Hong Kong conducts first mental health survey

A busy street in Hong Kong
Image caption Hong Kong: one of the most crowded cities in the world

Hong Kong is currently carrying out its first mental health survey.

It is expected to take three years but preliminary findings show the region's mental health services to be inadequate.

Only 1% of Hong Kong residents are currently receiving mental health treatment but the need is thought to be far higher.

In 1997 Hong Kong transferred from a British colony to a region with special status under Chinese rule.

Caught between the traditions of Chinese culture and the westernising influence of 137 years of British rule, the city has experienced dramatic political, social and economic change leaving some of its most vulnerable citizens out in the cold.

Linda Lam is Chief Editor of the Hong Kong Journal of Psychiatry. She believes that the provision of mental health services in the city is way below need.

"We don't have figures for the prevalence of most psychological disorders in Hong Kong but like most developed cities there are estimates that anxiety and depressive disorders would be over 10%.

"If we project this to Hong Kong then our mental health needs would be tremendous."

It is widely assumed among mental health professionals in Hong Kong that mental illness is vastly under-diagnosed.

Fear of the mentally ill

Image caption Strong religious beliefs lead people to see mental illness as a curse

One of the main reasons for this is rooted in traditional Chinese beliefs and the idea of reincarnation.

In China, it is widely believed that misfortune in this life is the result of misdeeds in the past.

Professor Daniel Wong, a practicing therapist and social scientist at the City University of Hong Kong, explains this attitude to mental illness.

"In Hong Kong when you mention anything about mental illness people immediately think that this person is dangerous, violent and is going to kill someone.

"The general public is quite scared of people with mental illness and does not want to mix with them."

Discrimination against those with mental illness is a world-wide problem but in Hong Kong the situation is particularly acute.

Roy Chen is a 45-year-old mature student at Hong Kong University and has experienced this first hand.

Eight years ago, he was working on the reservations desk of an airline when his colleagues discovered he had been diagnosed with bipolar disorder.

"They started to have strange feelings about me, they didn't want to take the elevator with me, instead they just took the stairs. They didn't want to have lunch with me."

The hardship of life

One group that is particularly at risk of mental illness are Chinese migrants, as "Wendy" from Guang Dong province in China explains.

"I was a stranger in Hong Kong," she says. "Life was miserable compared to my life back in mainland China.

"All my family were squeezed into a small room where there was only one table and a bed.

"I even thought of committing suicide because the weight of life was unbearable."

But what makes it especially hard for people like Wendy to get help is that the actual word for depression isn't part of their vocabulary.

"I don't accept it," she says. "I just know that I lose my temper easily. They asked me to take medicines to get the situation under control, but I disagreed.

"To me, feeling stressed and depressed is only a natural reaction towards the hardship of life."

For Linda Lam this attitude is not surprising.

"It is not deliberate that they are hiding their depression," she explains, "but it is very hard for Chinese subjects, particularly older people, to talk openly about their emotions."

She has found that a general attitude exists in Hong Kong and across China that Chinese people don't get depressed. She believes people misinterpret the physical symptoms of depression for other illnesses.

"We are taught since we are very young not to talk about our feelings," she says.

Getting old

Recently this attitude has started to change and in the last six years demand for mental health services has doubled. It is now far exceeding supply.

Often patients will wait up to two or three years for their first consultation and even if they are able to see a doctor, consultation time is only two or three minutes.

Chief officer for the Mental Health Association of Hong Kong, Mr Chi Kong Ching, explains this shortage.

"In Hong Kong the spending is 0.25% of GDP, I think it is only one quarter of what is spent in the US or Australia."

Added to this is the problem of a rapidly ageing population.

Men in Hong Kong live longer than anywhere else in the world, while women's longevity is second only to Japan. In less than twenty years, a quarter of the population will be over 65.

"We used to say that the baby prams are disappearing," says Linda Lam, "but wheelchairs are becoming much more prevalent."

As more and more old people try to adapt to the pressures of intense city living it presents a ticking time-bomb for mental health services.

"The government really needs to have a mental health policy that cuts across different bureaus with a long term plan for mental health services," says Lam.