We need an honest conversation about mental health

Brian YS Wong October 13, 2021 08:49

October 10, 2021 was World Mental Health Awareness Day.

That we opt to “remember” or – dare I say – ritualise – our understanding and attention paid to mental health awareness is a welcome first step. Yet a day of commemoration, of remembrance, or, indeed, of transient conversations, is by no means enough. It’s high time that we had an honest conversation about mental health.

In particular, for a city where studies have shown that one in seven Hong Kongers is likely to experience mental health issues of some sorts throughout their lifetimes, and with a mental health index score of 46.41 in 2019 (the par/passing score was 52), the plights confronting individuals suffering from mental health issues are neither acceptable at large, nor – in Hong Kong’s case in particular – something we’d expect from a city as highly developed as ours.

Prior to delving into prescriptions and solutions, here are a few observations. Firstly, mental health issues should not be conflated with personality traits and characteristics – it pains me to make this point (and there’s yet this tendency on the part of certain neo-Foucauldians to do so), but we shouldn’t dismiss mental health symptoms as merely manifestations of “weak character” or “troubling personalities”. Sure, there may be instances of over-diagnosis and the risks of over-medicalising mental health conditions, but these instances call for us to be more prudent in diagnosing mental health issues – as opposed to unduly and unjudiciously identifying ostensible agency in individuals’ distress, anxiety, depression, and such. We need to recognise the bare medical fact – also a sociological fact – that mental health conditions are at least partially rooted in bio-medical issues that require a multitude of responses.

Secondly, it’s one thing to say that we “care” about mental health. It’s another to move from the general to the particular – i.e. to “care” for others’ mental health in particular. We may find ourselves nodding away politely – even ardently – to grandstanding speeches calling for us to pay more attention to the malaise afflicting citizens in the city; yet such nodding, such performative assent, would mean very little unless we turned words into actions, and transformed our care for the general into actions directed towards the particular. Our friends, families, neighbours, and acquaintances deserve more than just talk.

Given the above, what are we to do? Firstly, it is high time that the administration investigated more thoroughly the barriers to accessing public health and medical services – in order to tackle them in a targeted and efficacious manner. The hamartia plaguing our public mental health services remains the substantial underfunding of the public welfare and health services at large, which in turn give rise to a roster of subsidiary problems, including gross bureaucratic inefficiencies, lack of understanding and awareness, communicative barriers and hurdles, and dearth of designated, trained specialists who are equipped to handle the plethora of mental health conditions Hong Kongers endure. The average number of psychiatrists employed by Hong Kong hospitals was 330 in 2017 – 400 fewer than the number recommended by the WHO for a city with our population back then. Children with mental health conditions must wait an average of 14.5 months before receiving treatment from public clinics.

For far too long we’ve turned a blind eye to these problems, content instead with answers such as, “It’ll take time to change this”, and “Let’s not rock the boat”. But what’s the point of keeping the boat afloat, if all it does is carry batch after batch of lost souls to dire fruitlessness? Hong Kong needs a sincere restructuring and expansion of our mental health services, in a way that empowers – as opposed to detracts from – the professionals who comprise Hong Kong’s mental health bedrock.

Secondly, we need improved and structured efforts at de-stigmatising mental health. TV dramas portraying mental health patients as criminal delinquents (these shows also play on the damaging tropes of alienating/ostracising criminals and those with past criminal records, but that’s for another day); popular media and idiosyncratic discourses framing mental health conditions as “reasons” for which individuals behave immorally and with impropriety… these phenomena contribute substantially towards the ongoing stigma with which we speak of and discuss mental health conditions.

We are told that successful politicians, businessmen, leaders cannot have mental health issues – that to be afflicted with them is akin to being a “weakling”. We’re also briefed on the ostensible facts that there are few better solutions than “toughening up” for those who must bear the brunt and burden of the black dog – often alone, often in surreptitious silence, often with embarrassment and shame.

Let’s do away with such nonsense. It’s high time for more MH-positive conversations and education at school; trainings in workplaces; open conversations spearheaded by politically neutral and publicly credible public health officials. Given the amount of talk sprouted by our politicians on the need to cater to the interests of our grassroots and vulnerable, why don’t they walk their talk and prove the point, when it comes to mental health issues?

Let’s put an end to the damning indifference that our city’s inhabitants have long held towards those who suffer from depressive, manic, bipolar disorders – and more. We owe it to not only each other, but our future generations, to right this wrong that has been perpetrated and sustained for far too long. In unyielding, compassionate candour, we must place our faith.

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Brian YS Wong

Assistant Professor, HKU