Cocaine, gambling, and ghosts: a day in the life of Hong Kong’s overloaded social workers
In Hong Kong's sprawling North District, superstition and social stigma hamper efforts to tackle mental illness, and the lack of space for counselling makes matters worse for staff with heavy caseloads
Ms Ng was considered lucky in the factory where she worked in Sichuan. The quality assurance manager – a suave man from Hong Kong – fell for her and moved Ng to the city. It was a dream come true, until he became addicted to gambling and cocaine. He was losing HK$200,000 a month and his psychosis was getting out of control. He began hitting Ng, then she began to think about killing him. One day, losing his grip on reality, he took a knife to their three-year-old son’s neck.
In Hong Kong’s North District, the story of Ng (not her real name) isn’t an uncommon one. She’s one of social worker Tammy Tam’s 80 active cases. Tam – with 12 other social workers – works for the district’s only government-funded outpatient centre for mental health. There’s at least one in every district, and sprawling North District – covering Fanling, Sheung Shui and the border villages – is the only district with no space for counselling. Instead, social workers have only an office for doing paperwork.
“We borrow space from other NGOs and the Social Welfare Department, but most of our intervention takes place in clients’ homes,” says Brian Chau, one of the social workers. “In extreme cases, counselling happens in open areas – like in a restaurant or the park – but there, we can’t protect their confidentiality.”
North District is the home of many new migrants from China, like Ng. They can experience serious problems adjusting to the city – the language barrier and small spaces, which often contribute to mood disorders – and social workers’ caseloads have increased to anywhere from 80 to 120. The Social Welfare Department recommends a local social worker’s caseload should be about 40. And because they have to travel to see clients, they can only schedule in two or three clients each day.
Another challenge for social workers in the less developed North District is that Chinese culture can still be very traditional, and stigmatisation runs deep. “Everyone knows each other in the villages and rural areas,” says Christine Cheuk, the office’s head social worker. “If you have a mentally ill patient at home, everyone will know, so they won’t go to see a doctor. Stigmatisation is from the outside and also from the patient.”