The pressure of work and study had been taking a toll on Esther Chan for some time. When she didn't get the promotion she thought she deserved, she finally broke down. "I had insomnia and lots of nightmares. I didn't want to go to work and my hands shook. I cried all the time and I felt hopeless," says Chan, who works in the finance industry. "Every time I stood on the balcony, my husband would say 'Come back, come back,' because I had thought about jumping off the building." Chan recalls these events of 2006 with composure and occasional laughter, but back then she was under a lot of stress, and saw no hope in life. She was in that state for more than a month until Lunar New Year's Eve, when she refused to go to her family reunion dinner. That's when her husband managed to persuade her that it was time to see a family doctor. "I didn't want to go [to the doctor] because I didn't think I was sick," says Chan, who was diagnosed with severe depression and was prescribed medication. Mental health experts in Hong Kong see many cases similar to Chan's. They say an overemphasis on work and success is one of the leading causes of depression in the city. A recent study by University of Hong Kong's Social Science Research Centre found almost a quarter of 1,031 adults polled said they were bothered by feeling down, depressed, or hopeless in the previous month. About a third of the respondents were bothered by having little interest or pleasure in doing things and worrying over the same period. "For most Hong Kong people, career and work are the top priority. Hong Kong people simply work too hard. Their sense of achievement and self can be lost if they don't have their work," says the study's co-author and clinical psychologist Dr Paul Wong Wai-ching. "Fame and money are important. We emphasise hard work and long working hours." Christine Klitsie, who works with the Hong Kong Samaritans, a non-profit group that helps people who are suicidal or distressed, has a similar observation. Every time I stood on the balcony, my husband would say 'Come back, come back,' because I had thought about jumping off the building Esther Chan "In the workplace, there is still the expectation for people to work long hours, even if they are not that productive. They don't have time to spend with family and friends," says Klitsie. The HKU study involved a telephone survey conducted between March and June this year of adults 18 years old or above who had worked for more than 20 hours in the previous week before the interview. The distribution of the respondents in different industries was similar to the Hong Kong 2011 Population Census. The researchers also found that some 90 per cent of respondents said they needed better mental health support in the workplace. Chan felt isolated when she had depression. "I didn't talk to anyone at work and my colleagues felt I was strange. I had to bear everything by myself, and I had no friends at work," she says. In Hong Kong, the cultural stigma attached to mental illness is a barrier for people seeking help. Chan didn't tell her family or colleagues; she also kept it to herself when, in 1989, she had her first breakdown after she discovered that her ex-husband had had an extramarital affair. Her stigmatisation of depression goes back to her childhood. "My dad had depression. He couldn't fall asleep and become very agitated. He sometimes would hold a knife, which made us very scared," says Chan. Chan did not speak to her father after his mental disorder and had never talked to anybody about her father's problem. Mental health disorders should be treated just like any other physical disorder and are common, says Professor Linda Lam Chiu-wa, president of the Hong Kong College of Psychiatrists. Long waiting times to see a psychiatrist or psychologist in public hospitals have made it difficult for people with mild mental health problems to seek help. Hong Kong has only around 300 qualified psychiatrists and psychologists. "It could take 18 months to see a psychiatrist, but consultation lasts for only three to five minutes," says Klitsie. Chan was fortunate enough to be able to afford a private psychologist. When her second breakdown happened, she saw her family doctor first, and then sought professional help from a psychologist. That cost HK$2,500 per month and she went for three months. But for most people, private consultation is out of the question. It's especially difficult for those who get depressed because of financial problems. Fortunately, Hong Kong has a number of NGOs and non-profit organisations that help ease the strain on the city's mental health services Chan joined a workshop organised by Joyful Mental Health Foundation, which has since "transformed her life". "I go to Joyful's monthly meet-up, and I have made many friends via its programme," Chan says. She has also joined some NGOs and gone to see children in poverty-stricken areas of Sichuan and Yunnan. For Chan, a loving and caring family and friends are really important for people who have depression. One also has to learn to love themselves, she says. "I didn't know how to love myself. I have a family who love me very much but I didn't know that. People who have mental problems confine themselves to a very limited space," she says.