O ver the past three weeks, Kwong has barely slept. “Whenever I close my eyes, I can hear only the sound of gunshots,” says the 30-year-old, recalling the scene on June 12 when police fired rubber bullets and tear gas at protesters demanding the withdrawal of a bill that would clear the way for ad hoc extradition arrangements from Hong Kong to other jurisdictions including mainland China. One image in particular haunts him: the bandaged face of a protester being carried onto an ambulance. Kwong now knows this was a secondary school student who, bleeding profusely after being hit in the face with a tear-gas canister, appeared in a video that went viral on social media . “People were cheering him on, but all I remember were his lifeless eyes,” says Kwong, who asked for his full name not to be revealed. The doctoral student at the University of Oxford in Britain, who is also a visiting lecturer at a local tertiary institution, now spends much of his time – in between attending rallies and protests against the bill – sobbing inconsolably. After nearly four weeks of unprecedented protests against the extradition bill, experts are warning that Hong Kong faces a mental health crisis. In that short space of time, four deaths and various attempted suicides have been linked to the protests, as has an uptick in the number of patients checking in to community centres with mental health complaints. Crucially, it is not only protesters who are at risk, but the entire community. Many policemen are seeking psychological counselling, too. Some have been driven to their limits by emotional and physical exhaustion, others fear for their safety and that of their families after receiving threats online. Studies suggest that even members of the public not directly involved in the protests are at higher risk of depression. COLLECTIVE EMOTION “There is a very strong collective emotion in society, which is unusual,” says David Yip, president of the Hong Kong Institute of Christian Counsellors and a clinical supervisor. “The worry is that it will be difficult for people to return to normal lives, even after the saga is over, especially for those who are already suffering from emotional disturbances and have lower mental resilience.” Liu Kwong-sun, a specialist in psychiatry, estimates that 30 per cent of his clients suffering anxiety, depression and schizophrenia have experienced flare-ups since the protests began. “Some have required higher dosages of antidepressants,” Liu says. The community clinic he works at has also received an influx of new patients showing symptoms of insomnia, depression and mania. What next for Hong Kong’s extradition bill protesters? The observations of Yip and Liu dovetail with the results of a 2016 study by the University of Hong Kong into the effects of Occupy Central , a youth-led civil disobedience movement seeking universal suffrage that blocked roads in the city for 79 days in 2014. The study found that “major depression increased by 7 per cent after Occupy Central, regardless of personal involvement in the protests”. The throwback to Occupy Central – sometimes referred to as the Umbrella Movement – is not lost on Kwong. It was following the failure of the Occupy movement to extract any concessions from the central government that he first became depressed. Five years on, much about the current protests is all too familiar: the clashes at the legislature, the tear gas, the baton-wielding riot police and the government’s refusal to make meaningful concessions. Particularly depressing was the June 9 protest when he and an estimated 1 million others took to the streets in protest against the bill, only for Chief Executive Carrie Lam to say its second reading would go ahead (she has since shelved the bill, deeming it effectively dead but it has not been withdrawn, a key demand of protesters). “It felt like the game was over,” he says of that first protest and the stony reaction from Lam. This is no Singapore living in fear, this is a city ripping itself apart Three days later, as a follow up protest descended into violent clashes between protesters and law enforcement, Kwong found himself gripped by fear that he would be accosted by police. He rushed home, frantically deleted his phone messages, threw away his masks and goggles and changed his clothes. But even then, the paranoid thoughts would not leave him alone. “People may become hyper-vigilant and anxious. But at the other extreme, there can also be a numbing effect, where people dissociate themselves and become detached from reality,” says the psychiatrist Liu. Liu explains that direct exposure to traumatic events, as well as secondary exposure through video footage, television and social media, can lead to acute stress disorder. If the symptoms persist for more than a month, it is considered post-traumatic stress disorder and people should seek professional help. STRESS FOR ALL The city’s police force is also feeling the stress. With the protesters’ frustration with the government mounting, Secretary for Security John Lee Ka-chiu has urged protesters not to vent their fury on the police force, whose headquarters were besieged twice last month. During clashes on July 1, 13 officers were splashed with an unidentified liquid and two had an unknown powder thrown at them. Some officers have sought psychological counselling. “Physically some of them worked up to 40 hours in a shift without going home. They were insulted by protesters during the long hours of duty. You can imagine my men are very emotional,” says Lam Chi-wai, chairman of the Junior Police Officers’ Association, which represents 25,000 members of the force. “Moreover, the personal details of their own family members were exposed online. Officers are worried about the personal safety of their wives and children around the clock.” The inside story of Lam’s bid to push through extradition bill Some officers have complained of protesters ringing their doorbells, and even visiting the workplace of family members. Lam, who has been criticised by protesters for backing the use of tear gas at the June 12 protest, says suggestions the police have been heavy handed are unfair. “Police officers stay neutral and passive,” says Lam. “The protesters look for trauma, but we do not. We expected to be targeted by protesters, but our family did not.” While the force’s psychological services group has reached out to front line officers, it’s likely some are suffering in silence. Some may not recognise their problems, others may be unwilling to admit weakness. Chan, a mother of two and the wife of a policeman, says most officers “keep their emotions to themselves and shy away from seeking consultation, fearing it will affect their chances of promotion”. “It’s disheartening to see all the criticisms we have received,” says a newly recruited officer. “Most of us joined with a sense of mission and seeing the overwhelming reproach is very discouraging.” “It’s a very lonely profession because we have no ways to express ourselves. A lot of us just want to do our duty well. Under the uniform and clothes, we are all humans.” A DEEPER MALAISE The psychiatrist Liu says members of the general public may be even more vulnerable, noting that “the rest of the community usually doesn’t have that structure in place”. Liu believes this is an opportunity for the Hong Kong government to review the public mental health care system, which he characterises as overburdened and under equipped. According to government figures, the median waiting time in the public health system for patients to receive psychiatric services is 22 weeks. Depending on the area, patients in stable condition have to wait anything from 38 weeks to 159 weeks for their first appointment. From Singapore to Manila, how Asia sees Hong Kong protests Amanda Li Chiu-ming, a clinical psychologist, says it is too simplistic to attribute the decreased emotional well-being solely to the protest movement. “Mental health cannot be separated from the society and the feeling of helplessness piles up over time. The movement simply reveals deep-rooted social problems,” Li says. To tackle the root of the problem, however, requires not only psychiatric care for individuals, but structural reform, too, she says. “The mental health crisis is inevitably linked to the political environment. Well-being is a holistic concept that concerns different aspects, including emotional, psychological and social. It is affected by whether we can find satisfaction and meaning in life as well as if the society is functioning reasonably. So problems such as the government not answering to its people and the lack of democracy all affect our well-being adversely,” Li says. HELP IS AT HAND Amid the fears of a mental health crisis, the community has been quick to respond. Outreach groups consisting of hundreds of residents from each district have formed on the social media app Telegram. They aim to respond to alerts immediately and will send out teams of volunteers and social workers on call. On Instagram, a group of social workers and psychologists have formed the account @spritiualemotionhk, where protesters can reach out for help or for someone to talk to. Elsewhere on social media, articles giving advice on self-care abound. Among the tips are: unplug from the internet; let your emotions out instead of suppressing them; document how you are feeling through writing or drawing. Counsellors advise those feeling down to seek help from friends and family. Those offering help should be non-judgmental, offer support unconditionally, and encourage the troubled person to seek professional help, if necessary. Why young Chinese-Canadians support Hong Kong protesters “It is a complicated situation that is constantly evolving and unpredictable. It is difficult to offer quick and definite answers to how we can face this uncertainty, but one important thing is to acknowledge our struggles and feelings,” Li says. Despite the bleak atmosphere, “there is a ray of hope created by our collective actions, which is why people are not entirely paralysed but are still persisting,” she adds. That ray of hope has been enough to encourage even Kwong out of his despondency. “The protesters have not lost hope. That keeps my faith in humanity,” he says. ■ Additional reporting by Christy Leung People in need of support can contact the Samaritan Befrienders’ 24-hour hotline on 2389 2222; Suicide Prevention Services on 2382 0000; or the Society for the Promotion of Hospice Care on 2868 1211. A hotline for those who have lost a loved one to suicide is available at 2382 2737