06/08/2020 The Landscape of Mental Health in Hong Kong: Report (June 2020) - Google Docs

www.m ind.org.hk

The Landscape of Mental Health in Hong Kong

Research Report June 2020

1

https://docs.google.com/document/d/1YE0ULzbOwvjkGKGSZlEvd_8txF6d0EThuMwkL5Eolcw/edit 1/27 06/08/2020 The Landscape of Mental Health in Hong Kong: Report (June 2020) - Google Docs

www.m ind.org.hk

Table of Contents

Mental Health on the Global Agenda 3 SDG 3: Good Health and Well-being 4 SDG 17: Partnerships for the Goals 4 Mental Health in Hong Kong 5 Demographics 5 Workplace 6 Increase In Youth Diagnosed with Mental Health Problems 7 Recent Government Initiatives 8 Upcoming Government Mental Health Objectives 9 Hong Kong’s Mental Health Budget for 2019-2020 10 Public Health Service Availability/Accessibility 11 Shortage of Professional Help 11 Stigma and Lack of Understanding of Mental Health 14 Mental Health Interventions 15 Summary of resources available (non-profit, private) 15 Appendix 16 References 23 About Mind HK 24

2

https://docs.google.com/document/d/1YE0ULzbOwvjkGKGSZlEvd_8txF6d0EThuMwkL5Eolcw/edit 2/27 06/08/2020 The Landscape of Mental Health in Hong Kong: Report (June 2020) - Google Docs

www.m ind.org.hk

Mental Health on the Global Agenda

The World Health Organisation defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” In Hong Kong and globally, mental health remains largely misunderstood and not equated (in both prevention and treatment) to physical illness. Over the past five years, there has been an increase in mental health programmes, from capacity building to awareness campaigns, in both developed and developing countries, with the US, UK, Canada, Australia and New Zealand leading the way.

The recent growth in attention towards mental health is in part due to the 2030 Agenda for Sustainable Development. Implemented in 2015, the Sustainable Development Goals (SDGs) on mental health are telling of how world leaders recognize the need to promote mental health and well-being and remove the gaps in preventative and treatment programmes between physical health and mental health problems. The below SDGs targets are implementable high-level strategy targets for stakeholders, including Mind HK, in the mental health sector city-wide:

1 SDG 3: Good Health and Well-being Ensure healthy lives and promote well-being for all at all ages

3.4. By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being. 3.5. Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol. 3.d Strengthen the capacity of all countries, in particular developing countries, for early warning, risk reduction and management of national and global health risks.

2 SDG 17: Partnerships for the Goals Strengthen the means of implementation and revitalize the global partnership for sustainable development

A 2016 comparative study by the Economist Intelligence Unit (EIU) assessed 15 countries across the Asia-Pacific about how well each country treats those living with

1 United Nations A/RES/70/1 - Transforming our world: the 2030 Agenda for Sustainable Development. Retrieved from h ttps://www.un.org/ga/search/view_doc.asp?symbol=A/RES/70/1&Lang=E 2 U nited Nations A/RES/70/1 - Transforming our world: the 2030 Agenda for Sustainable Development. Retrieved from h ttps://www.un.org/ga/search/view_doc.asp?symbol=A/RES/70/1&Lang=E

3

https://docs.google.com/document/d/1YE0ULzbOwvjkGKGSZlEvd_8txF6d0EThuMwkL5Eolcw/edit 3/27 06/08/2020 The Landscape of Mental Health in Hong Kong: Report (June 2020) - Google Docs

www.m ind.org.hk

mental illnesses outside of institutions, and how well their integration back into society is supported. Hong Kong ranked seventh with an aggregated score of 65.8 on the Mental Health Integration Index, based on four categories: i) Environment, ii) Access, iii) Opportunities, and iv) Governance. These categories serve as useful indicators reflecting the key issues Mind HK is facing, namely the categories of Access (for people with mental health problems to obtain medical help and services), and Governance (efforts to reduce 3 stigma and promote awareness and the human rights of mental health service users). These two categories are reflected in existing research and in the three primary issues Mind HK has been working to improve since its inception:

1) Shortage of mental health services 2) Lack of understanding of mental health 3) The stigma around mental health

Mental Health in Hong Kong

Demographics

An estimated one-in-seven people in Hong Kong will experience a common mental 4 disorder at any given time. Of those experiencing a mental health disorder, three-quarters 5 will not seek professional help. Many will continue to suffer in isolation as a result of stigma, feelings of shame, lack of awareness about their condition, and a shortage of accessible professional support. Further statistics show that many environmental, personal and social stressors also contribute to mental health problems.

Suicide statistics between 1981 and 2018 show a peak in suicide rates between 2001-2004, particularly amongst individuals aged 65 and above (See Figure A and B in Appendix). Since then, suicide rates have stabilised, with the latest official statistic released for 2018 indicating a suicide rate of 12.2 per 100,000 individuals. Individuals aged 65 and

3 T he Economist Intelligence Unit. Mental health and integration. Provision for supporting people with mental illness: A comparison of 15 Asia Pacific countries. Retrieved from https://eiuperspectives.economist.com/sites/default/files/Mental_health_and_integration.pdf?utm_medium=so cial&utm_source=linkedin.company&utm_campaign=postfity&utm_content=postfityf78f1 4 Food and Health Bureau, Hong Kong Special Administrative Region Government (2017, March). Mental Health Review Report. Retrieved from https://www.fhb.gov.hk/download/press_and_publications/otherinfo/180500_mhr/e_mhr_full_report.pdf 5 Lam LC, Wong CS, Wang MJ, et al. (2015, Feb 8). Prevalence, psychosocial correlates and service utilisation of depressive and anxiety disorders in Hong Kong: the Hong Kong Mental Morbidity Survey. Soc Psychiatry Psychiatr Epidemiol. Published online first: 2015 Feb 8. DOI: 10.1007/s00127-015-1014-5.

4

https://docs.google.com/document/d/1YE0ULzbOwvjkGKGSZlEvd_8txF6d0EThuMwkL5Eolcw/edit 4/27 06/08/2020 The Landscape of Mental Health in Hong Kong: Report (June 2020) - Google Docs

www.m ind.org.hk

6 above remain more at-risk for suicide compared to other age groups. However, youth 7 suicide rates (aged 10-19) in Hong Kong more than doubled between 2014 and 2017 , and 8 40% of students in Form 1 (Year 7) continue to be at risk of committing suicide.

According to Mind HK’s research in September 2019, 61% of individuals in Hong Kong 9 currently have poor mental well-being. According to the Hong Kong Mental Morbidity Survey 2010-2013, the most common disorders among Chinese adults between the ages of 16 and 75 were mixed anxiety and depressive disorder (6.9%), followed by generalised anxiety disorder (4.2%), depressive episode (2.9%), and other anxiety disorders including panic disorders, phobias and obsessive-compulsive disorder (1.5%; See Figure C in 10 Appendix). A 2014 survey also suggested that 4.8% of the general public aged between 18 11 and 64 could be classified as having severe non-specific psychological distress.

Workplace

Workplace stress is a likely contributor to poor mental health for individuals in the 12 workforce. In 2014, 60% of Hong Kongers reported job-related stress and anxiety. By 2017, 32% of working people in Hong Kong were classed as having unsatisfactory mental health – 13 up from 29% in 2016.

Hong Kong is found to have one of the longest working hours in the world, with the 2018 AIA Vitality Healthiest Workplace survey reporting that 46% of Hong Kong employees worked more than 50 hours per week. T his survey, which assessed the health and wellbeing

6 HKJC Centre for Suicide Research and Prevention, HKU. (2020). S tatistics. Retrieved from https://csrp.hku.hk/statistics/ 7McCarthy, S. (2018, Dec 29). Is anyone listening? Hong Kong educators and counsellors call for more attention to rising student suicide rates. Retrieved from https://www.scmp.com/news/hong-kong/health-environment/article/2179694/anyone-listening-hong-kong-e ducators-and 8Yau, C. (2017, May 16). One in three primary school students in Hong Kong at risk of suicide. Retrieved from https://www.scmp.com/news/hong-kong/education-community/article/2094561/one-three-primary-school-s tudents-hong-kong-risk 9 M ind HK. (2019, Oct 10). PRESS RELEASE: World Mental Health Day #HowOkayAreYouCampaign. Retrieved from https://www.mind.org.hk/press-releases/wmhd2019/https://www.mind.org.hk/press-releases/wmhd2019/ 10 L am LC, Wong CS, Wang MJ, et al. (2015, Feb 8). Prevalence, psychosocial correlates and service utilisation of depressive and anxiety disorders in Hong Kong: the Hong Kong Mental Morbidity Survey. Soc Psychiatry Psychiatr Epidemiol. DOI: 10.1007/s00127-015-1014-5. 11 Department of Health (2015). Behavioural Risk Factor Survey (April 2014). Hong Kong: Department of Health. Retrieved from https://www.fhb.gov.hk/download/press_and_publications/otherinfo/180500_mhr/e_mhr_full_report.pdf 12 Lindeman, J. (2017, Nov 3). Out of the shadows: Making mental health a priority for Hong Kong employers P acific Prime h ttps://www.pacificprime.com/blog/mental-health-hong-kong.html 13 Moon, L. (2017, Oct 14). Is your workplace toxic? Mental health of many Hongkongers on the brink due to long hours and overbearing bosses, experts warn. Retrieved from https://www.scmp.com/news/hong-kong/health-environment/article/2115293/your-workplace-toxic-mental-h ealth-many

5

https://docs.google.com/document/d/1YE0ULzbOwvjkGKGSZlEvd_8txF6d0EThuMwkL5Eolcw/edit 5/27 06/08/2020 The Landscape of Mental Health in Hong Kong: Report (June 2020) - Google Docs

www.m ind.org.hk

of over 26,000 employees in the Asia-Pacific region, found that despite long working hours, Hong Kong scored the largest average amount of productive time lost per year amounted to 77.4 days. This is in stark contrast to the UK, where 12.5% of employees worked more than 50 14 hours a week, and employees lost 58 days of productive time per year.

More than half (57.2%) of employees interviewed were subject to at least one dimension of work-related stress. A lthough this has declined from 63.8% of employees in 15 2017 , this remains a large proportion, which is a concern. Research suggests that unhealthy workplace culture may be a contributing factor to workplace stress. 22.0% of employees reported they have been bullied at the workplace, and 12.1% have moderate or severe 16 symptoms of depression, the largest proportion of all Asia-Pacific countries surveyed.

Poor management of employee mental health issues in the workplace may perpetuate poor mental health as well, particularly due to managers’ limited understanding of navigating mental health in the workplace. Of line managers surveyed in a 2017 Bupa survey, 66% say they are worried about saying the wrong thing when approached about mental health 36% of managers also reported not having had any guidance or training on 17 how to support others affected by mental health challenges. Among all respondents, 56% had seen mental health issues handled inappropriately in the workplace, and 40% of respondents felt they would be penalised for talking about their mental health, with an even 18 higher percentage (48%) among the younger generation. Help-seeking behaviors should be encouraged amongst employees, but statistics show that improvements in employee mental health assistance infrastructure are necessary as well.

14 Boyde, E. (2019, Nov 21). Workers in Asia show high levels of physical and mental ill health. Retrieved from https://www.ft.com/content/cc56a824-d941-11e9-9c26-419d783e10e8 15 A IA Hong Kong (2018, Oct 31). 2018 “Healthiest Workplace by AIA Vitality” Hong Kong Survey Findings. Retrieved from https://www.aia.com.hk/en/about-aia/media-centre/press-releases/2018/aia-press-release-20181031.html 16 A IA Hong Kong (2018, Oct 31). 2018 “Healthiest Workplace by AIA Vitality” Hong Kong Survey Findings. Retrieved from https://www.aia.com.hk/en/about-aia/media-centre/press-releases/2018/aia-press-release-20181031.html 17 B UPA (2017, Oct 10). Employees not Comfortable Talking about Mental Health in the Workplace. Retrieved from https://www.bupa.com.hk/en/media-centre/2017-10-10/ 18 BUPA (2017, Oct 10). Employees not Comfortable Talking about Mental Health in the Workplace. Retrieved from https://www.bupa.com.hk/en/media-centre/2017-10-10/

6

https://docs.google.com/document/d/1YE0ULzbOwvjkGKGSZlEvd_8txF6d0EThuMwkL5Eolcw/edit 6/27 06/08/2020 The Landscape of Mental Health in Hong Kong: Report (June 2020) - Google Docs

www.m ind.org.hk

Increase In Youth Diagnosed with Mental Health Problems

Mental health problems can start early, and an increasing number of children and adolescents have been diagnosed with mental health problems in recent years. Youth-focused prevention and early intervention programmes are high impact, given 75% of mental health problems develop before the age of 24 and 50% are established by the age of 19 14. Targeting youth is the most effective way to prevent any further as well as the initial development of common mental health problems.

Currently, clinical symptoms of depression and anxiety are prevalent among Hong Kong adolescents. In 2018, 7,500 pupils in Form One to Six at 21 schools across Hong Kong found 51.5% displayed symptoms of depression, a significant increase since 2012. 20 Approximately a quarter of respondents also displayed symptoms of high anxiety. With the rise in reported clinical cases, implementing preventative measures for at-risk youth populations is now more important than ever.

Recent Government Initiatives

The 2017 Mental Health Review Report by the Review Committee on Mental Health 21 lists a series of government-initiated, city-wide mental health schemes:

1. Joyful@HK was launched in 2016, along with the “Student Mental Health Support Scheme” in September 2016 and the “Dementia Community Support Scheme” in February 2017. The objectives of the three-year Joyful@HK Campaign were: to (i) increase public engagement in promoting mental well-being; and (ii) increase public knowledge and understanding about mental health.

2. Since October 2010, the social welfare department (SWD) has established 24 Integrated Community Centres for Mental Wellness (ICCMWs) to strengthen community support for ex-mentally ill individuals, with an estimated annual expenditure of $303 million since 2016-17.

19 World Health Organization. (n.d.). Child and adolescent mental health. Retrieved from https://www.who.int/mental_health/maternal-child/child_adolescent/en/ 20 Baptist Oi Kwan Social Service (2018, Sep 2). 2018. Retrieved from https://www.bokss.org.hk/content/press/74/%E4%B8%AD%E5%AD%B8%E7%94%9F%E6%8A%91%E9%AC%B1%E7 %84%A6%E6%85%AE%E7%8B%80%E6%B3%81%E8%AA%BF%E6%9F%A52018pdf.pdf 21 Food and Health Bureau, Hong Kong Special Administrative Region Government (2017, March). Mental Health Review Report. Retrieved from https://www.fhb.gov.hk/download/press_and_publications/otherinfo/180500_mhr/e_mhr_full_report.pdf

7

https://docs.google.com/document/d/1YE0ULzbOwvjkGKGSZlEvd_8txF6d0EThuMwkL5Eolcw/edit 7/27 06/08/2020 The Landscape of Mental Health in Hong Kong: Report (June 2020) - Google Docs

www.m ind.org.hk

3. An enhanced Common Mental Disorder (CMD) Clinic at Kwai Chung Hospital of the Kowloon West Cluster was launched in July 2015, where eligible patients are first assessed by a team consisting of a psychiatric doctor, psychiatric nurse, and occupational therapist. Through assessment results and a multi-disciplinary case conference, care plans are tailored for each patient, with a nurse coordinator assigned to monitor each patient until discharge upon completion of the programme. By March 2016, more than half of the patients who completed the CMD programme were successfully discharged from the psychiatric specialist outpatient (SOP) service. Additionally, the 90th percentile waiting time of patients booking new cases triaged into routine cases in Kowloon West Cluster decreased from 61 weeks in June 2015 (prior to implementation of the new programme) to 47 weeks.

4. Social welfare department (SWD) has been providing long-term residential care and active maintenance services for ex-mentally ill persons through various avenues, including long-stay care homes, halfway houses, and supported hostels. As of December 2016, there were 3221 subvented residential care places, and a total of 485 additional locations to be provided by 2022. There were 12587 subvented vocational rehabilitation places provided by the end of 2016, and an additional 1200 locations to be provided by 2022.

5. In 2014-15, the HA repositioned all newer generational oral antipsychotic drugs from special to general drug category in the HA Drug Formulary to prescribe them as first-line drugs (except for clozapine, due to certain side effects).

6. The Hospital Authority (HA) launched the EASY programme to address early signs of psychosis in young adults in 2001. Since then, this programme has been enhanced, with multidisciplinary medical teams at cluster service centres providing referral, assessment, and treatment services for 1300 patients each year ranging from 15 to 64 years old.

7. As of 2015-16, HA introduced peer support workers (those rehabilitated from mental illness) into the Case Management Programme, where patients with severe mental illness are followed closely by a designated case manager (average ratio of case manager to patients with SMI being 1:47) to help reintegrate into society

8. A three-tier collaboration platform by the HA and social welfare department (SWD) has been utilised since 2010 to facilitate collaboration between stakeholders in medical and social care sectors across central, district, and service delivery levels (See Figure E in Appendix). To address service gaps previously identified by stakeholders and patient groups, a task group was set up in 2014 to review the existing service model and develop the “Service Framework on Personalised Care for

8

https://docs.google.com/document/d/1YE0ULzbOwvjkGKGSZlEvd_8txF6d0EThuMwkL5Eolcw/edit 8/27 06/08/2020 The Landscape of Mental Health in Hong Kong: Report (June 2020) - Google Docs

www.m ind.org.hk

Adults with Severe Mental Illness in Hong Kong” to improve communication between the social welfare department (SWD) and major NGOs operating community mental health services.

Upcoming Government Mental Health Objectives

According to the Hospital Authority Annual Plan (2019-20), the upcoming mental 22 health targets for 2020 are as follows:

1. The Student Mental Health Support Scheme (SMHSS) piloted in 2016 across several districts will be expanded to more schools. Enhanced support for child and adolescent psychiatric specialist outpatient centre (SOPC) services is also to be incorporated into four districts by 1Q20.

2. Implement the Mental Health Direct (MHD) rotation scheme for case managers of Community Psychiatric Service to strengthen their understanding of mental health disorders.

3. Sponsor around 450 simulation training classes, including crew resource management training for doctors and nurses in all Clusters. 156, 65 and 12 specialty training enhancement programmes for nurses, allied health professionals and pharmacy staff will be provided respectively. Additionally, two multi-disciplinary programmes for mental health and primary care services will be offered by the first quarter of 2020.

4. Specialist outpatient clinics (SOPC) new case quotas will be added for adult patients with common mental disorders, and case managers will be added for patients with mental illness in Hong Kong East Cluster (HKEC).

5. Provide 450 additional SOPC new case attendances for adult patients with common mental disorder and recruit two additional case managers in HKEC for patients with mental illness

6. The Kowloon Hospital (KH) Psychiatric Department will recruit one additional case manager to manage patients with mental illnesses.

22 Hospital Authority Annual Plan (2019-2020). h ttp://www.ha.org.hk/haho/ho/ap/AP2019-20_Eng1.pdf

9

https://docs.google.com/document/d/1YE0ULzbOwvjkGKGSZlEvd_8txF6d0EThuMwkL5Eolcw/edit 9/27 06/08/2020 The Landscape of Mental Health in Hong Kong: Report (June 2020) - Google Docs

www.m ind.org.hk

For a more up-to-date assessment of local mental health demographics, the HK Department of Health (DH) will be releasing data outcomes and analyses for the Mental 23 Health Survey 2019 in 2021. This survey will cover around 5,000 Hong Kong land-based non-institutional persons aged 12 to 75 years, and results are to be used by the government for public education and mental health promotion.

Hong Kong’s Mental Health Budget for 2019-2020

In 2018, the government subsidised $73 million to employ 90 psychiatric staff and inputted $40 million to promote mental wellness through Peer Support Service in 24 Community Psychiatric Service Units. In 2018, it was announced that $100 million will be distributed to the Department of Health to promote a healthy community, without 25 specifically addressing mental health. Wong Yan-lung, the chairman of the Advisory Committee on mental health, explained: "We will continue to advise the government on mental health policies, including the establishment of more integral and comprehensive approaches to tackle multi-faceted mental health issues in Hong Kong".

Public Health Service Availability/Accessibility

In 2018, there were 6.07 million attendances at Department of Health (DH) outpatient 26 clinics and 16.8 million attendances at Hospital Authority (HA) outpatient clinics. A more detailed breakdown shows there were 6.08 million attendances at HA general outpatient clinics, 7.9 million attendances at specialist outpatient clinics, and 2.83 million allied health outpatient attendances (See Figure F in Appendix). The number of specialist outpatient (SOP) new attendances increased by 3.4% between 2016 and 2017, and 6.5% from 2017 to

23 Centre for Health Protection h ttps://www.chp.gov.hk/en/static/101591.html 24 Yung & Li (2018, Feb 28). Budget 18/19: healthcare expenditure increased while no specific plans on mental health mentioned. Retrieved from http://tyr.jour.hkbu.edu.hk/2018/02/28/budget-18-19-healthcare-expenditure-increased-while-no-specific-plan s-on-mental-health-mentioned/ 25 Yung & Li (2018, Feb 28). Budget 18/19: healthcare expenditure increased while no specific plans on mental health mentioned. Retrieved from http://tyr.jour.hkbu.edu.hk/2018/02/28/budget-18-19-healthcare-expenditure-increased-while-no-specific-plan s-on-mental-health-mentioned/ 26 Department of Health (2019). Health Facts of Hong Kong. Retrieved from https://www.dh.gov.hk/english/statistics/statistics_hs/files/Health_Statistics_pamphlet_E.pdf

10

https://docs.google.com/document/d/1YE0ULzbOwvjkGKGSZlEvd_8txF6d0EThuMwkL5Eolcw/edit 10/27 06/08/2020 The Landscape of Mental Health in Hong Kong: Report (June 2020) - Google Docs

www.m ind.org.hk

2018, with a total of 7.7 million clinical attendances as of 2018 (both new and follow-up; See 27 Figure G in Appendix).

Shortage of Professional Help

There remains a shortage of professionals in Hong Kong to meet the rising demand for mental health services. Between 2010 and 2015, the number of young people seeking treatment for mental health problems at public facilities increased from 12,500 to 22,300, 28 according to the Hospital Authority’s psychiatry department. From 2015 to 2017, the number of individuals 18 years and below diagnosed with a mental disorder increased from 28,000 people to 33,900. For those under 15 years of age, there was a 75% increase in new 29 attendances. Overall, the number of patients with mental problems has increased by 21.9%, from 197,600 to 240,900 in the past five years. I n contrast, the number of health workers has 30 only increased by 9%. A comparison between the number of psychiatric staff and patients seeking help for a mental health problem is illustrated below, in Figure 1.

27 Hospital Authority (2018, March). Chief Executive’s Progress Report on Key Performance Indicators (KPIs) (KPI Report No. 38) Retrieved from h ttp://www.ha.org.hk/haho/ho/cad_bnc/AOM-P1390.pdf 28Moon, L. (2017, Nov 11). As one in six Hong Kong people suffers from mental illness, Dr Lucy Lord talks about how the city can change its outlook. Retrieved from https://www.scmp.com/news/hong-kong/health-environment/article/2119364/one-six-hong-kong-people-suf fers-mental-illness-dr 29 Moon, L. (2017, Nov 11). As one in six Hong Kong people suffers from mental illness, Dr Lucy Lord talks about how the city can change its outlook. Retrieved from https://www.scmp.com/news/hong-kong/health-environment/article/2119364/one-six-hong-kong-people-suf fers-mental-illness-dr 30 Yung & Li (2018, Feb 28). Budget 18/19: healthcare expenditure increased while no specific plans on mental health mentioned. Retrieved from http://tyr.jour.hkbu.edu.hk/2018/02/28/budget-18-19-healthcare-expenditure-increased-while-no-specific-plan s-on-mental-health-mentioned/

11

https://docs.google.com/document/d/1YE0ULzbOwvjkGKGSZlEvd_8txF6d0EThuMwkL5Eolcw/edit 11/27 06/08/2020 The Landscape of Mental Health in Hong Kong: Report (June 2020) - Google Docs

www.m ind.org.hk

Figure 1. T he number of psychiatric staff to that of patients with mental problems in Hong Kong (Yung & Li, 2018) Retrieved from: http://tyr.jour.hkbu.edu.hk/2018/02/28/budget-18-19-healthcare-expenditure-increased-while-no-specific-plans-on -mental-health-mentioned

As of March 2018, 68 clinical psychologists are working in the Hospital Authority, and 139 additional clinical psychologist grade posts spanning five other government 31 departments (See Figure H and I in Appendix). Most recent records from the HA show that as of 2017, there are 18 specialist outpatient clinics (SOPCs), 356 psychiatric doctors, 2473 32 psychiatric nurses, 256 occupational therapists, and 243 psychiatric social workers. In 2018, there were 139 community psychiatric nurses, a mere increase of 2 nurses since 2016; and 33 there was no increase in the 889 psychiatric day places available from 2016 to 2018. The table below indicates a relatively slow growth in psychiatric health workers across professions, with no increase in the number of outpatient clinics since 2013.

31 HKSAR Government Press Releases (2018, Nov 28). LCQ12: Diagnoses and treatments provided by clinical psychologists. Retrieved from h ttps://www.info.gov.hk/gia/general/201811/28/P2018112800608.htm 32 HKSAR Government Press Releases (2017, Apr 26). LCQ13: Treatment and support for patients with mental illness. Retrieved from h ttps://www.info.gov.hk/gia/general/201704/26/P2017042600712.htm 33 Hospital Authority (2018, March). Chief Executive’s Progress Report on Key Performance Indicators (KPIs) (KPI Report No. 38) Retrieved from h ttp://www.ha.org.hk/haho/ho/cad_bnc/AOM-P1390.pdf

12

https://docs.google.com/document/d/1YE0ULzbOwvjkGKGSZlEvd_8txF6d0EThuMwkL5Eolcw/edit 12/27 06/08/2020 The Landscape of Mental Health in Hong Kong: Report (June 2020) - Google Docs

www.m ind.org.hk

Allied health professionals

Number of Psychiatric Psychiatric Clinical Occupational out-patient clinics doctors nurses psychologists therapists 17 332 2,296 65 218 18 335 2,375 71 227 18 333 2,442 77 236 18 344 2,472 82 245 18 356 2,473 89 256

Figure 2. N umber of Psychiatric SOPCs and Manpower (Chan, 2018) R etrieved from https://www.info.gov.hk/gia/general/201704/26/P2017042600712.htm

This marginal increase in the number of health workers is concerning, as the demand 34 for patient services has increased. With 356 psychiatric doctors to date , the number of public sector psychiatrists per 100,000 people is approximately 4.8 for Hong Kong, versus 35 8.59 for high-income countries . Similarly, Hong Kong has half the number recommended 36 by the World Health Organisation for our population size.

Currently, Hong Kong lags behind similar high-income countries in terms of the provision of professional mental health support. With increased caseloads (The HA children 37 and adolescent psychiatric team increased by 50% from 2011/12 to 2015/16 alone) , the quality, frequency, and consultation wait time for psychological health services are likely to be negatively affected. In the public healthcare system, patients’ wait for 38 psychiatrists/specialist appointments can exceed 2 years . Additionally, low-income 39 families may be unable to afford unsubsidised healthcare.

34 HKSAR Government Press Releases (2017, Apr 26). LCQ13: Treatment and support for patients with mental illness. Retrieved from h ttps://www.info.gov.hk/gia/general/201704/26/P2017042600712.htm 35 Tsang, E. (2017, April 19). Study reveals need for psychiatric services in Hong Kong, but also warns against forcing treatment on mentally ill. Retrieved from https://www.scmp.com/news/hong-kong/health-environment/article/2088626/study-reveals-need-psychiatri c-services-hong-kong 36 World Health Organisation (2011). World Mental Health Altas 2011. 37 Food and Health Bureau, Hong Kong Special Administrative Region Government (2017, March). Mental Health Review Report. Retrieved from https://www.fhb.gov.hk/download/press_and_publications/otherinfo/180500_mhr/e_mhr_full_report.pdf 38 Cheung, E. (2017, Feb 20). Long waiting times at Hong Kong public hospitals for mentally ill patients. Retrieved from https://www.scmp.com/news/hong-kong/health-environment/article/2072183/long-waiting-times-hong-kong -public-hospitals?edition=international 39 Healthy Matters (2019, June). How much does it cost to see a psychiatrist in Hong Kong? Retrieved from https://www.healthymatters.com.hk/the-ultimate-guide-to-psychiatrists-in-hong-kong/

13

https://docs.google.com/document/d/1YE0ULzbOwvjkGKGSZlEvd_8txF6d0EThuMwkL5Eolcw/edit 13/27 06/08/2020 The Landscape of Mental Health in Hong Kong: Report (June 2020) - Google Docs

www.m ind.org.hk

Stigma and Lack of Understanding of Mental Health40

In Late February of 2019, Mind HK released a study conducted on the Hong Kong general public’s attitudes towards mental health and analysed the public stigma surrounding issues of mental health. Although nearly 89% of 1,210 randomly selected respondents agreed that there is a need to adopt a more tolerant attitude toward people with mental illness, under 30% of those indicated they would be willing to live with someone with a mental health problem in the future. This suggests that many are not comfortable or willing to engage closely with the issue of mental health. It is evident that stigma and negative attitudes toward mental health are factors requiring consideration. 61% of respondents also agreed that “there is something about people with mental illness that makes it easy to tell them apart'', and 41% agreed that one of the main causes of mental illness is a lack of self-discipline and willpower. This implies a greater need for awareness and knowledge of what constitutes mental illness, for individuals to navigate mental health responsibly.

In addition to demonstrating the negative and inaccurate beliefs surrounding mental health amongst the Hong Kong public, our findings suggest that more than half of the public lack sufficient knowledge on the mental health and community services available. Around 60% of respondents reported not knowing where to seek help regarding mental health outside of hospitals, which includes NGOs and other community organisations, indicating a 41 need for awareness building.

Mental Health Interventions

Evidence-based early intervention for mental health problems has been shown to 42 have clinically important benefits over standard care. Currently, the government-funded EASY programme targets individuals showing early signs of psychosis, expanding its caseload and age range of patients beyond young adults since 2001. In light of the

40 Mind HK. (2018, Oct 10). Mind Hong Kong Unveils New Research Ahead of World Mental Health Day. Retrieved from h ttps://www.mind.org.hk/press-releases/timetochangehkresearch/ 41 Mind HK. (2018, Oct 10). Mind Hong Kong Unveils New Research Ahead of World Mental Health Day. Retrieved from h ttps://www.mind.org.hk/press-releases/timetochangehkresearch/ 42 B ird, V., Premkumar, P., Kendall, T., Whittington, C., Mitchell, J., & Kuipers, E. (2010). Early intervention services, cognitive–behavioural therapy and family intervention in early psychosis: Systematic review. B ritish Journal of Psychiatry, 1 97( 5), 350-356. doi:10.1192/bjp.bp.109.074526. Retrieved from https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/early-intervention-services- cognitivebehavioural-therapy-and-family-intervention-in-early-psychosis-systematic-review/27B4BBAFFD9D8E 29458290B843EB0E10

14

https://docs.google.com/document/d/1YE0ULzbOwvjkGKGSZlEvd_8txF6d0EThuMwkL5Eolcw/edit 14/27 06/08/2020 The Landscape of Mental Health in Hong Kong: Report (June 2020) - Google Docs

www.m ind.org.hk

increased need to prevent and treat early signs of various other mental disorders (particularly depression and anxiety), city-wide early assessment and intervention programmes are needed, particularly for youth. With the ratio of mental health workers to patients well under the advised WHO standards, children are unable to receive treatment from public clinics in a timely manner, waiting an average of 14.5 months before receiving 43 treatment. One example of a private, smaller-scale early assessment intervention presently being utilized is the Know My Students Digital Suicide Prevention Program by The Brightly 44 Project, implemented across several schools in Hong Kong. This computer program uses games and an AI chatbot to assess students’ mental health and flags the school upon indication of poor mental health. In addition to providing affordable ways for individuals needing treatment, preventative programmes may serve a role in minimising the incidence of severe mental health problems in the future.

Summary of resources available (non-profit, private)

In Hong Kong, mental health services span public, private, and non-profit sources - though there are limitations in terms of capacity within each of these sectors. In October 2019, Mind Hong Kong launched an online community directory tool for users to identify relevant mental health services according to preferred language, form of treatment and support, service population type, service hours, and/or mental health condition. There are currently 72 mental health service providers listed across the city in this community directory.

43 Cheung, E., & Tsang, E. (2016, May 25). Hong Kong children wait more than a year for mental health treatment as list increases to 27,000. Retrieved from https://www.scmp.com/news/hong-kong/health-environment/article/1953927/hong-kong-children-wait-mor e-year-mental-health 44 T he Brightly Project h ttps://www.thebrightlyproject.com

15

https://docs.google.com/document/d/1YE0ULzbOwvjkGKGSZlEvd_8txF6d0EThuMwkL5Eolcw/edit 15/27 06/08/2020 The Landscape of Mental Health in Hong Kong: Report (June 2020) - Google Docs

www.m ind.org.hk

Appendix

Figure A. General Hong Kong Suicide Statistics (HKJC Centre for Suicide Research and Prevention, HKU) R etrieved from h ttps://csrp.hku.hk/statistics/

Figure B. Suicide Rates by Age Group in Hong Kong (HKJC Centre for Suicide Research and Prevention, HKU) R etrieved from h ttps://csrp.hku.hk/statistics/

16

https://docs.google.com/document/d/1YE0ULzbOwvjkGKGSZlEvd_8txF6d0EThuMwkL5Eolcw/edit 16/27 06/08/2020 The Landscape of Mental Health in Hong Kong: Report (June 2020) - Google Docs

www.m ind.org.hk

Figure C. Mental Health Problem in Chinese Adults (Mental Health Morbidity Survey Team, 2015) L am LC, Wong CS, Wang MJ, et al. (2015, Feb 8). Prevalence, psychosocial correlates and service utilisation of depressive and anxiety disorders in Hong Kong: the Hong Kong Mental Morbidity Survey. Soc Psychiatry Psychiatr Epidemiol. DOI: 10.1007/s00127-015-1014-5.)

Figure D. Prevalence of DSM-IV disorders in Chinese adolescents (Leung et al., 2008) (Leung, Patrick & Hung, Se & Ho, Ting-pong & Lee, Chi-chiu & Liu, Wai-sum & Tang, Chun-pan & Kwong, Shi-leung. (2008). Prevalence of DSM-IV disorders in Chinese adolescents and the effects of an impairment criterion: A pilot community study in Hong Kong. European child & adolescent psychiatry. 17. 452-61. 10.1007/s00787-008-0687-7.)

17

https://docs.google.com/document/d/1YE0ULzbOwvjkGKGSZlEvd_8txF6d0EThuMwkL5Eolcw/edit 17/27 06/08/2020 The Landscape of Mental Health in Hong Kong: Report (June 2020) - Google Docs

www.m ind.org.hk

Figure E. T hree-tier collaboration platform amongst major service providers (Review Committee on Mental Health, 2017) R etrieved from https://www.fhb.gov.hk/download/press_and_publications/otherinfo/180500_mhr/e_mhr_full_report.pdf

Figure F. Accident and Emergency and Outpatient Attendances in 2018 (Hospital Authority, 2018) R etrieved from https://www.dh.gov.hk/english/statistics/statistics_hs/files/Health_Statistics_pamphlet_E.pdf

18

https://docs.google.com/document/d/1YE0ULzbOwvjkGKGSZlEvd_8txF6d0EThuMwkL5Eolcw/edit 18/27 06/08/2020 The Landscape of Mental Health in Hong Kong: Report (June 2020) - Google Docs

www.m ind.org.hk

Figure G. Service Growth in response to Population Change and Ageing Effect (Hospital Authority, 2018) R etrieved from h ttps://www.ha.org.hk/haho/ho/cad_bnc/AOM-P1390.pdf

19

https://docs.google.com/document/d/1YE0ULzbOwvjkGKGSZlEvd_8txF6d0EThuMwkL5Eolcw/edit 19/27 06/08/2020 The Landscape of Mental Health in Hong Kong: Report (June 2020) - Google Docs

www.m ind.org.hk

*CSD = Correctional Services; DH = Department of Health; HKPF = Hong Kong Police Force; ImmD = Immigration Department; SWD = Social Work Department Figure H. Manpower of clinical psychologist grade (GovHK, 2018) R etrieved from https://www.info.gov.hk/gia/general/201811/28/P2018112800608.htm

Figure I. A verage waiting time of clinical psychologist service by department (GovHK, 2018) R etrieved from https://www.info.gov.hk/gia/general/201811/28/P2018112800608.htm

20

https://docs.google.com/document/d/1YE0ULzbOwvjkGKGSZlEvd_8txF6d0EThuMwkL5Eolcw/edit 20/27 06/08/2020 The Landscape of Mental Health in Hong Kong: Report (June 2020) - Google Docs

www.m ind.org.hk

Figure J. W aiting Time for New Case Booking at Psychiatry Specialist Out-patient Clinics R etrieved from https://www.ha.org.hk/visitor/ha_visitor_index.asp?Content_ID=214197&Lang=ENG&Dimension=100&Parent_ID=1 0053

21

https://docs.google.com/document/d/1YE0ULzbOwvjkGKGSZlEvd_8txF6d0EThuMwkL5Eolcw/edit 21/27 06/08/2020 The Landscape of Mental Health in Hong Kong: Report (June 2020) - Google Docs

www.m ind.org.hk

References

AIA Hong Kong (2018, Oct 31). 2 018 “Healthiest Workplace by AIA Vitality” Hong Kong Survey Findings. Retrieved from https://www.aia.com.hk/en/about-aia/media-centre/press-releases/2018/aia-press-relea se-20181031.html

Baptist Oi Kwan Social Service (2018, Sep 2). 2018. Retrieved from https://www.bokss.org.hk/content/press/74/%E4%B8%AD%E5%AD%B8%E7%94%9F%E6%8A %91%E9%AC%B1%E7%84%A6%E6%85%AE%E7%8B%80%E6%B3%81%E8%AA%BF%E6%9F%A52 018pdf.pdf

Bird, V., Premkumar, P., Kendall, T., Whittington, C., Mitchell, J., & Kuipers, E. (2010). Early intervention services, cognitive–behavioural therapy and family intervention in early psychosis: Systematic review. British Journal of Psychiatry, 197(5), 350-356. doi:10.1192/bjp.bp.109.074526. Retrieved from https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/early-in tervention-services-cognitivebehavioural-therapy-and-family-intervention-in-early-psychosi s-systematic-review/27B4BBAFFD9D8E29458290B843EB0E10

Boyde, E. (2019, Nov 21). W orkers in Asia show high levels of physical and mental ill health. Retrieved from h ttps://www.ft.com/content/cc56a824-d941-11e9-9c26-419d783e10e8

BUPA (2017, Oct 10). E mployees not Comfortable Talking about Mental Health in the Workplace. Retrieved from h ttps://www.bupa.com.hk/en/media-centre/2017-10-10/

Centre for Health Protection h ttps://www.chp.gov.hk/en/static/101591.html

Cheung, E. (2017, Feb 20). Long waiting times at Hong Kong public hospitals for mentally ill patients. S outh China Morning Post, H ealth & Environment Retrieved from https://www.scmp.com/news/hong-kong/health-environment/article/2072183/long-waiti ng-times-hong-kong-public-hospitals?edition=international

Cheung, E., & Tsang, E. (2016, May 25). Hong Kong children wait more than a year for mental health treatment as list increases to 27,000. S outh China Morning Post, H ealth & Environment Retrieved from https://www.scmp.com/news/hong-kong/health-environment/article/1953927/hong-kon g-children-wait-more-year-mental-health

22

https://docs.google.com/document/d/1YE0ULzbOwvjkGKGSZlEvd_8txF6d0EThuMwkL5Eolcw/edit 22/27 06/08/2020 The Landscape of Mental Health in Hong Kong: Report (June 2020) - Google Docs

www.m ind.org.hk

Department of Health (2015). B ehavioural Risk Factor Survey (April 2014). Hong Kong: Department of Health. Retrieved from https://www.fhb.gov.hk/download/press_and_publications/otherinfo/180500_mhr/e_mhr_ full_report.pdf

Department of Health (2019). H ealth Facts of Hong Kong. Retrieved from https://www.dh.gov.hk/english/statistics/statistics_hs/files/Health_Statistics_pamphlet_E. pdf

Food and Health Bureau, Hong Kong Special Administrative Region Government (2017, March). M ental Health Review Report. Retrieved from https://www.fhb.gov.hk/download/press_and_publications/otherinfo/180500_mhr/e_mhr_ full_report.pdf

Healthy Matters (2019, June). H ow much does it cost to see a psychiatrist in Hong Kong? Retrieved from https://www.healthymatters.com.hk/the-ultimate-guide-to-psychiatrists-in-hong-kong/

HKJC Centre for Suicide Research and Prevention, HKU. (2020). Statistics. Retrieved from https://csrp.hku.hk/statistics/

HKSAR Government Press Releases (2017, Apr 26). L CQ13: Treatment and support for patients with mental illness. Retrieved from https://www.info.gov.hk/gia/general/201704/26/P2017042600712.htm

HKSAR Government Press Releases (2018, Nov 28). L CQ12: Diagnoses and treatments provided by clinical psychologists. Retrieved from https://www.info.gov.hk/gia/general/201811/28/P2018112800608.htm

Hospital Authority (2018, March). C hief Executive’s Progress Report on Key Performance Indicators (KPIs) (KPI Report No. 38) Retrieved from http://www.ha.org.hk/haho/ho/cad_bnc/AOM-P1390.pdf

Hospital Authority (2019). A nnual Plan (2019-2020). R etrieved from http://www.ha.org.hk/haho/ho/ap/AP2019-20_Eng1.pdf

Hospital Authority (2020). W aiting Time for New Case Booking at Psychiatry Specialist Out-patient Clinics. R etrieved from https://www.ha.org.hk/visitor/ha_visitor_index.asp?Content_ID=214197&Lang=ENG&Dimensi on=100&Parent_ID=10053

23

https://docs.google.com/document/d/1YE0ULzbOwvjkGKGSZlEvd_8txF6d0EThuMwkL5Eolcw/edit 23/27 06/08/2020 The Landscape of Mental Health in Hong Kong: Report (June 2020) - Google Docs

www.m ind.org.hk

Leung, Patrick & Hung, Se & Ho, Ting-pong & Lee, Chi-chiu & Liu, Wai-sum & Tang, Chun-pan & Kwong, Shi-leung. (2008). Prevalence of DSM-IV disorders in Chinese adolescents and the effects of an impairment criterion: A pilot community study in Hong Kong. European child & adolescent psychiatry. 17. 452-61. 10.1007/s00787-008-0687-7

McCarthy, S. (2018, Dec 29). Is anyone listening? Hong Kong educators and counsellors call for more attention to rising student suicide rates. South China Morning Post, H ealth & Environment. Retrieved from https://www.scmp.com/news/hong-kong/health-environment/article/2179694/anyone-lis tening-hong-kong-educators-and

Mind HK. (2018, Oct 10). M ind Hong Kong Unveils New Research Ahead of World Mental Health Day. Retrieved from h ttps://www.mind.org.hk/press-releases/timetochangehkresearch/

Mind HK. (2019, Oct 10). P RESS RELEASE: World Mental Health Day #HowOkayAreYouCampaign. Retrieved from https://www.mind.org.hk/press-releases/wmhd2019/https://www.mind.org.hk/press-relea ses/wmhd2019/

Moon, L. (2017, Oct 14). Is your workplace toxic? Mental health of many Hongkongers on the brink due to long hours and overbearing bosses experts warn. S outh China Morning Post, Health and Environment. Retrieved from https://www.scmp.com/news/hong-kong/health-environment/article/2115293/your-work place-toxic-mental-health-many

Moon, L. (2017, Nov 11). As one in six Hong Kong people suffers from mental illness, Dr Lucy Lord talks about how the city can change its outlook. S outh China Morning Post. H ealth and Environment. Retrieved from https://www.scmp.com/news/hong-kong/health-environment/article/2119364/one-six-ho ng-kong-people-suffers-mental-illness-dr Jessica Lindeman. (2017, Nov 3) Out of the shadows: Making mental health a priority for Hong Kong employers. P acific Prime. R etrieved from https://www.pacificprime.com/blog/mental-health-hong-kong.html

Lam LC, Wong CS, Wang MJ, et al. (2015, Feb 8). Prevalence, psychosocial correlates and service utilisation of depressive and anxiety disorders in Hong Kong: the Hong Kong Mental Morbidity Survey. S oc Psychiatry Psychiatr Epidemiol. 5 0, 1379–1388. DOI: 10.1007/s00127-015-1014-5.

The Brightly Project (2020). Th e Brightly Project. R etrieved From https://www.thebrightlyproject.com

24

https://docs.google.com/document/d/1YE0ULzbOwvjkGKGSZlEvd_8txF6d0EThuMwkL5Eolcw/edit 24/27 06/08/2020 The Landscape of Mental Health in Hong Kong: Report (June 2020) - Google Docs

www.m ind.org.hk

The Economist Intelligence Unit. (2016) Mental health and integration. Provision for supporting people with mental illness: A comparison of 15 Asia Pacific countries. E conomist Intelligence Unit briefing paper Retrieved from https://eiuperspectives.economist.com/sites/default/files/Mental_health_and_integration. pdf?utm_medium=so

Tsang, E. (2017, April 19). Study reveals need for psychiatric services in Hong Kong, but also warns against forcing treatment on mentally ill. S outh China Morning Post, H ealth & Environment. Retrieved from https://www.scmp.com/news/hong-kong/health-environment/article/2088626/study-rev eals-need-psychiatric-services-hong-kong

United Nations (2015) A /RES/70/1 - Transforming our world: the 2030 Agenda for Sustainable Development. R etrieved from https://www.un.org/ga/search/view_doc.asp?symbol=A/RES/70/1&Lang=E

World Health Organisation (2011). W orld Mental Health Altas 2011.

World Health Organization. (n.d.). C hild and adolescent mental health. Retrieved from https://www.who.int/mental_health/maternal-child/child_adolescent/en/

Yau, C. (2017, May 16). One in three primary school students in Hong Kong at risk of suicide. South China Morning Post, H ealth & Environment. Retrieved from https://www.scmp.com/news/hong-kong/education-community/article/2094561/one-thr ee-primary-school-students-hong-kong-risk

Yung & Li (2018, Feb 28). B udget 18/19: healthcare expenditure increased while no specific plans on mental health mentioned. Retrieved from http://tyr.jour.hkbu.edu.hk/2018/02/28/budget-18-19-healthcare-expenditure-increased-w hile-no-specific-plans-on-mental-health-mentioned/

25

https://docs.google.com/document/d/1YE0ULzbOwvjkGKGSZlEvd_8txF6d0EThuMwkL5Eolcw/edit 25/27 06/08/2020 The Landscape of Mental Health in Hong Kong: Report (June 2020) - Google Docs

www.m ind.org.hk

About Mind HK

Mind HK (Mind Mental Health Hong Kong Limited) is a registered S88 charity (91/16471) committed to improving awareness and understanding of mental health in Hong Kong. We collaborate with other local and international mental health charities and provide online support and training programmes, based on global best practice, to empower anyone experiencing a mental health problem and equip them with the resources they need. Through collaborative research, Mind HK is leading the way in understanding mental health problems in the city and providing its population with the right support and resources. For more on Mind HK and it’s mission and vision, please visit: w ww.mind.org.hk

26

https://docs.google.com/document/d/1YE0ULzbOwvjkGKGSZlEvd_8txF6d0EThuMwkL5Eolcw/edit 26/27 06/08/2020 The Landscape of Mental Health in Hong Kong: Report (June 2020) - Google Docs

www.m ind.org.hk

ww ww.mind. org.hk [email protected] | h [email protected] .hk

© 2020 Mind Mental Health Hong Kong Limited. All rights reserved

27

https://docs.google.com/document/d/1YE0ULzbOwvjkGKGSZlEvd_8txF6d0EThuMwkL5Eolcw/edit 27/27