The Urban Epidemic: Stress in Hong Kong

Part I – High-pressure work culture
Stress is all too common in our lives, especially for those of us living the busy city life. The hectic Hong Kong lifestyle drains our time to cope with stress. According to the Census and Statistics Department, Hong Kong people work a massive 600 hours MORE per annum than other developed countries, with many working uncompensated overtime hours.

It’s no wonder Hong Kong is Asia’s stressed-out city.

The need for money in this expensive city, fierce workplace competition and social expectations about work and laziness often encourage many of us to stay silent over the large workloads handed to us. Work and familial responsibilities, time pressures and information overload also contribute to burden placed on Hong Kong’s work force. 
Unfortunately, this high-pressure work culture has transcended to our children and youth who are handed high academic expectations by teachers and parents from a young age. From a mental health and developmental perspective, the local education system needs to become laxer, to allow young children time to play, explore and socialize, rather than placing them on an academic production line.
Drawing from my own experiences, my two years in a local kindergarten was (personally) not ideal. We had homework every day, and regular assessments. School life was strictly regimented and hugely conformist. When I attended an international primary school afterwards, it was a complete turnaround: we played in the sand and water, did lots of art, show and tell, stories.

Two educational approaches: ordered and academically focused versus explorative and creative with less boundaries

Of course, back in the kindergarten we did have fun music classes and fun breaktimes. However, the educational approach was completely different, one was ordered and academically focused whilst the other was explorative and creative with less academic boundaries, with the former possibly stunting rather than enhancing myself. When this burdened young generation grows up, they are channeled into the same philosophy of work and achievement for years ahead, and may collect a buildup of so much stress that it becomes chronic, which affects the immune system and leads to many physical ailments.
Alice Pearce is a Final year Psychologist at Durham University. She wrote this because growing up in HK and studying in the UK has made her realise how big the gap is between Asia and the West in psychological and educational understanding.


Reconceptualising misconceptions of mental health: Can results of Hong Kong’s mental health survey be explained by cultural and societal reasons? 
In many Western societies, awareness and understanding of mental health problems have grown drastically in the past few decades. However, many Asian societies lag still lag behind in this acceptance due to differences in cultural perceptions of mentality, health and the self.
Hong Kong is very unique when it comes to its mental health landscape. As a Chinese city living through 137 years under British rule, Hong Kong has been caught in between its Western influences and its traditional Chinese culture. The integration of these two cultural streams have effected dramatic social, political and economic change, which have been experienced by many of its citizens.

For those caught in the whirlwind side of the international city’s fast-paced, business-oriented and stressful lifestyle, it is easy to prioritise climbing the corporate and social ladder over our emotional needs.

And for an overlapping majority who have been born and brought up with traditional Chinese cultural values, it concerns experiencing some side-effects have been ingrained in the city’s social fabric. Of course, many aspects of traditional Chinese culture are without doubt beautiful and ingenious, but a minority of its values have bred a negative social mentality from which mental health stigma’s stem from. 
The massively underdiagnosed mental health population can be attributed to many misconceptions in Chinese culture. Firstly, there is a fear of the mentally ill. This originates from the Chinese belief of reincarnation, where misfortune is the result of wrongdoings in past life. Therefore, many perceive mentally ill individuals as dangerous, violent and going to kill someone, and don’t want to mix with them. Although stigmatization and discrimination against those with mental illnesses is a global problem, it is particularly acute in Hong Kong. 

One of my friends recently opened up about their depression diagnosis, and shared the mixed responses they received; some friends were supportive and continued their friendship as it had always been, whilst other began to distance themselves and behave awkwardly. 

Secondly, for many Chinese, they have been taught since young not to talk about their emotions, and so it is very hard for them to openly talk about what they feel or to empathise. It could be this reason why those with depression are not easily recognised by themselves or others -and not that they are hiding it deliberately.
In the BBC Health article on Hong Kong’s survey, they interviewed a lady who migrated from China to Hong Kong, who had suicidal thoughts and major depression. She revealed that there is no actual word for depression in Chinese. Her perception of her depression in her words was: “feeling stressed and depressed is only a natural reaction towards the hardship of life”. (BBC, 2011). 
It could also just be a matter of denial from both parties, with the attitude of ‘if I pretend there’s nothing wrong, then it doesn’t exist’, when really, it just digs a deeper hole and more problems in the future that will make it harder to climb out of. These are just a few of the myriad of problems that underlie mental health misconceptions.

Although professional help is necessary for major and serious mental illnesses such as schizophrenia and major depression, we can all do our small part in preventing and easing the minor symptoms of mental illness. It can start with lifestyle changes, having honest conversations, listening, opening up, taking up hobbies, eliminating the environmental triggers. 

Fortunately, the recognition that mental disorders and mental health are serious health issues that need to be addressed have begun to surface in our collective consciousness. This is evident in the need of mental health services tripling in the past 20 years, and hopefully we can see Hong Kong society and its health services catching up to modern day needs. 

“Mental illness is nothing to be ashamed of, but stigma and bias shame us all” – Bill Clinton

References: BBC (2011). Hong Kong conducts first mental health survey. [Online] Available at: [Accessed 23/09/16]
Alice Pearce is a Final year Psychologist at Durham University. She wrote this because growing up in HK and studying in the UK has made her realise how big the gap is between Asia and the West in mental health understanding -and HK’s first mental health survey highlights exactly this, as well as pointing to major underlying cultural reasons for this gap. 


Hong Kong’s growing mental health decline: We need to face up, not save face. Let’s talk mental health in the skyscraper jungle. Back in 2010, Hong Kong conducted its first mental health survey (a bit late don’t you think?). The population-based interview was conducted over three years; on 5,700 ethnic Chinese men and women aged between 16 and 75 years old. The researchers cited the rising burden of mental disorders on quality of life, society, and health care systems as the reason behind the need to conduct such a survey. This initial territory-wide study of mental morbidity provided much needed information for planning health and social services, monitoring mental disease trends and generating hypotheses for future research.
The study is a promising (baby) first-step to addressing the growing mental health problem in Hong Kong, not just in terms of therapeutic treatment for individuals, but to also break down deep-rooted Chinese cultural barriers that misconceptualise mental health.

What researchers found was worrying, but not surprising. Factors such as being separated, a lack of exercise, stress, alcohol, substance abuse and financial difficulties were associated with common mood disorders. 1 in 7 individuals suffer from a common mood disorder (such as depression or anxiety), but only 26% of them sought professional psychiatric help. 

Not only are mental illnesses hugely underdiagnosed in Hong Kong, but it’s mental health services are inadequate and taking in more than it can handle. The number of people seeking treatment has almost doubled to over 300,000 in the past 12 years. Those who do manage to get on a government waiting list to see a government psychiatrist have to wait up to 3 years before their first consultation, which lasts less than 15 minutes. This gives almost no time for therapists and patients to build rapport, trust and understanding – key ingredients to proper diagnosis and formulating an effective treatment plan. 
Additionally, the lack of mental health service in the primary care sector means that up to three quarters of patients fail to get the help they need. This is just a snippet of the survey, and the survey is just the tip of the iceberg -but it tells us how much work needs to be done. Obviously, primary care services need to be boosted to screen for patients at risk of mental health problems to ease the pressure on mental services. The government needs to start spending more on its mental health services to meet the demand and shorten waiting lists, and to really start community education on mental illness.
As a developed, global city laced with cultural intricacies, collective acceptance and understanding of mental illness is first and foremost a vital starting point. Becoming more mindful about yourself, your lifestyle, body and your emotions instead of ignoring it, because many unexplained physical symptoms are related to mental health -and whilst you get treated for the physical side-effects, your mental health remains neglected. 

In my workplace and at home, I notice how quickly we become bystanders to those struggling from mental health problems -often minor or common ones like stress; especially when the individual presents the stress aggressively (verbal or physical), or becomes tired & loses focus, or retreats into themselves.

Admittedly, we live in a crowd culture and we don’t really like being the odd one out, whether it is the one who has a mental health problem, or the one who steps up and offers a hand to them. Looking honestly at situations and taking a moment of compassion to meaningfully ask ‘what’s wrong?’ or ‘how are you doing?’, and to listen, can make a big difference to someone. Passing off someone’s stress-related behaviour or mental illness as them being ‘weird’, ‘crazy’ or ‘weak’ redirects a real issue into a stereotyped view of misunderstanding, and keeps things in stage one. But why as a society are we reluctant to ‘lose face’ and pretend nothing is wrong?
Alice Pearce is a Final year Psychologist at Durham University. She wrote this because growing up in HK and studying in the UK has made her realise how big the gap is between Asia and the West in mental health understanding -and HK’s first mental health survey highlights exactly this, as well as pointing to major underlying cultural reasons for this gap.