Mental Health Is Everyone’s Business: Interview with Dr Lam Ching-choi
//vol.16-1 Interview: Dr Lam
Mental Health Is Everyone’s Business
An interview with Dr Lam Ching-choi
In light of the intricate and interconnected nature of mental health issues, Dr Lam Ching-choi, Chairman of the Hong Kong government’s Advisory Committee on Mental Health, emphasises the importance of innovative thinking and the development of a service model in which everyone can contribute.
He underscores the importance of treating youth mental health issues as a public mission. “Mental health is everyone’s business. If we do well among the children and youth, we will do well in adulthood.”
Hong Kong, one of the world’s most densely populated metropolises, is no stranger to confined living spaces and a fast-paced lifestyle in a fiercely competitive studying and working environment. These factors, whether culturally inherited or developed over the course of its history, are leaving marks on the collective psyche and mental wellbeing of its residents.
In Hong Kong, mental health is frequently-discussed by the government, both as a public health concern relevant to every citizen, and also as a complicated and burgeoning challenge that requires cross sectoral collaboration.
While constantly adapting to new circumstances, both physically and psychologically, the mental wellbeing of adolescents emerges as the bedrock that significantly influences subsequent life stages. One may say “there is no health without mental health,” or, to put it another way, there is no mental wellbeing without positive youth development on mental health.
During an exclusive interview with Youth Hong Kong, Dr Lam admitted Hong Kong is not in an “advantageous position” when dealing with youth mental health. This predicament is largely attributed to the competitive nature of education and employment, where success is the primary focus. Through its identity as an urban port city, policy implementation and the provision of diverse career choices for the youth are constrained, despite some improvement with the introduction of the Greater Bay Area initiative.
“Studies indicate that urbanisation poses a challenge to mental health, and in the case of Hong Kong, the entire region is essentially urban. Unlike other places, we’ve been urban from birth to death and are living in a fast-paced, high-pressure metropolitan city where stress is always on,” said Dr Lam.
Silver Lining
However, as Dr Lam stated, when things look black, there’s always a silver lining. In response to the escalating mental health challenges faced by the city in the early 2000s, the government took the proactive step and strategic response of establishing the Advisory Committee on Mental Health (ACMH) in 2017.
In 2010, Hong Kong’s Hospital Authority introduced the Case Management Programme across 18 districts, offering community-based support services for individuals with severe mental disorders. Due to a shortage of medical personnel in Hong Kong, the ratio of case managers to patients stands at approximately 1:50, higher than in developed countries including Australia and the United States, where ratios range from about 1:20 to 1:25.
Since its inception, the Committee has developed a comprehensive framework to address the diverse facets of mental health challenges in Hong Kong, which followed the traditional trajectory of promotion, prevention, early detection, early intervention and treatment for individuals across all age groups.
Taking the helm as the new ACMH Chairman in 2023, succeeding former Secretary for Justice, Wong Yan-lung, Dr Lam describes the establishment of the Committee as a “bold initiative,” which serves as a crucial guide for the government, instigating policy changes that are pivotal in addressing mental health concerns.
Functioning as a conduit for advice and coordination among stakeholders, the ACMH, according to Dr Lam, serves as an effective platform for policymakers to collaboratively work towards improvement.
“We have a robust system and have seen strong goodwill from all stakeholders to do better. I can see the silver lining. I still have my confidence in pulling all the resources together, pulling all the brains together to improve our system, to make sure all the efforts are well delivered to the right place, to the right people, at the right time,” Dr Lam added.
A survey conducted by The Chinese University of Hong Kong (CUHK)’s Faculty of Medicine in 2023 revealed that 24.4% of children and adolescents experienced at least one mental health issue in the past year. Dr Lam is concerned about the growing mental crisis among youth, while being aware of a human capital shortage, especially among health professionals.
Out of the Box
When asked about the Committee’s future strategies, the Chairman highlighted its plan of adopting an innovative service model by training more “helpers” on the spot to ease the medical professional shortage.
Dr Lam believes in the concept of “point of care” or “point of contact.” This means that ideally, mental health challenges should be addressed in the settings where they arise. This could be, for instance, that students should receive care in schools, members of a youth service centre within that specific centre, or young workers within their workplaces.
However, the only way to implement such a service, is to empower laypersons or peers with mental health first aid skills for early intervention to build up the capacity. It might mean that students get trained to offer peer support, parents, colleagues, and volunteers could also learn the skills to recognise people in the first throes of struggle. These collective early interventionist steps could help reduce the workload on social workers, teachers and professionals.
Relying solely on the current referral system, according to Dr Lam, is not tenable given the shortage of professionals. There is also the problem with high dropouts during the referral process.
“Mental health is for everyone. It is not just for those grappling with mental illnesses.”
Dr Lam believes that the government should think of ways to acknowledge and involve more counsellors in the medical system and even embrace individuals who want to become counsellors after having experienced mental health issues themselves.
“We must think out of the box and deliver a new service model to engage more so called ‘helpers’ so that we can pull the resources together,” said Dr Lam, who views this approach as an opportunity to expand Hong Kong’s medical capacity and the caring net. “We can save lives by just doing these simple things.”
To facilitate collaboration and make full use of the current resources, the Integrated Community Centre for Mental Wellness, under the Social Welfare Department, plays an essential role in resource integration, while the Heath Bureau takes the lead in involving relevant parties. The coming years, said Dr Lam, will require substantial alignment, integration, and realignment efforts from different parties.
The Chairman said he didn’t see any boundaries set among different parties, but instead saw goodwill to work together, although the collaborations, on occasions, do involve “stepping on someone’s toes.” Yet, the common purpose and good intention to get things done remains.
Universal Concern
Dr Lam highlighted a trend of post-COVID youth suicide cases which do not exhibit typical mental illness symptoms like depression or anxiety disorders. Instead, students are often triggered by overwhelming emotional outbursts that they struggle to handle. In those cases, the line between what is considered “normal” and “abnormal” becomes blurred, making the prevention and treatment work more challenging.
The hidden risks revealed by those cases require a better understanding towards the issues surrounding mental health. Understanding that having mental health struggles is nothing to be ashamed of, and everyone – at some point – may experience emotional disturbances is crucial to move forward. If society recognises mental health as a universal concern, Dr Lam concluded, Hong Kong will be better positioned for the promotion, intervention, and treatment of mental illnesses.
Speaking to us from his Tseung Kwan O office surrounded by plants, which he refers to as his therapeutic garden, he said, “Mental health is a concern for everyone. It is not just for those grappling with mental illnesses. It is the responsibility of each individual to take care of themselves and those around them.” ■
Timeline
2001 Early Assessment Service for Young People with Psychosis (EASY)
2010 Case Management Programme
2013 The Review Committee on Mental Health
2016 “Joyful@HK” Campaign
2017 The First Mental Health Review Report
The Advisory Committee on Mental Health
2020 “Shall We Talk”
2023 “18111 – Mental Health Support Hotline”