Mental Health in Hong Kong

What is the mental health situation in Hong Kong?

“Progress in mental health in a population cannot be made without tackling the issues of stigma and discrimination. To curb these is a challenge to the entire society, not just patients and professionals.”

The World Health Organisation defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” In Hong Kong and globally, mental health remains largely misunderstood and not equated (in both prevention and treatment) to physical illness.

An estimated 1 in 7 people in Hong Kong will experience a common mental disorder at any given time. Of those experiencing a mental health disorder, three-quarters will not seek professional help. Many will continue to suffer in isolation as a result of stigma, feelings of shame, lack of awareness about their condition, and a shortage of accessible professional support. Further statistics show that many environmental, personal and social stressors also contribute to mental health problems.

Prevalence of Mental Health Problems

Poor mental health can arise from many common environmental, social and personal stressors, including stressful life events, lack of regular exercise, alcohol and substance misuse, financial difficulties, living in public housing and chronic illness [1].

  • 61% of Hong Kong adults currently suffer from poor mental well-being [2], with 1 in every 7 people developing a common mental disorder in their lifetime [3].
  • The number of psychiatric patients has doubled from 2004 to 2014 [4].
  • 74% of mental health sufferers do not seek any form of professional help [5].
  • Anxiety and depressive disorders are the most common mental health issues in Hong Kong [6].

Unhealthy Work Culture and Workplace Stress

Workplace factors that contribute to poor mental health include lack of physical and mental space, limited opportunities to take breaks, low job security, as well as tense workplace cultures transmitted from conflict and stressed bosses [7].

  • Hong Kong has one of the longest working hours in the world (51.1 hours per week), with 39% of people working 4-8 hours overtime each week [8].
  • 1 in 4 Hong Kong workers suffer symptoms of depression and anxiety – 2.5 times the global average – and around 18% require psychological treatment [9].
  • 73% are unaware of any mental health support programmes provided by their employer [10], and 56% have seen mental health issues handled inappropriately in the workplace [11].
  • In 2018, 46% of Hong Kong employees worked more than 50 hours per week and Hong Kong employees lost an average of 77.4 days of productive time per year [12].
  • Hong Kong ranked 45th out of 50 countries in work-life balance and ranked top overworked cities [40].

Social Stigma and Lack of Understanding

Research indicates there is a long way to go in dismantling the stigma around mental health:

  • 71% survey respondents were unwilling to live with mental health sufferers, with 1 in 3 even willing to end friendships with those diagnosed with mental illness [13].
  • 41% consider “lack of self-discipline and willpower” a main cause of mental illness [14].
  • More than half believe they will be penalized at work for talking about their mental health challenges [15].
  • 55% have experienced stigma or know someone who experiences stigma [16].

Increase in Youth Mental Health Problems

  • The number of child and adolescent psychiatric patients has increased by 50% from 2011/12 to 2015/16 [17].
  • 51.5% of secondary school pupils now show symptoms of depression, and 25% demonstrate clinically-high levels of anxiety [18]. Among university undergraduates, 69% currently show symptoms of depression, with 54% suffering from anxiety [19].
  • Youth suicide rate (aged 10-19) more than doubled from 2014-2017 [20], with 1 in 3 primary school students and 40% Form 1 students at risk of suicide [21].
  • Targeting at-risk youth is the most effective way to prevent mental health problems as 75% of mental illnesses develop before the age of 24 [22].

Ageing Population Mental Health

The elderly (aged 65 or above) currently make up 16% of Hong Kong’s population. By 2041, almost 1 in 3 of our population will be aged 65 or above [23].

  • The suicide rate among the elderly is multiples higher than of other age groups [24].
  • The prevalence of dementia doubles with every five-year increment in age after 65, with an estimated 100,000 people (10% of the elderly population) currently suffering from the condition in Hong Kong [25].

Shortage of Professional Mental Health Support

  • The number of public sector psychiatrists per 100,000 people is 4.8 for Hong Kong, versus 8.59 for high-income countries [26]. With less than 400 psychiatric doctors, Hong Kong has half the number recommended by the World Health Organisation for our population size [27].
  • From 2011/12 to 2015/16, the number of Hospital Authority psychiatric patients increased by 22%, but psychiatric staff increased only 13%, with the number of psychiatrists in particular increasing only 3% and psychiatric hospital bed count remaining unchanged [28].
  • Currently, there is a total number of 25,671 registered social workers [29], 603 clinical psychologists registered under Hong Kong Psychological Society [30], and a total of 422 psychiatrists including both public and private sector registered under the Medical Council of Hong Kong [31].
  • Patients’ wait time to see a psychiatrist can be up to almost 2 years [32], and each appointment lasts on average only 6-8 minutes [33].
  • 60% of Hong Kong adults do not know where to seek help regarding mental health outside of hospitals [34].
  • Low-income families are often unable to afford unsubsidised health as the cost of private sector psychiatric consultations ranges from $790 to $3,000 [35].

Government Support and Initiatives

The 2017 Mental Health Review Report lists a series of government initiatives [36]:

  • Joyful@HK, the Student Mental Health and Dementia Community Support Schemes were launched in 2016-2017 to increase public knowledge and engagement in promoting mental well-being.
  • 24 Integrated Community Centres for Mental Wellness has been established since 2010 to strengthen community support 
  • The Hospital Authority (HA) reviewed and re-categorized certain oral antipsychotic drugs to allow prescription as first-line drugs.
  • The psychosis-targeted “EASY programme”,  launched in 2001, was expanded.
  • A joint platform by the HA and Social Welfare Department (SWD) was launched in 2010 to facilitate collaboration between medical and social care sectors.
  • For 2019-2020, the Department of Health announced a $100 million budget to promote a healthy community, including mental health issues.

Upcoming mental health targets are as follows [37]:

  • The SWD will expand residential care places and vocational rehabilitation services for ex-mentally ill persons by 10-15% from 2016-2022.
  • The Mental Health Direct rotation scheme will be implemented to improve Community Psychiatric Service case managers’ understanding of mental health.
  • The Student Mental Health Support Scheme launched in 2016 will be expanded to more schools. 
  • Specialist Outpatient Clinics (SOPC) case quotas will be increased.
  • Child and adolescent psychiatric services at SOPC will be enhanced.
  • Additional hospital case managers for mental illness patients will be recruited.

Other Mental Health Initiatives

  • Using computer games and an AI chatbot to assess students’ mental health, The Brightly Project’s early-intervention Know My Students Digital Suicide Prevention Program has been implemented in a number of Hong Kong schools.
  • In 2019, Mind HK launched an online community directory tool for mental health services.
  • The Jockey Club “Open Up” 24/7 online text platform, which is co-operated by Hong Kong Federation of Youth Group (HKFYG), Caritas Hong Kong, and The Boys and Girls Association of Hong Kong (BGCA), launched in 2018 to provide psychological support for young people who are experiencing emotional distress. The platform recorded over 10,000 cases after half-year of launch [38].
  • The Samaritans Befrienders Hong Kong (SBHK) launched a mobile application, “Chatpoint” in 2018. The application allows users to chat with trained volunteers anonymously to provide emotional support and possible early intervention for users with suicidal thoughts. Over 4,600 users have benefited from online counselling services [39]