Hong Kong schools need more diagnostic help under its suicide prevention system, experts say. Photo: ShutterstockHong Kong’s three-tiered student suicide prevention system needs streamlining, experts say, after 280 cases were reported in the highest tier. They said cumbersome procedures and parental reluctance are hindering access to support services, while schools are concerned about long waiting times for psychiatric care.
Observers weighed in on Wednesday after Chief Executive John Lee Ka-chiu expressed worries over an imbalance in the number of students being referred to public hospital psychiatrists under the highest level of the emergency three-tier system introduced in December last year.
Authorities earlier said more than 280 cases had been reported in the third, or highest, tier as of the end of the summer holiday, compared with 120 cases in the second.
Professor Paul Yip Siu-fai said cumbersome procedures and reluctance from parents could be behind the lower number of students being treated in the second tier, under which patients visit off-campus social work services. Others have pointed to long waiting times for psychiatric services as the cause behind the issue.
“Even when their children are referred to the second tier of the mechanism, parents think the effectiveness is not that great, so a lot of the time they are not willing to proceed with the services provided at the second tier,” said Yip, who is head of the Hong Kong Jockey Club Centre for Suicide Research and Prevention at the University of Hong Kong.
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Under the first tier, schools prioritise helping students at higher risk of suicide by seeking professional counselling or treatment services for them.
If schools are short on staff, education authorities then refer cases to the off-campus support network team organised by the Social Welfare Department under the second tier.
The final tier involves principals referring students with severe mental health needs to the psychiatric specialist services of the Hospital Authority. Students with urgent cases are given priority treatment.
Yip said parents might be reluctant to have their children sent off-campus for help in the second tier, either due to a lack of understanding, an unwillingness to involve third-parties or a lack of confidence in the treatment.
He said school principals had also voiced frustration over the referral process to access the second tier services, with a report also required to be submitted to the Education Bureau.
He suggested streamlining the three-tier school-based emergency mechanism procedures by not requiring parents to sign consent forms or the school to report cases to the bureau.
“However, if we are talking about student suicides, this three-tiered mechanism is not a 100 per cent solution to handle the issue of student suicides,” he said.
Esther Ho Yuk-fan, chairwoman of the Hong Kong Association of Career Masters and Guidance Masters, told a radio programme schools were not “overreacting” when they triggered the third tier.
“With the third tier, we can flag emergency and urgent cases, such as those who self-harm or have unstable emotions to get immediate attention,” she said. “Without it, previously the wait for [public] psychiatric services could take one to two years.”
By the time a specialist could see them, the students would have graduated, or in other cases, their condition might have grown worse, which affected not just their studies but also their relationships with friends and their family, she warned.
Ho said authorities should not only look at the numbers of students involved but understand why the school thought it was necessary to refer these cases to medical professionals.
“We do not refer students on a whim, we have a selection process. We are not doctors so we might make decisions differently, but students in a range of mental states could end up in situations we wish to avoid,” said Ho, who is also principal of Carmel Secondary School.
“I don’t see it as us abusing the referral system. We are doing it from the perspective of the student’s safety and well-being.”
She suggested the second-tier framework be expanded to include community health providers, with doctors assessing at-risk students and deciding whether they should be referred under the third-tier to alleviate stress on the public healthcare system.
City leader Lee earlier raised concerns about the third tier being used more than the second one was.
“If it was a normal three-tiered mechanism, it should be like a triangle,” he said, adding he understood that schools might be concerned about their students and immediately go to the highest level of the mechanism even though this might not be necessary.
The chief executive said that one improvement to the mechanism could be informing stakeholders about when social workers would be able to help students.
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.