Four suicide attempts within a 27-hour period were reported at Penny’s Bay last week. Police and firefighters were called to talk down a 59-year-old woman who was threatening to jump from a building. Meanwhile, a man who slept outside his isolation unit to protest a lack of support in getting urgent medication for a chronic condition said, “It [isolation] is like a concentration camp. No one would know if I died.”

“It is the tip of the iceberg,” says Professor Paul Yip Siu-fai, director of the Centre for Suicide Research and Prevention at Hong Kong University (HKU), referring to the recent spate of reported suicide attempts at Penny’s Bay. “The general mental health is not good.”

New guidebook aims to help Hongkongers beat quarantine stress

“Wellcation”, an online guidebook that a group of HKU professors compiled offering mental health support for those in isolation, saw a massive spike in visits over the last week, Yip says, from 8,000 in the week before February to 212,000 visits a week a fortnight later.

Research shows that prolonged isolation has a profound negative impact on people’s mental well-being, Blaine says. She is concerned that this isn’t being addressed, nor are measures in place to protect the most vulnerable.

“In Hong Kong, people are not screened for any mental health issues before they go into [mandatory] quarantine, they are not asked if they are at risk or what medication they are on,” she says.

In Australia, those who are vulnerable or who have a previous mental health condition are assigned a different kind of accommodation: a flat with windows that open, and from which knives are removed, Blaine says. And everyone in quarantine receives a daily phone call from the government to check in on them and ask how they are coping.

Acknowledging the lack of screening of the vulnerable in Hong Kong, Yip calls for better support and resources.

“If you say you have a phobia, I don’t think they will let you off the hook. But I think they could provide additional support for people who are susceptible [to mental health problems or suicide ideation],” he says, adding that help hotlines have been jammed, leading him to recommend the government opens a 24-hour text line.

“Removal of agency is a key factor in the stress that people experience. For people who are vulnerable, if you remove their support systems, it makes it harder for them to manage behaviour factors which can keep mood under control,” he says.

He points to the increase in suicides in 2003, coinciding with the Sars (severe acute respiratory syndrome) outbreak in Hong Kong that year.

A 2010 academic paper by Yip and three colleagues – “The impact of epidemic outbreak: the case of severe acute respiratory syndrome (Sars) and suicide among older adults in Hong Kong” – looked at how the Sars outbreak resulted in a higher suicide rate, especially among older adults in Hong Kong.

The report concluded: “We recommend that the mental and psychological well-being of the community, in particular older adults, be taken into careful account when developing epidemic control measures to combat the future outbreak of diseases in the community.”

Blaine does not see that happening in Hong Kong at present. She sees the government doing its best to mitigate the effects of the virus and protect people’s physical well-being, but in the pursuit of those goals, she questions whether the government has lost sight of the humanity.

For many people, the lack of autonomy around the mandatory quarantine means that it is perceived as a punishment, and this has an adverse effect on how you deal with quarantine, she says.

“If you were given some sense of autonomy, for example being able to isolate at home with your own things around you, it would mitigate these mental health issues,” she says.

Blaine sees Hongkongers, who collectively went through the experience of Sars, as having a high sense of civic responsibility and much more likely to accept decisions if the process leading to those decisions is inclusive, responsible and reasonable.

“Aside from Covid-19, it’s the general fear around being taken to Penny’s Bay that is gripping everyone, and the separation from families. Entering these situations with an already high level of anxiety, the potential suicide risk is high,” she says.

Commenting on the widely circulated video of the distressed woman at Penny’s Bay, Blaine expresses concern about the “bystander effect”. Most people’s natural reaction would be to comfort a distressed individual, but everyone is too scared because they are concerned about being punished, she says.

“How badly distressed must a person be for you to go there and help and b***** the consequences? It goes against the natural way of being, the natural support you’d ordinarily give a person,” she says.

Mental health tips for those in isolation

Dr Hannah Reidy, CEO of mental health charity Mind HK, says it is understandable and completely normal to feel frightened if you are quarantining alone, and that you may wish to escape some of these big feelings.

“Ground yourself by focusing in on your breath or an object in the room, helping yourself to slow down a little and remind yourself that this experience in isolation is temporary and it will change,” says Reidy.

Quickly reach out for support and someone to listen to how you are feeling. At this early stage, that person could be a mental health professional or someone who cares about you, such as a friend or family member.

“If you are feeling you can’t keep yourself safe and you are isolating at home, we recommend calling 999 or a suicide hotline,” Reidy says.

“If you are in isolation in a professional facility, then we recommend urgently calling the nurses or the care staff managing that facility, or the hotline of the isolation facility, and you could also seek help on one of the suicide prevention hotlines.

“Please remember you are not on your own through all of this.”