As of March, 168 students with mental distress had been referred to public psychiatry clinics through the three-tier school-based emergency mechanism. Photo: SCMPHong Kong lawmakers and experts have cautioned against medicalising mental health issues. The warning came after school principals referred more than 160 pupils to psychiatrists through a government suicide prevention mechanism.
They also called for more support for schools and the community as the Education Bureau updated lawmakers on Wednesday on the mechanism, set up in December last year in response to an uptick in student suicide cases.
A total of 168 students with mental distress had been referred to public psychiatry clinics through the three-tier school-based emergency mechanism as of March, the bureau revealed. Seventy-five inquiries from principals had also been received through a designated hotline.
But only 3 per cent of the cases were categorised as urgent. Forty per cent were semi-urgent, while the rest were stable or already receiving psychiatric care. Sixty-nine students were referred for off-campus support provided by five designated non-governmental organisations.
“With our concerted effort, there was a higher mental health awareness among school workers, who can effectively identify and support students at risk at an early stage,” Secretary for Education Christine Choi Yuk-lin said.
“The second and the third tiers of the mechanism have been running smoothly and are able to provide appropriate and timely counselling and treatment services to students in need.”
Choi said the government would closely monitor the operation of the mechanism and hire a consultant to review its efficacy.
Under the mechanism’s first tier, schools prioritise counselling students at higher suicidal risk by seeking professional counselling or treatment services for them.
If schools are short on manpower, education authorities then apply the second tier assistance by referring the cases to the off-campus support network team organised by the Social Welfare Department.
Under the third tier, school principals refer students with severe mental health needs to the psychiatric specialist services of the Hospital Authority.
But lawmaker Lilian Kwok Ling-lai found the proportion of students referred for second-tier and third-tier support “unreasonable”.
“From overseas experience, the second-tier support should be able to handle more than 80 per cent of cases,” she said.
“Some principals told me that they chose to call the hospitals because they found the support services offered through the second tier no different from the first tier.”
Kwok urged authorities to strengthen manpower of the external support network and offer a variety of therapy services, such as art, music and play therapy, to better address the mental health needs of the semi-urgent cases “so that they would not need to be escalated from the first to the third tier”.
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Professor Paul Yip Siu-fai, director of the University of Hong Kong’s Centre for Suicide Research and Prevention, said referring students who were already receiving psychiatric care to psychiatrists through the mechanism was a “mismatch of resources”.
“It’s possible that principals are not yet familiar with the operation of the mechanism, so they do not know whether the cases need a psychiatric referral and they may have simply gone the medical way due to a ‘safety first’ mindset,” he said.
“But we need more time to know whether the mechanism is helpful for students, like whether those referred to psychiatrists saw their mental health improve.”
Yip said it would be best if milder cases could be handled in a school setting, without elevating them to the second or third tier, but it was crucial to enhance support for teachers, schools and parents to empower them with such capacity.
“After resolving the suicide crisis of those with more severe distress, they need to work together on improving the school environment, strengthening the bond between teachers and students and reviewing the curriculum.”
Meanwhile, education sector lawmaker Chu Kwok-keung, also a primary school principal, called on authorities to initiate “structural changes” to the education system, which he said focused on cramming and competition.
But minister Choi stressed that many improvements had been made to the curriculum to cater for students with different learning needs and allow flexibility in lesson hours.
“We have asked schools to evaluate the stress of students and review their assessment framework,” she said. “We also actively promoted different pathways that students can take apart from going to universities and encouraged them to plan their career from a young age.
If you have suicidal thoughts, or you know someone who is, help is available. For Hong Kong, dial +852 18111 for the government-run “Mental Health Support Hotline” or +852 2896 0000 for The Samaritans and +852 2382 0000 for Suicide Prevention Services. In the US, call or text 988 or chat at 988lifeline.org for the 988 Suicide & Crisis Lifeline.
For a list of other nations’ helplines, see this page.