users. Also, it ensures user privacy as AI instead of humans are used to monitor the conversations.

Hong Kong’s healthcare system – time for a reform?

“Well, even if you are Li Ka-shing, if you are willing to endure the long queuing time, you can also enjoy the affordable healthcare services from

public hospitals. In that sense, the healthcare system is fair in that it treats everyone equally.”

It would be reasonable to assume those who are well off would

A 27-year stalemate

of the population must endure queuing for public health services

The need for a reformation of the healthcare system was already

though the debate on reforming the healthcare system dates

multiple reports suggesting solutions to the health financing

improve the system since then.

Secretary of Health and Welfare Elizabeth Wong said that the

simply visit a private clinic for their medical problems, while most

while suffering from their illnesses left untreated. Regrettably,

apparent since the colonial era. Since 1993, there have been

back to a few decades ago, nearly nothing has been done to

problem rooted in Hong Kong’s healthcare system. The then

healthcare system will collapse within two years if Hongkongers do not choose a health financing solution. “It’s been 26 years

“If the government does not intend to reform the healthcare system, I suppose we can still maintain this ‘fair’ system where everyone suffers equally.”

until they finally came up with the voluntary health insurance scheme, but even that is but a desperate measure which fails to solve the underlying problems of the system.”

Chung pointed out that every Chief Executive has tried to reform the healthcare system since the first. Tung Chee-hwa invited scholars from Harvard University to write up a report on health

financing in Hong Kong, and Donald Tsang was keen on a

voluntary health insurance scheme, which he would have gone

for even if only 300,000 people were to be involved. However, those attempts ended in smoke due to various reasons, such

as low rating of the Chief Executive. “Then we have the likes of Leung Chun-ying and Carrie Lam, whose policies revolve

around the Chinese government’s goals rather than issues such as healthcare.” To this day, the problem of health financing

remains unsolved, remaining to be a priority agenda item which overshadows other healthcare issues such as mental health.

“Hong Kong started the reformation discussion on 1993, when it was virtually unspoke of in Taiwan. By

1995, they had implemented health insurance for all Taiwanese, and recently they tackled the pressing

issue of long term care. Other countries such as Japan and South Korea have also tackled the issue, with Japan even providing dental healthcare. Hong Kong has barely moved for 27 years.”

consulting the same one every time. Compounding that with

the fact that there is no comprehensive health record sharing

Not a matter of copy and paste One of the main reasons why psychiatrists are overloaded

system in Hong Kong means that the merits of family doctors

playing the role of initial diagnosis are largely absent in Hong Kong’s case.

with work is the Hospital Authority’s near non existent system

Chung instead suggests an alternate solution which he believes

working in public hospitals.

additional professional training for nurses in psychiatric wards

This is not only the case in mental healthcare, but rather, almost

consultation sessions for psychiatric wards are relatively short,

of triage: even the mild cases are referred to the psychiatrists

every specialist ward, leading to exhausted doctors and a lack of support for the patients with urgent, dire needs.

There have been many voices among the community suggesting the government to adopt the system from other countries; light

cases are treated by family doctors, then referred to different psychiatry specialists as necessary.

Chung agrees that the system above is the most effective on principle. Citing the case of Australia, where family doctors are extremely common, and is where most seek medical advice for

all sorts of medical problems they encounter from birth, only seeking a specialist if deemed necessary by the family doctor after an initial diagnosis.

The benefits of such a system are twofold: Firstly, the workload

of specialists in all fields are reduced due to the initial diagnosis

leading to a more efficient allocation of medical resources.

Secondly, Chung highlights the fact that family doctors often have

access to the patients’ medical history, as well as the patients’ family’s medical history, which would help with improving the efficiency of diagnosis.

However, Chung states that such a system is difficult to implement in Hong Kong, despite its merits on principle. Such

is due to the high mobility of the Hong Kong population - most people take the most conveniently accessible doctor rather than

to be more effective in Hong Kong’s environment: providing which enables them to assist with triage. Chung adds that the

which makes it difficult for doctors to perform in depth analysis of their patients.

Most of the time, the session boils down to asking if the patient

has suicidal thoughts. Psychiatric nurses are already equipped with elementary knowledge of the field, which would mean that

simple additional professional training would suffice for enabling psychiatric nurses to make an initial diagnosis of a patient. “It

might be more effective for a nurse to perform screening since a session with a psychiatrist probably lasts around two to three minutes.”

On top of screening, Chung also suggested that psychiatric nurses can also take up the responsibility of follow-up consultations for patients with mild cases. While many stable

patients are required to revisit the doctor, it usually amounts to

a very short session consisting of updating the doctor of their currency condition, as well as the severity of the side effects

of the medication. Chung believes that experienced nurses are

able to deal with follow-up consultations, given that they are trained. Such a system is already implemented in the United States and the United Kingdom.

However, speaking from an angle of monetary and career interests, there is currently a lack of motivation for nurses to

take up the training nor the extra responsibilities involved with extending their job content to such a degree.

Combinatory effort?

Ray of hope?

Sessions with psychiatrists amounting to an extremely brief meeting for medication inspires a question: Is it possible for

psychiatrists of public hospitals to cooperate with clinical psychologists and social workers, allowing the counselling to be

“When I was your age, I hoped to witness a reform in the healthcare system, I am now 60”

handled by them?

Shaking his head, Chung said “What you are describing is called a multi-disciplinary approach.” This approach has been

implemented in countries such as Australia, yet it is again

unfeasible in Hong Kong, due to the lack of clinical psychologists, especially those working in public hospitals.

When asked about whether he is hopeful about a meaningful

reform of Hong Kong’s healthcare system, Chung laughed

bitterly. “I will speak plainly. The solutions we discussed above

such as mental health triage, setting long term policies would all be beneficial to the healthcare system, however, under the current model of governance the Hong Kong government

employs, I don’t see any meaningful change happening any time “In other countries, you can have family doctors,

soon. The government lacks the ability to lead, the population

round to discuss each case and subsequently,

How can you expect such a population to value and commit to

resources. This is simply a case of too much work

the current circumstances, the government’s plans to promote

clinical psychologists, and social workers gathering

has lost faith in its governing, and the future of this society.

the optimal course of treatment and allocation of

reforms that would only be beneficial in the long term? Under

and too few pair of hands.”

changes such as voluntary healthcare insurance schemes and medical reforms will certainly be met with great resistance.”

“We must always bear hope… but a stitch in time saves nine, and we are getting off to a late start.”

Acknowledgements Dr. Au Yeung Kwok Leung Prof. Chung Kim Wah Jim, Cofounder of Mentalok Gloria (Wounded Healer Facebook Page) Sabrina Yu Jonathan Law Shall We Talk Mind HK Mental Health Month Hospital Authority The Equal Opportunities Commission Adrian Yu (Cover illustrator) rawpixel.com / Freepik

Special thanks to Tina, our advisor for guiding us on our Capstone project.

Team Members: Ling Yi Kwan Ingrid Yau Hoi Man Li Cheuk Yin Ryan