Opinion | From crisis to care: Improving responses to youth mental health issues

As various sectors are currently reviewing whether to improve or extend the "Three-tier Emergency Response Mechanism" for preventing youth suicide, established by the Education Bureau for secondary schools and set to expire at the end of this year, troubling incidents continue to emerge. Once again, the emotional distress and suicide problems among adolescents have sparked deep concerns across society.

The ongoing impact of the three-year pandemic, coupled with social issues during the same period, has led to persistent emotional and social problems affecting both families and society. Last year, there were 32 publicly reported suspected suicide cases among primary and secondary school students in Hong Kong, compared to 21, 25, and 25 cases in 2020, 2021, and 2022, respectively—an obvious upward trend. While this year’s city-wide statistics have yet to be released, many expect the figures will also be alarming.

In response to this serious issue, the Education Bureau launched a one-year "Three-tier Emergency Response Mechanism" for secondary schools last year to prevent youth suicide. However, this mechanism is set to expire by the end of this year.

The Secretary for Education, Christine Choi Yuk-lin, stated in a recent TV interview that the mechanism was an additional or special arrangement targeting a peak period and that making it a permanent fixture might affect other communities' access to mental health services. The mechanism will undergo a phased review, and based on the actual situation, a decision will be made on whether to extend it. Schools and various sectors of society have called for a review and improvement of the mechanism, particularly in light of the harsh reality that emotionally and mentally troubled youths face a two-year wait for psychiatric specialist services. Imagine a troubled youth, left unattended due to a lack of social or external support, spiraling into further distress—the eventual outcome is all too predictable. Authorities must consider how to provide timely counseling and guidance to troubled youths in light of rapid social changes.

During implementing the "Three-tier Emergency Response Mechanism," school principals referred more than 200 cases to psychiatric services, and over 120 required external support—a total of 320 cases. Christine Choi believes the solution lies in addressing the root causes and reducing severe cases: "In the long run, we should focus on mental health from a holistic perspective rather than treating all cases as emergencies." She also mentioned that the number of school social workers and school-based psychologists is insufficient.

However, the problem remains that tragedies like these continue to occur precisely because the support from school social workers and psychological counseling is inadequate. If social workers had enough resources to follow up on cases thoroughly, providing appropriate counseling and guidance, how many young lives could have been saved from the brink? This is not to blame the school social workers, as no one wishes to see such heartbreaking tragedies unfold.

The question, though, is whether there are enough hands on deck—from parents to schools, from social workers to psychologists, and even from psychologists to psychiatric specialists—to detect and closely monitor troubled youths in time. In essence, the issue is not just about whether there are enough social workers and psychologists but about how society can work together to prevent these recurring tragedies.

The authorities have introduced the "4Rs Mental Health Charter" for the new school year, focusing on students' emotional development. So far, 393 primary and secondary schools have signed the charter, covering about 40% of schools across Hong Kong, a higher response than expected.

Chairperson of the Association of Careers Masters and Guidance Masters, Ho Yuk-fan, recently pointed out that students' mental health will not see immediate or significant improvement by the end of the year, and fundamental changes are even less likely.

As economic pressures on grassroots families increase, related problems will only multiply. Therefore, the "Three-tier Emergency Response Mechanism" should be made permanent, and counseling services should be strengthened rather than abruptly halted before the issue has shown any clear signs of improvement. At the very least, the mechanism allows school principals to refer cases directly to the Hospital Authority, avoiding the tragedy of students waiting up to two years to see a psychiatric specialist at a public hospital.

Given this context, the authorities should not focus excessively on various exams and tests. Still, they should consider establishing a high-level professional committee to conduct cross-departmental and cross-professional reviews of short- and medium-term measures addressing student mental health issues. When necessary, timely intervention and counseling should be provided to students suspected of having emotional and mental problems.

In the long run, the education system, curriculum, school activities, exam methods, and even systemic social issues such as youth employment and upward mobility should be reviewed to foster a sense of ambition and hope for the future among young people. At the very least, they should be able to see hope and pathways for their future rather than being stuck in subdivided flats for years with no prospect of improvement. In short, young people must feel that "you have not been forgotten, your voices are being heard, and each of you is the hope of Hong Kong's future."

A prior study by the Faculty of Medicine at the Chinese University of Hong Kong revealed that 24.4% of surveyed children and adolescents aged 6 to 17 had experienced at least one mental health disorder in the past year. However, nearly half of their caregivers were unwilling to seek professional help. Among the overall survey participants, 3.9% had experienced suicidal thoughts, 1.9% had made suicide plans, and 1.1% had attempted suicide in the past year.

The situation was even worse among secondary school students, with rates of 8.4%, 3.8%, and 2.3%, respectively. Common risk factors were divided into three main categories: significant emotional distress among parents, sleep disorders in children and adolescents, and academic difficulties (such as repeating a year, suspension, or absenteeism).

A very practical issue is that while there are many channels for suicide prevention and help-seeking in society, which is undoubtedly a good thing, their effectiveness is questionable due to fragmented services. Various suicide prevention hotlines include the "Shall We Talk" mental health support line (1811), The Samaritan Befrienders Hong Kong (2389 2222), Suicide Prevention Services (2382 0000), Caritas Family Crisis Support Centre (18288), Social Welfare Department (2343 2255), The Samaritans (2896 0000), TWGHs CEASE Crisis Centre (18281), and the Hospital Authority’s Mental Health Direct (2466 7350), as well as the Jockey Club Online Youth Emotional Support Platform—"Open Up." If these official and non-official hotlines could be consolidated into a more professional 24-hour service platform that works closely with schools to provide professional follow-up counseling for emotionally distressed students, it might prove more effective. A simple fact is that suicide is often an impulsive act during a moment of emotional breakdown. In such moments of impulsive turmoil, would someone still have the presence of mind to calmly call for help?

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