[SCMP Column] Grave Challenge

April 22, 2017

What do Lady Gaga, Prince Harry, and Sesame Street’s Julia all have in common? They are all in their separate ways trying to bring the stigmatized problem of mental ill-health out of the closet.

For those that missed these outpourings, coinciding with World Health Day just two weeks ago, Lady Gaga went public about the post-traumatic stress disorder (PTSD) that engulfed her after sexual assaults in her teens. For Prince Harry, it was the depression following the death of his mother Princess Diana, which was compounded by the British “stiff upper lip” culture, and social reluctance to talk openly about mental ill-health. For Sesame Street, it was the deliberate and controversial decision to introduce a new character Julia to the show: Julia suffers autism, and is there to make Sesame Street fans think more about kids that are in their many ways different.

And credit to them. The World Health Organisation has just released a report that claims over 320m people worldwide are suffering depression, with a similar number crippled by anxiety disorders. This amounts to around 40 per cent of all illness (by contrast, strokes, cancer, heart disease and diabetes together account for 20 per cent). Almost half of these are in Asia, and India and China alone account for 100 million cases – but most of them are either never recognized, or hidden as guilty family secrets.

The brilliant 2014 book “Thrive”, by Richard Layard and David Clark, examined mental ill-health in the UK, and concluded that one in three families include a family member who is mentally unwell, and that more than one third of us will at some point in our lives suffer some form of debilitating mental illness:
This makes mental ill health by far the world’s gravest medical challenge, costing the world economy billions in terms of absenteeism or “presenteeism” – present but unable properly to work. I have found no global dollar cost, but in the US, the Centres for Disease Control calculates that 200m work days are lost every year because of depression or other mental sickness, with a price tag of $44 billion in lost productivity and insurance payments. Casting its net more broadly, Britain’s national Health Services says poor mental health carries and economic and social price tag of Pounds 105 billion a year.

Most of the world’s 800,000 suicides a year are linked to mental disorders, making mental ill-health a much bigger killer than murders or deaths in war.

For Hong Kong, while reliable data is virtually non-existent, and wehre the government has always baulked at drafting a formal Mental Health Policy, the challenge is probably even more grave. Not only does embarrassment and stigma make mental ill-health an “untouchable” subject, but distinct local problems suggest higher levels of mental ill-health than will be found elsewhere. Life in Hong Kong is infamously stressful, both at work and in the claustrophobic shoe-boxes that most families try to call home.

Economic difficulties that have recurred for the past 20 years – from the 1998 Asian Financial Crisis, to the Dot-Com crash, to SARS, and to the 2008 global financial crash – have clobbered household incomes, and undermined job security. Depression concentrates among the elderly – and Hong Kong has one of the fastest-ageing communities in the world.

There is little wonder that in world “happiness” rankings, Hong Kong performs so badly, and that we see so many stories of schoolkid suicides. But in addition, we are ill-equipped to deal with the nature or the scale of the problem. The 2014 Mental Morbidity Survey – undertaken for the first time in two decades – suggested that one in six Hong Kong people are suffering depression or other common mental disorders. That is more than 1m people, and more than 200,000 of these are severely ill.

With just 350 psychiatrists working in Hong Kong – that amounts to about 4.8 per 100,000 people – Hong Kong has less than half the number of professionals here to help treat the mentally ill compared with other cities in developed economies. Non-urgent patients can take four years to get an appointment – and these average just 6 minutes. In the UK, that wait is on average four weeks.
Clearly, as we press the government to spend less on new hospitals and hospital wards, and more on community primary care centres, these should all include one-stop mental wellness centres. In fact, the Government has taken a tentative half-step in this direction. In his 2009 Policy Address, CY Leung announced he would establish 24 Community Centres for Mental Wellness. But today, eight years later, just 14 are in operation.

Recent work in the WHO, and the UK’s Mental Health Taskforce, also interestingly note that while mental illness flourishes in old age, its roots are well established in childhood. Apparently half of all mental health problems have been established by the age of 14, and 75 per cent by the age of 24. They are also closely linked with unstable employment, and uncertain housing. They are then closely correlated with smoking, alcoholism, drug dependency and social dysfunction. In the UK, for example, someone who is mentally unwell is 20 times more likely to end up in prison.

This suggests that the issue of mental illness not only needs to come out of the closet – it needs to do so in our schools and in classrooms. And businesses need to recognize the pressing business case for bringing the mental health issue out of the closet.

Layard and Clark in the UK summarise well: “Depression and anxiety cause more misery in our society that all physical illness put together,” they said: “This is unacceptable because effective remedies exist but are not used. These remedies are not expensive and would pay for themselves in terms of enhanced workplace productivity. Failure to give mental illness the attention it deserves is both grossly efficient and grossly unjust.”

Our soon-to-be anointed Chief Executive made much in her election campaign about healing the rifts in our society, and getting to the root of alienation among the young. She can start nowhere better than here.

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