The number of students suffering from stress, anxiety and depression in Hong Kong is rising and, as the public becomes increasingly aware of mental health issues, more are coming forward to seek treatment.
However, it's difficult to determine exactly how many teenagers have such problems because local studies are scarce and sporadic. In a study by Polytechnic University on "Self-Harm and Suicidal Behaviours in Hong Kong Adolescents", published in the August edition of the Scientific World Journal, 32.7 per cent of 3,328 students polled reported at least one form of deliberate self-harm. Some 13.7 per cent of respondents had contemplated suicide, and 4.7 per cent had attempted suicide.
"When I first started in psychiatric practice 25 years ago, deliberate self-harm was unusual," says Dr Barry Connell, a psychiatrist at the Central Health Medical Practice. "Today we are facing a virtual epidemic, if not a change in the cultural expression of emotional distress in young people."
Now, help is on the way. Hollywood actress Goldie Hawn's educational charity, the Hawn Foundation, is introducing its "MindUP" programme to schools across the city over the next year.
The programme follows Social Emotional Learning (SEL) principles that teach children preventive and coping skills to manage anxiety and stress and, in theory, ready the mind for learning. Students are taught to be optimistic and encouraged to perform random acts of kindness. Mindful breathing exercises are practised for about a minute three times a day.
MindUP will be piloted at Beacon Hill School. If it is successful, the ESF will look to implement the programme at all of its primary schools. The programme is also being adopted by schools in the United States, Britain, Ireland and New Zealand.
A number of factors can induce stress in children during school life: homework, bullying, peer pressure, fear of failure, and speaking aloud in class. And stress is known to impair learning ability.
"Unhappy children find it very hard to access the curriculum," says Tim Conroy-Stocker, an educational psychologist at ESF Therapy Centre, which is run by the English Schools Foundation. "So a big focus in helping children is looking at preventative measures that foster resilience, and give them strategies to deal with anxieties that arise."
Students on the MindUP programme learn through activities such as taking a "brain break", where they get comfortable, close their eyes and listen out for the chimes.
"Mindful breathing helps me go to sleep. It helps me think and it helps me concentrate. It makes me calm," six-year-old Abe says on the website. "One day I was sick and it helped me. Sometimes I do it at home. I showed my friend how to use it and he uses it all the time."
Parents are encouraged to support the MindUP programme by practising the exercises at home. The breathing activity is a good starting point. Hawn urges parents to "sit with your children for 10 minutes a day," in her new book, 10 Mindful Minutes. "Focus on your breathing, then ask your children to sit comfortably with their hands in their lap and close their eyes."
Last month, the Hawn Foundation held its first series of professional development workshops for parents and child advocates at various local schools. More than 300 teachers from Beacon Hill, Carmel, and Singapore International primary schools were trained to teach the programme.
A 2011 study by the department of psychology of Loyola University Chicago, involving 270,034 students from kindergarten to high school, found that children engaged in SEL programmes "demonstrated significantly improved social and emotional skills, attitudes, behaviour and academic performance". It said this "reflected an 11-percentile-point gain in achievement" over the course of about 15 weeks.
The programme "helps kids to understand their bodies and stress and how the brain works", says Dr Marc Meyer, director of education and strategic partnerships at the Hawn Foundation. Given the demand for mental health services in the territory, there have been calls for the government to provide additional resources for an illness that can effectively be treated.
However, the Department of Health has declined to say whether the government will invest in additional community and school resources to treat anxiety and depression among students.
Psychiatrists and psychologists usually treat patients with anxiety and/or depression with cognitive behavioural therapy. "Teenagers can be very fussy about psychologists, but if they like you they'll often do as they're told," says John Shanahan, a developmental and child psychologist at Southside Family Health Centre.
Shanahan recommends six steps to combat depression: adequate sleep, a healthy diet including omega-3 and omega-6 fish oils, regular exercise, relaxation techniques such as deep breathing, therapy, and increased exposure to sunlight.
Combining these measures with other relaxation strategies such as meditation, yoga, reading a book, watching television and taking a hot bath, may also help lift the mood.