Ten-year-old Karen (not her real name) sits next to her father in the Castle Peak Hospital activity room. The two smile and chat about her day at school and her friends. A few years ago, it was quite a different story. That was when Karen's father started talking to himself and behaving strangely. As a result, the frightened youngster often hid in the toilet and cried. The turnaround is due to an innovative programme at the hospital aimed at children of mentally ill parents. Since 2006, the Youth Ambassador Programme has counselled and supported about 400 children aged between five and 16. The hospital's nurse consultant, Jolene Mui Hang-chun, said emotional problems were common in children of mentally ill patients. 'These children see their parents' psychotic symptoms and behaviour - such as delusion, talking to themselves or attempts to commit suicide - and because they do not understand it, they are scared,' Mui said. 'And when their parents are admitted to hospital, the children also suffer separation anxiety. The situation is even worse if both the children's parents are mentally ill.' The hospital team recently commissioned Chinese University to survey children whose parents suffered mental illness, and found they had high levels of stress. They also had low self-esteem and many did not want their friends to know about their parent's condition. The study showed that children had better relationships with their parents and lower stress levels after they joined the programme and learned more about mental illnesses. Like other participants, Karen attended seminars, counselling and other activities to learn more about mental illnesses. She also shared her experiences. Her father Joe, 57, has suffered from severe depression for more than five years and is now an outpatient. The illness caused him to suffer delusions and occasionally behave bizarrely. He quit his job as a driver and showed no interest in life. 'I could not control my moods, I quarrelled with my wife frequently, my two daughters were stressed, I felt helpless,' he said. Recalling the days before joining the programme in 2009, Karen said she always felt scared by her father's behaviour. 'One day he ran out of the flat and said he wanted to die,' she said. 'My mother, my elder sister and I grabbed him and cried. He threatened to chop off our arms and I was very frightened. 'Sometimes I hid in the toilet and cried,' she said. 'I dared not say anything that could irritate my father.' For years, she kept her father's mental illness from friends because she was ashamed. 'I was so worried that my friends would abandon me if they knew my father had mental problems,' she said. 'Now that I understand mental illnesses are treatable, I am not afraid to tell others about my father.' Joe was very moved when Karen wrote him a card last year telling him how much she loved him. 'My family is with me now, I have the strength to fight against my illness,' he said. Tim Pang Hung-cheong, spokesman for the Patients' Rights Association, said services for children with severely mentally ill parents were seriously lacking. 'Some mentally ill patients have problems taking care of themselves, not to mention their children, they need a lot of support,' Pang said. 'Doctors, as the first contact with the patients, should be alert if the patients have young children as they may have some problems taking care of them. Community groups should be providing more support to these children because they may suffer from emotional trauma.'