The mental health crisis must be tackled with pragmatism

Brian YS Wong June 07, 2023 06:00

The events that have unfolded over the past few days, no doubt have weighed on the minds of many of us. Many of us, qua Hong Kongers. Qua citizens who love this city dearly. And que folks who may personally be troubled by mental health issues, or know of friends and family who experience such malaise.

There is no doubt that mental health is a serious issue in Hong Kong. This is a city rife with socioeconomic inequalities and barriers to mobility for ethnic and sexual minorities. This is also a city with some of the most expensive rents and cutthroat work environments in the world. As beautiful as our home may be, the reality is far from rosy for the one in seven Hong Konger who - per MINDHK, in citing a report from the Food and Health Bureau - that experiences a common mental health disorder at any given time.

Statements from the government have affirmed the severity of the situation. Chief Executive John Lee reacted swiftly to the callous stabbing of two young female victims in Diamond Hill last week, by pledging that he would bolster the disciplined services and health and welfare bureaus’ responses to the ongoing mental health pandemic that afflicts the city. Other voices have noted the increasingly overstretched nature of the public psychiatric system, as well as the dearth of training for professionals in taking on cases where patients elude intervention, behave in a problematically violent matter, or fail to stick to pre-existing therapeutic routines.

These statements indicate that the mental health crisis is well acknowledged to be a problem, with a large volume of potential explanations and causes cited to back the respective solution and individuals who champion it with conviction. Pouring more resources into tackling resource-sensitive bottlenecks - e.g. cases that require tracking, intimate care, and hands-on therapy and support, as well as promoting better targeted physical and social treatments, are most certainly welcome. Initiatives such as ‘Shall We Talk’ have worked wonders in raising consciousness (a more sophisticated version of awareness) and de-stigmatising mental health issues, in a city where denizens remain by and large tight-lipped about their own troubles.

Yet pragmatism calls for comprehensiveness. Comprehensiveness requires community-level solutions - solutions that empower individual citizens to become co-caretakers, co-champions, and companions to friends in need. The government must obviously step up, but counting on the state and public institutions alone quite simply won’t cut it. What is needed here, is a genuine transformation of the mindsets prevalent amongst our citizenry. There are two levels to this - with practical implications.

Firstly, there is nothing wrong with struggling with mental health. There is nothing intrinsically ‘criminal’ about being a schizophrenic or someone with bipolar disorder. Whilst reporting on cases of crimes committed by those who are mentally ill should of course be exact and accurate - should it be verified that the suspect in question possesses a mental illness, news media should in general err on the side of caution in two ways: first, in ensuring that they do not mindlessly and groundlessly conjure speculative rumours over the motives (or lack thereof) of particular suspects; second, in emphasising that there is no strict causal relationship - or at least one that we should take actively into account - between mental health conditions, and heinous crimes.

To the latter point, I’d like to clarify that I am not denying the possibility that individual criminals perpetrate crimes due to their mental health struggles - but positing and affirming that is one thing, suggesting that mental health struggles (strongly) increase the probability of criminal offence, unduly dilutes the agency of relevant actors (e.g. public and private actors who could have acted otherwise in intervening, or who should have done more in preventing such calamities to begin with), as well as bakes into the minds of consumers the thought that ‘Mental Illness = Crime = Dangerous’. It is imperative that we decouple these two sets of thoughts in our day-to-day discourse, such that those with mental health issues do not feel perturbed or deterred from speaking up where and when they need help. Undue paranoia cannot be the way.

Secondly, we must embrace the fact that we are all responsible, to some extent, for the general welfare of our society, but also for the wellbeing of our friends, colleagues, and associates. We possess a prima facie duty of social care, of ensuring that those who are largely socially isolated and delinquent, can receive the necessary attention and minimal care they need in order to function as capable beings. For those of us in positions of power and capacity, we should indeed go one step further, in serving to draw attention of mental health patients to prospective, official medical treatments that are widely recognised, as opposed to shunning them for their purported deviance. We should also befriend, where possible, and provide psychological support and counselling to those who are mentally anguished.

Sure, psychosocial support is by no means sufficient. This is especially the case when it comes to those whose causes for mental illness are physiological and physical at their core. Yet for a vast majority of individuals afflicted with such conditions, talking candidly and openly can help. Receiving psychological reassurance and counselling can be helpful. Above all, understanding that their struggles are by no means rare, malignant, or fundamentally astray from ‘societal expectations’ and the so-called norm, is absolutely essential.

So it’s not just the government that must react. It’s also the people. It’s also folks like you and I, who are proud to make this city our home. And who owe it to one another, wherever is possible - if indeed possible - to make a positive difference. I know this is easier said than done.

It’s much easier to postulate the case for de-stigmatising mental health, than to substantively undertake actions to make the mentally ill feel at ease about talking about their own conditions.

It’s much easier to present the solution as more funding, more resources, more everything, whilst distancing ourselves from the ‘everything’ of which we need more.

It’s much easier to clutch at straws of pseudo-parsimony, at the expense of reality.

But we must resist. Do the right thing, not the easy thing.

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Brian YS Wong

Assistant Professor, HKU