Mental health care in Hong Kong falls woefully short amid social stigma and lack of policy direction
Alfred C.M. Chan calls for a long-term government strategy on mental health care reform and tackling the shortage of psychiatric staff, along with greater social empathy for the mentally ill
Mental health has been in the news lately. After the World Health Organisation last month announced a year-long campaign to raise awareness about depression, Britain’s Prince Harry spoke openly about his stifled grief and near-mental breakdown following the death of his mother.
Then there was Hong Kong’s much-discussed film Mad World , with its young protagonist struggling with bipolar disorder.
As his family disintegrates, he crumbles under the strain of having to care for his ailing, hysterical mother all by himself and allegedly causes her death, leading to his arrest and admission to a psychiatric hospital. His estranged father, a happy-go-lucky man, takes him back home and tries to help him along the rocky road to recovery.
Watch: Mad World director and screenwriter discuss the film
My attention is naturally drawn to issues related to discrimination and the rights of vulnerable groups, including the stigmatisation and ostracism of those with mental disorders, the burden on their carers, and a health care system that fails to help many of these people.
Mental illnesses, according to the WHO, are “generally characterised by some combination of abnormal thoughts, emotions, behaviour and relationships with others”. This definition encompasses a broad spectrum of conditions, from bipolar disorder to depression, anxiety, schizophrenia and intellectual disabilities and developmental disorders, such as dementia and autism.
In recent years, various mental health issues have raised the alarm in Hong Kong – including depression and suicide among our youths, special educational needs, elderly dementia, and tragedies caused by early psychosis.
While the government keeps no record of the overall number of residents with mental illness, the Hospital Authority Mental Health Service Plan for Adults 2010-2015 extrapolated from worldwide data that the prevalent rate would be 15 to 25 per cent. This means somewhere between one and nearly two million people – almost the population of Hong Kong Island – are struggling with some form of mental illness, diagnosed or otherwise.
People with mental illness used to be confined in “madhouses” and be subjected to undignified treatment. In response to global trends and the rising demand for human rights for all, Hong Kong today relies heavily on community care to rehabilitate this group subsequent to their deinstitutionalisation.
What has gone away is the indiscriminate locking up of people with mental health problems, but prejudice lingers. A 2015 study by the Equal Opportunities Commission found that the biggest challenge operators of integrated community centres for mental wellness face in finding permanent sites for their premises is opposition from residents in the neighbourhood of identified sites.
It would, however, be unfair to place the entire blame on the community for harbouring biases towards mental illnesses, which are, after all, no easy matter to fathom.
Educational efforts from both the public and private sectors are imperative for mental health literacy among the public to improve.
But no amount of education will suffice if it is not matched with sensible and timely policies.
The social welfare and medical sectors have expressed time and again the need for urgent mental health care reform, particularly in enhancing community care services and increasing manpower.
Provisional data from the government suggests that over 240,000 people are receiving treatment at Hospital Authority-run facilities, and the number is rising. The growth rate is even higher among children and adolescents, with about 10,000 new cases every year. Yet, as at the end of 2016, the authority had only 356 psychiatric doctors.
Investigations by the media have revealed it takes mentally ill patients not in an immediately life-threatening condition from eight months to three years to get their first appointment at specialist outpatient clinics. In contrast to the long wait, a patient is usually spared no more than 10 minutes for a consultation due to the service demand overload.
We are deeply concerned about this grave lack of resources, which is depriving patients of opportunities to get proper treatment, recover and integrate into society.
Four years after a committee was set up, the Food and Health Bureau has finally published its Mental Health Review Report. Notwithstanding the 40 wide-ranging recommendations, little has been said about the medical manpower required to support service demand in the long run, a crucial factor for the success of the reform.
In a paper comparing the support for people with mental illness in 15 Asia-Pacific territories, the Economist Intelligence Unit suggests that mental health services in high-income Asian societies, including Hong Kong, tend to be underdeveloped and understaffed because it takes them time to increase budgets, train personnel and align different government sectors on policy directions.
It is high time the Hong Kong government came up with comprehensive, long-term health care strategies and policies before it is too late – if it is not already so.
As the government is urged to fix the problems, we, ordinary citizens, can also help by giving those afflicted by mental illness the respect and understanding they deserve.
Unlike the protagonist of Mad World, who at least enjoyed the support of his father and a precocious boy living next door, a lot of people with mental health problems are living in isolation and loneliness.
In this maddening world, small gestures of kindness may be all it takes to heal a tormented soul. So go ahead and offer a helping hand when you spot someone suffering alone. You may actually save a life.
Professor Alfred C.M. Chan is chairperson of the Equal Opportunities Commission