Resources

Supporting Young People Through the 5th Wave

Supporting Young People Through the 5th Wave

The current COVID-19 pandemic has been immensely disruptive to our young people; disruption to the school year and daily routines, separation from friends or family, postponement or cancellations of milestone events. Additionally, other stressors associated with the pandemic have been seen to negatively impact mental health wellbeing, such as uncertainty, alarming news feeds, and contradictory information. It is therefore important to help young people navigate these challenging times and foster resilience. 

How to speak with your youth about the current situation 

Start a conversation. Don’t shy away from talking about the challenges brought on by COVID19. Young people appreciate honest, open, non-judgemental conversations. What is unhelpful is to ignore or dismiss their concerns, this may drive them away from coming to you, and may lead them to seek answers and support on social media, which may not be as helpful and in some cases may be harmful. 

Give them the space to explore how they are feeling and in turn how these feelings may be impacting the way they perceive the current situation as well as their behaviours, all in a non-judgemental environment. 

Conversation starters: 

“We are going through such difficult times, have you noticed any impacts on how you are feeling?” 

“I have noticed that you have been down lately, is there anything you would like to talk about?” 

“What is the hardest thing for you these days?” 

Validate. Validate their feelings, showing them that you understand how difficult this has all been for them. Letting them know that “it’s ok to feel [sad/frustrated/angry] right now” can also help open a conversation about healthy ways to cope with these feelings. What is essential is to first listen to their concerns without jumping to solutions. Allow them to explore their feelings and letting them be heard first, before any exploration of solutions. 

Provide reassurance. Discuss their specific concerns and provide reasurancess when possible. Exploring with them (it is important that this is something you do with them rather than telling them what to do)  any strategies they can engage in to keep them safe and healthy. I.e. if they are concerned about getting infected, you can speak to them about helpful health supporting behaviours like washing hands, wearing a mask. This allows them to see that while some things are out of their control there are many things that are within their control. 

Self-compassion. Reminding them to be gentle and kind to themselves. When we struggle we may have feelings of self-blame and self-criticism. Reminding them that these are challenging times and you are doing the best you can. 

New routines. Encourage them and work with them to set a regular routine, replacing any cancelled/postponed activities with new engaging activities, and including health supporting behaviours such as: 

  • Regular bedtimes 
  • Exercise 
  • Connecting with friends and loved ones 
  • Engaging in a hobby or activity they are passionate about

Managing anxiety during COVID 

The current pandemic has provoked anxiety in many people. While some anxiety can motivate us to protect ourselves and help keep us safe, if anxiety is not managed well it can impact day to day functioning. 

Signs that a young person is struggling with anxiety: 

  • Preoccupation with their fears/worries 
  • Maladaptive coping behaviours (i.e. avoidance, substance reliance) 
  • Physical symptoms associated with their anxiety (which have been assessed by a GP but do not have physical origin) – i.e. headaches, muscle tension, pain, stomach discomfort 

Supporting young people experiencing anxiety 

Supporting young people who are experiencing anxiety will be through helping them to explore and recognise their anxious thoughts, validating their feelings and supporting them to engage in coping strategies. Supporting them to explore more measured ways to look at the situation. However, if they are having difficulties with this and their anxieties, seeking professional help will be helpful (more details on seeking professional support can be found at the end of this article)

Strategies: 

  • Help them to think of evidence to support their anxious thoughts and evidence that challenge their anxious thoughts. This will allow them to find a balance in their thinking and will help them challenge their anxieties 
  • Explore with them more optimistic ways of thinking about their situation – what is the upside 
  • Encourage them to practice mindfulness or grounding techniques which help bring us back to the present moment

Coping with isolation & low mood 

The isolating nature of social distancing and school disruptions can lead to low mood and possibly depression, if helpful coping strategies are not used. Social contact and friendship development is an important developmental milestone in the adolescent years. Social connection disruption impacts both mood and healthy social development. 

Signs that a young person is struggling: 

  • Low mood  
  • Further isolation, avoiding contact with friends 
  • Maladaptive coping behaviours (i.e. avoidance, substance use, self harm) 
  • Physical symptoms associated with their low mood (which have been assessed by a GP but do not have physical origin) – i.e. generalised pain, stomach discomfort

Supporting young people experiencing low mood 

  • Encourage them and support them to connect with friends and loved ones 
    • Allowing for more time on-line (within reason) on social platforms or gaming platforms that allow them to connect with their friends 
    • This is also a good time to speak to them about staying safe on-line 
    • Allowing for safe in-person meeting (within the limitations of social distancing guidelines)
  • Help them set manageable expectations. Understanding that “good enough” and accomplished is better than perfect but not achievable, particularly during times of challenge 
  • Support them to explore hobbies or activities they can take up, to help them feel fulfilled and give them a sense of mastery and accomplishment 

Seeking professional help 

It is important to recognise when professional help is needed; such as speaking to a counsellor or psychologist to process experiences or engage in structured talk therapy. Many therapists are offering services virtually or have safety guidelines to help facilitate in-person therapy. To learn more about seeking mental health supports in Hong Kong follow the link here 

How do I know a young person needs professional help?

  • They are increasingly withdrawn, isolated or disengaged, and not responsive to coping strategies 
  • Engaging in self harm, substance reliance, or expressing suicidal thoughts 
  • Significant disruptions to their daily activities and engagement with the world around them due to their anxiety or mood 

If you are concerned about safety or think your young person needs emergency supports please see the list of emergency services here

Taking care of yourself is essential during this time. You will not be able to effectively support others if you are struggling. The strategies above apply to your self-care as well, so ensure you are engaging in healthy coping strategies, this will also model healthy behaviours to the young person you are supporting. 

Resources

Coping with Bad World News

“Incredible change happens in your life when you decide to take control of what you do have power over instead of craving control over what you don’t”

Steve Maraboli, behavioural scientist, speaker and author

We currently live in a world that’s more connected than ever before.

Nowadays, the news is no longer limited to traditional mass media like TV and newspapers, but it also floods our social media and smartphone apps.

With so much information at our fingertips, we might feel pressured to constantly stay up to date, or worry that we’re missing out on important announcements if we don’t check the news.

While having access to world news has many benefits, especially during a global pandemic, it can also get extremely overwhelming and take a toll on our mental health.

Being surrounded by technology, it can be hard to take a break from the news, or to know how and when to limit the amount of negative, sensational information we’re receiving.

Given that watching or reading the news is an integral part of many of our lives, it’s important to learn how to cope with bad world news in a healthy way.

How much is too much?

It can be tricky to know if you’re feeling overwhelmed by the news – especially when feeling sad, scared, or shocked can be normal reactions to alarming events that have been reported in the media.  Evolutionarily, we have a natural tendency to focus on negative information because it could serve as important cues for potential threats (Vaish, Grossmann, & Woodward, 2008).

However, if you find yourself constantly thinking about the news even after turning your attention to other activities; re-checking updates and feeling panicky, agitated or restless if you don’t keep up; or feel that your reactions are interfering with your daily life, you might benefit from taking a break.

Tips on coping with bad world news

  1. Seek reliable sources and understand the media’s motives 

Nowadays, a lot of content creators and even news sources rely on clicks or views to generate revenue for their work, and there’s been more competition to capture the viewer’s attention. This has led to a rise in sensationalism – the presentation of stories in a way that is designed to provoke an exaggerated emotional response. Headlines that are crafted to grab your attention might emphasise serious consequences or harm but may not fully convey the actual risk of such events happening. 

Keeping this in mind, it’s especially important to seek reliable sources from trusted news agencies and websites who are able to rely less on sensationalism and put out a balanced view more consistently.

  1. Reflect on your limits and set boundaries

Everyone may have different triggers and it can be helpful to have a think about what part(s) of the media specifically cause distress.

For example, if you find seeing images or videos stressful, you could try downloading apps that just show the news with text or listening to the radio or podcasts.

If you find that reading the news late at night disturbs sleep, you could set a limit (for example, 6pm), after which you will not consume any news and tell yourself that you can always catch up on anything you’ve missed the next day.

If there are specific social media accounts or pages that are repeatedly showing you unwanted content, you can also unfollow or mute the pages or mark specific posts as ‘unhelpful’, which can reduce the likelihood you will be shown similar content in the future, or switch off all breaking news notifications entirely.

You can also try setting limits at family gatherings where everyone agrees not to discuss the news.

  1. Actively seek positive news

Stanford’s Gore-Felton noted that we can actually end up feeling worse when we “deprive [ourselves] of happiness in hard times out of a sense of solidarity with those who are suffering”.

In fact, it’s been shown that actively seeking positive news can help us feel better, too. People who access a constructive news summary (i.e. stories that highlighted societal progress and solutions) are more likely to feel positive than those who consumed traditional news (McIntyre, 2020).

Remind yourself of things that make you happy – and search for good news in your own life, instead of just consuming bad news.

  1. Set a “worry time”

This is a technique to help digest news and manage symptoms of anxiety, where you focus on worrying for a short period of time, rather than having a wide range of situations and contexts throughout your day that could potentially elicit personal worry.

It has been demonstrated to help lower levels of worry, anxiety, and insomnia among individuals with high trait levels of worry (McGowan and Behar, 2012).

To practice this strategy effectively, our clinical advisor Odile suggests that you can try:

  • scheduling your “worry time” for the same time every day
  • making sure that it is later in the day but not too close to bed time 
  • keeping it shorter than 30 mins 
  • making sure it is not in a place that is associated with comfort (e.g. not in bed) 
  • plan what you will do after your worry time (a fun or comforting activity) 
  • using the worry time productively to assess if the worry is in your control or not (if it is in your control, make a plan; if it is outside your control, reflect on whether it is worth the time and energy you are giving it)

When worries inevitably arise throughout the day, you can jot them down in a notebook and come back to them during your allocated worry time!

  1. Talk it out

Seeking connection with friends, family, classmates or colleagues may help you cope with recent world events that have brought anxiety, sadness or other confusing emotions. By talking it out, you may be able to pinpoint specific things that caused fear, put them into perspective, and feel less alone.

However, it is important to remind ourselves that we cannot control other people’s reactions and not everyone may have interpreted things the way we have. Just because someone is not having the same reaction does not mean yours is any less valid, nor does it mean they must eventually be convinced to have the same thoughts as you.

Remember to secure your own oxygen mask first – if you aren’t okay, then you won’t be able to help anyone else feel better either. No matter what goes on in the world, what you can control is how well you look after and treat yourself.

  1. Keep up with self-care

Sometimes it is inevitable that unfortunate events happen in global affairs. After we learn about upsetting incidents, it can be helpful to engage in self-care.

For example, some newspapers may have sections on sports, or arts and culture (including restaurant, book or music reviews) which you may find interesting.

You can save some of your favourite songs in a playlist to listen to after a podcast or news clip brings you down. Or, you can take a digital detox by disconnecting from the internet for a bit and going outside for a short walk or taking a hot shower.

Choosing not to keep up with the news if it is bringing you stress doesn’t make you an ‘uneducated’ or ‘lazy’ person – finding balance for yourself, no matter what that looks like, is key.

Self -care idea: try progressive muscle relaxation techniques!

First proposed by Jacobson in 1938, the idea is to tense up and relax different muscles in your body.

A study by Szabo & Hopkinson (2007) found that with 15 minutes of progressive relaxation exercise, participants showed improvements in mood disturbance and anxiety in response to watching TV news.

A guide to the muscle groups:

  • Hands (clench) 
  • Wrists and forearms (extend and bend) 
  • Biceps and upper arms (bend and flex) 
  • Shoulders (shrug) 
  • Forehead (wrinkle into a frown)
  • Eyes and bridge of the nose
  • Cheeks and jaws (smile!) 
  • Around the mouth (press lips together)
  • Neck (tilt head back) 
  • Chest (deep breath, hold, exhale) 
  • Back (arch up and away from floor/chair) 
  • Stomach (suck) 
  • Thighs (clench) 
  • Feet (point toes)

For more info:

https://www.studenthealth.gov.hk/english/relaxation/relaxation.html

Youth sharing

Charlotte Chan, 22, Coolminds Website Project Coordinator

I have a few news apps on my phone and at the start of the pandemic, I had the habit of checking them as little ‘study breaks’ in between tasks – but I always found myself getting sucked in and having a hard time redirecting my focus away from the news, even after I put my phone down! One article seemed to lead to another, and after lots of scrolling and checking, I noticed myself feeling quite drained afterwards. It was only when I started being more mindful of the kinds of headlines I was reading that I realized probably 80% of the articles I was reading was bad news, such as COVID deaths or other upsetting events that had happened. With that imbalance, and the lack of good news I was consuming, no wonder I felt low afterwards!

Read more tips from our youth writers on the Coolminds Blog!

Nichole Chong, 3rd year Psychology & Neuroscience student at HKU: https://www.coolmindshk.com/en/coping-with-bad-world-news-youth-sharing-from-nichole-chong/

Marta Gramatyka, 21, student at CUHK: https://www.coolmindshk.com/en/coping-with-bad-world-news-youth-sharing-from-marta/

Janice To, 18, 1st year Biomedicine student at University of Melbourne: https://www.coolmindshk.com/en/coping-with-bad-world-news-youth-sharing-from-janice/

Lesley Yuen, 3rd year Psychology student at Lancaster University: https://www.coolmindshk.com/en/coping-with-bad-world-news-youth-sharing-from-lesley/

References 

  1. “Stress in America™ 2020: A National Mental Health Crisis.” American Psychological Association, American Psychological Association, 2020, www.apa.org/news/press/releases/stress/2020/report-october. 
  2. Beyer, Rebecca. “How to Cope with the News.” STANFORD Magazine, Mar. 2019, stanfordmag.org/contents/how-to-cope-with-the-news. 
  3. Bodas M, Siman-Tov M, Peleg K, Solomon Z. Anxiety-Inducing Media: The Effect of Constant News Broadcasting on the Well-Being of Israeli Television Viewers. Psychiatry. 2015;78(3):265-76. doi: 10.1080/00332747.2015.1069658. PMID: 26391834.
  4. Johnston WM, Davey GC. The psychological impact of negative TV news bulletins: the catastrophizing of personal worries. Br J Psychol. 1997 Feb;88 ( Pt 1):85-91. doi: 10.1111/j.2044-8295.1997.tb02622.x. PMID: 9061893.
  5. Lau JT, Lau M, Kim JH, Tsui HY. Impacts of media coverage on the community stress level in Hong Kong after the tsunami on 26 December 2004. J Epidemiol Community Health. 2006 Aug;60(8):675-82. doi: 10.1136/jech.2005.041897. PMID: 16840756; PMCID: PMC2588088.
  6. Liu, Jean C, and Eddie M Tong. “The Relation Between Official WhatsApp-Distributed COVID-19 News Exposure and Psychological Symptoms: Cross-Sectional Survey Study.” Journal of Medical Internet Research, vol. 22, no. 9, 2020, doi:10.2196/22142. 
  7. McGowan, Sarah Kate, and Evelyn Behar. “A Preliminary Investigation of Stimulus Control Training for Worry.” Behavior Modification, vol. 37, no. 1, 2012, pp. 90–112., doi:10.1177/0145445512455661. 
  8. McIntyre, Karen. “‘Tell Me Something Good’: Testing the Longitudinal Effects of Constructive News Using the Google Assistant.” Association for Education in Journalism and Mass Communication, vol. 14, no. 1, 2 Mar. 2020, pp. 37–54. 
  9. Ni, Michael Y, et al. “Depression and Post-Traumatic Stress during Major Social Unrest in Hong Kong: a 10-Year Prospective Cohort Study.” The Lancet, vol. 395, no. 10220, 2020, pp. 273–284., doi:10.1016/s0140-6736(19)33160-5. 
  10. Shabahang, Reza. “Online Health Information Utilization and Online News Exposure as Predictor of COVID19 Anxiety.” North American Journal of Psychology, vol. 22, no. 3, 2020, pp. 469–482., www.researchgate.net/publication/344408789_Online_Health_Information_Utilization_and_Online_News_Exposure_as_Predictor_of_COVID19_Anxiety. 
  11. Vaish A, Grossmann T, Woodward A. Not all emotions are created equal: the negativity bias in social-emotional development. Psychol Bull. 2008;134(3):383-403. doi:10.1037/0033-2909.134.3.383

Further Reading

  1. https://au.reachout.com/articles/dealing-with-bad-world-news 
  2. https://www.harpersbazaar.com/uk/culture/culture-news/news/a41925/10-ways-to-handle-bad-news-without-despairing/
  3. https://www.medicalnewstoday.com/articles/327516
  4. https://www.calmmoment.com/wellbeing/how-to-cope-when-the-news-makes-you-feel-stressed-and-depressed/ 
  5. https://www.health.com/condition/stress/how-to-cope-with-bad-news-anxiety-depression 
  6. https://www.readersdigest.ca/health/healthy-living/when-the-world-seems-horrible/ 
  7. https://stanfordmag.org/contents/how-to-cope-with-the-news 
  8. https://www.anxietyuk.org.uk/blog/health-and-other-forms-of-anxiety-and-coronavirus/ 

Emergency support

If you are experiencing strong levels of distress or trauma which are interfering with your life, remember that you do not have to face it alone, and that help is available.

For emergency support, please contact the hotlines below:

Emergency hotline: 999

The Samaritans 24-hour hotline (Multilingual): (852) 2896 0000

Samaritan Befrienders Hong Kong 24-hour hotline (Cantonese only): (852) 2389 2222

Suicide Prevention Services 24-hour hotline (Cantonese only): (852) 2382 0000

OpenUp 24/7 online emotional support service (English/Chinese): http://www.openup.hk

More support services can be found here: https://www.coolmindshk.com/en/emergency-hotlines/

More non-urgent support services can be found here: https://www.coolmindshk.com/en/communitydirectory/

Resources

Parents’ Guide to Navigating COVID-19

Efforts to stem the spread of COVID-19 through public health measures such as social distancing and self-isolation have taken a toll on Hong Kong’s youth. With prolonged school closures, many youth have increased their screen time and reduced their physical activity as well as face-to-face social interaction, which can contribute to low mood and loneliness. Changes in routine combined with the anxiety and stress associated with a new and unknown virus can lead to changes in behavior.

As a parent, it may be stressful to take care of both your own and your children’s mental health and wellbeing. This booklet aims to discuss how you, as a parent, can support your kids as well as yourself during these difficult times.

Talk it out

Talking to your young person about what is going on and why can help relieve some tension from both your and their minds. If you have noticed changes in your teenager, gently let them know what you have noticed and let them know there is no judgement. This is especially important to build trust. As parents, you are probably busier than ever, trying to manage work, home learning and other responsibilities. Therefore, it’s important to make a conscious effort to keep the lines of communication open.

Timing

Find a good time to talk, when you feel in a good headspace to do so and will be unlikely to be interrupted. If it’s not the right time, let your child know that you want to give them your full attention, and let them know when that will be.

Honesty

Be honest about what is happening in the world, and share only the facts to avoid unnecessary worries. It’s OK to say you don’t know the answer to a question and follow-up with the information later on or explain that there are many unknowns right now. Helping your teenager learn to sit with uncertainty is an important life lesson.

Active listening

Ensure that you are really listening to what they say, and let the conversation progress at their pace. Be a good listener, communicate that you respect their point of view, and validate what they are experiencing and their feelings. Remember, you can validate their experience even if you don’t agree with it or feel the same way. Offering reassurance or advice too quickly can have the opposite effect. Instead, focus on the idea of ‘listening without fixing’.

Shared resources

Let them know that there is help available and encourage them to talk to a doctor, other health professional, friend or family member if they need it. Do share a list of services designed specifically for young people in Hong Kong, which you can find on the Coolminds website.

Missed opportunities + Handling grief

Young people will likely face a lot of disappointments during this time such as missed school, parties, graduation, visiting universities, sports, and competitions for which they have prepared. As some of these are important milestones, it’s crucial to acknowledge these losses and the impact they have.

Let them know that it’s OK to feel angry, sad and frustrated, this may actually help them accept the disappointment.

Reassure them they are not alone and that, during this confusing time, many have been impacted and are also grieving for the losses caused by the pandemic.

Missing out on these types of events can also cause anxiety and low mood, so it is important to be on the look-out for that.

Here are some tips to help your young person cope with these losses:

  • Stay connected

Find ways for them to stay connected to their friends. You may consider relaxing screen time rules to allow for this.

  • Engage in personal expression

Journaling, drawing, painting, playing music, and dancing among others.

  • Practising self-care

Ensure they get enough sleep and exercise, consider introducing meditation and/or yoga.

  • Challenge negative thoughts

Reframe negative thoughts that might be out of proportion with less extreme and more realistic ones.

  • Enjoying the wins

Some aspects of the situations such as missing classes they don’t like or activities they do not enjoy may be welcomed at this time, allow them to appreciate and celebrate these small “wins”.

  • Continue the conversation

Don’t just check-in once, do so periodically as feelings and thoughts may change.

You might also feel a sense of sadness and grief at missing important milestones in your children’s lives. It is important to take the time to recognize your own disappointment and practise self-validation by acknowledging that these feelings are fair and valid despite seemingly bigger issues in the world. Take the time to grieve for these losses.

Youth mental health

It is important to understand that the measures we have to use to protect us from COVID-19 can impact our mental health. The fear of getting infected, uncertainty about the future, and all of the changes we’ve made to our routines can cause feelings of anxiety, while social distancing measures can lead to feelings of isolation and low mood. This is true for all of us and even more pronounced for those who have struggled with their mental health before the outbreak. It is therefore important to pay attention to your child’s mental health and wellbeing.

Normalise anxiety

Explain to them that anxiety is a natural feeling to have when there is a threat present, as is the case right now.

Discuss their perspective on the dangers involved and ensure that they are not overestimating the gravity of the situation or underestimating their ability to take care of themselves and manage difficult things.

Focus on strengths

Remind them that they are resilient and able to navigate tough situations. Remind them of different ways in which they have done so in the past.

Limit news exposure

Encourage youth to limit the amount of time they spend reading and watching information on COVID-19. 

Remind them to refer only to reputable sources for updates.

Encourage helpful distractions

Such as watching movies, playing games, exercising and talking to friends. These can be used at times of distress or boredom.

Keep communication channels open

Encourage teenagers to discuss any concerns with family and friends.

Make sure that you are managing your own anxiety!

It’s possible that your kids are feeding off of you. If you are feeling particularly stressed, find someone to talk to or engage in an activity that usually helps you relax or calm down.

Youth may be especially frustrated with social distancing measures if some of their friends’ families are not participating in it. Explain that your family is doing what experts recommend and suggest that they blame you when telling their friends that they can’t go out. Remain open to suggestions as to how they can be social while remaining safe. Consider relaxing screen time rules to allow kids to connect with their friends online given they can’t always do it in person. At the same time, ensure that digital connecting does not replace in-person interactions with family, sleep or studying.

Don’t forget to give them time and space! Youth still need their privacy and alone time, especially with the increased togetherness created by working from home and no school. Don’t take it personally if they prefer to spend more time in their room, and do not give them a hard time about it as long as they are completing their school work and other responsibilities.

Self-care

Remember, in order to take care of your young person well, you need to take care of yourself first. Working from home or the office and trying to manage youth at home as well as home learning is hard. You may not be as efficient as you normally are. You may also feel you are not being the best parent you can be.

Be kind to yourself and give yourself a break, everyone is learning to navigate this new way of life, and it takes time to adapt and get things right. Keep in mind that spending more time together is not the same as the quality, focused time you probably have when you and your young person are accomplishing daily tasks separately.

Some self-care ideas include:

  • Make time to switch off from responsibilities and duties every day. Read a good book or watch TV.
  • Allow only a certain amount of time each day to learn about COVID-19 updates from reputable sources.
  • Engage with family and friends on the phone, Facetime, Zoom, Whatsapp, etc.
  • Schedule a date night with your partner or quality time alone with a friend at least once a week.
  • Practise mindfulness. There are many free apps available to support mindfulness if you are unsure of how to do it.

This is also a time of uncertainty with regards to jobs and financial stability, which can cause high levels of stress and anxiety. Seek support from family and friends where possible. There are also some government sources that can be helpful.

Physical health

Exercise can boost our immune system but it also boosts our mood, our concentration, our confidence, and improves our sleep. Encourage your young person to engage in some form of physical activity every day. It is equally important for parents to do the same. This can be an opportunity to spend fun, non-stressful time together.

Get outside! Go for a run, bike ride or long walk. Take advantage of the many free exercise videos available online and through apps. Play video dance games and use virtual sports simulators. Use what you have in the environment around you to engage in physical activity. Getting your endorphins flowing will be beneficial for everyone.

It is also important to maintain a consistent sleep schedule to ensure you and your child get enough rest. Try your best to eat a healthy diet and drink plenty of water.

Home Learning

Home Learning is challenging for youth, parents and teachers alike. There are equipment and internet requirements to successfully engage in home learning. If you do not have access to these resources, talk to your school about how they can help you and your teenager accomplish what you need.

It is important to remember that your teenager is probably a lot more capable than you realise and can manage much of what they need to do on their own. Make sure to give them that credit and the opportunity to show you that they can do it.

Helpful tips: Routines & Schedules

  • Draft a daily schedule together – make sure to get your teenager’s input instead of directing them. Empower them to be responsible for their time, which should allow them to get their school work done in addition to being “social” and engaging in other activities that are important to them. 
  • Try to use non-controlling, non-directive language to ensure teenagers are accomplishing what they need to, while communicating that they are still in control of their time. A good example of that is asking, “what is your plan today?” Agree on an amount of checking-in that is acceptable to both you and your youth. One idea is to schedule a window of time each day to check-in and provide any assistance that may be needed.

Try not to get stuck in thoughts about how you think youth will react and notice how they are managing. If they are acting more maturely than they have in the past, give them the autonomy to manage on their own accordingly.

Remember that most youth around the world are in a similar position. Your kids will most likely not be further behind others because of home learning. In addition, teachers are experts at managing such situations. They will help your child catch up when school resumes if necessary. For those who have kids graduating from secondary school or University, keep in mind that this is a global pandemic. Universities and employers are fully aware of the challenges faced during this time and the resulting repercussions for everyone. Keep in mind that this is not forever, kids will go back to school!

Use the extra time well!

Although the situation is far from ideal, families rarely get to spend this much time together so do not forget to enjoy it! Make time to do fun things together that you normally don’t have the time to do such as cooking, baking, playing board games, teaching a new skill, etc.

Give your closets and cabinets a good clear out, and donate things you no longer need to charity. Take the time to learn a new skill yourself. Take online classes if you are interested in a career change or to support your current line of work.

Most of all remember to look after yourself and your kids. Your mental and physical well-being are more important during this time than getting all of the school work done or being an exemplary employee. If you are feeling financially unstable, make use of government resources. If you or your kids are not able to maintain good mental health during this time using the suggestions provided, it’s important to seek professional help.

Emergency support

If you are experiencing strong levels of distress or trauma which are interfering with your life, remember that you do not have to face it alone, and that help is available.

For emergency support, please contact the hotlines below:

Emergency hotline: 999

The Samaritans 24-hour hotline (Multilingual): (852) 2896 0000

Samaritan Befrienders Hong Kong 24-hour hotline (Cantonese only): (852) 2389 2222

Suicide Prevention Services 24-hour hotline (Cantonese only): (852) 2382 0000

OpenUp 24/7 online emotional support service (English/Chinese): www.openup.hk

More support services can be found here: https://www.coolmindshk.com/en/emergency-hotlines/

More non-urgent support services can be found here: https://www.coolmindshk.com/en/communitydirectory/ 

Resources

Clinician Advice: Stigma, discrimination and mental health

Teresa Chan, Coolminds clinical advisor answers some hard-hitting questions youth have about stigma and discrimination and its association with mental health.

My past experiences of being discriminated against have really impacted my self-esteem, and I often feel insecure. What are some ways I can heal from this and gain confidence?

Try to understand why you feel the way you do. Self-esteem is how we see and feel about ourselves, and many people will experience low self-esteem at some point in their lives.

It can be caused by a number of things – comparing yourself to your friends/peers, difficult past experiences, problems with family or at school.

Try to challenge negative thoughts and feelings, and remind yourself of the positives that you may be overlooking, e.g:

  • Is there another way of looking at things? 
  • What advice would you give to a friend who was having similar negative feelings? 
  • Remind yourself about things that have happened which prove or indicate that these negative thoughts you may be having about yourself aren’t true.

You could also start by identifying a positive quality/characteristic or a strength about yourself, or a positive experience that demonstrated this:

  • When was the last time you received a compliment? 
  • The last time you did something for someone that made you feel good?

These might seem like small things, but it is important to recognise and learn to appreciate all the good things about yourself, and the reasons why people appreciate you for being who you are.

If you’re really struggling with negative feelings about yourself, try to talk to someone you trust, like a family member or teacher. You can also talk to your family doctor who will be able to tell you what sort of support might be available to you.

What are some coping mechanisms I could try when I am affected by mental health stigma?

Seek help from a mental health professional – getting yourself better is the priority. Treatment (this can be counselling or medications) will help identify the issue and address therefore reducing or eliminating the symptoms which have been disrupting your life. Getting help, understanding your condition and connecting with others who have also struggled will help you build your resilience. If your condition affects your academic performance (i.e. a specific learning difficulty or ADHD) get support at school. A clear learning plan will help you reach your potential. If teachers are unaware of the issues faced by their students it may lead to discrimination or a labeling of a “bad student”.

Don’t self stigmatise, this is when we allow the stigma to influence the way we think and feel about ourselves and our situation. Self stigma stops us from seeking help, and you may start to believe that your condition is due to your personal weakness.

Don’t define yourself by your illness. Your mental health struggle is something you experience but it is not you, you are much more than your illness. Reframe statements like “I am schizophrenic” to “I have schizophrenia ”

Don’t isolate yourself. When you struggle with your mental health you may be hesitant to share this with anyone. However, your friends, family, teachers and coaches could offer you compassion and support. Reach out to those you trust, and surround yourself with supportive people.

Speak out against stigma. In your recovery, consider speaking about the harmful effects of stigma. You may do this through sharing your own experiences or speaking about it more generally. If you do choose to speak about your experiences make sure you are well supported in doing this, as this can be difficult.

How does racism and discrimination impact a young person’s mental health?

Young people are particularly vulnerable to the damaging effects of racism and discrimination. A recent study* revealed a strong and consistent link between race-based discrimination and negative child health and wellbeing outcomes such as anxiety, depression and psychological distress. It also showed a relationship between race-based discrimination and behaviour problems such as ‘delinquent behaviours’.

​​Racism can affect our mental health in various ways, including: 

  • stress and negative emotions, having negative physiological and psychological effects 
  • individuals disengaging from healthy activities and coping by engaging in unhelpful behaviours that impact negatively on their health (such as smoking and excessive alcohol consumption)

*Research has linked racism to higher rates and risk of anxiety, depression and psychological distress (Priest et al. 2013).

How can young people do to combat prejudice and discrimination in society?

If you are experiencing racism, try to talk to someone you trust (as it can help to have another person aware of what is happening and how you are feeling). 

It can also help to find supportive groups and communities who might understand what you are going through (as it can be difficult to explain how you feel to someone who has not experienced racism, whether directly or indirectly). 

Online communities can be one way to find like-minded people with similar experiences and shared interests that you can talk to, share with, and have a safe space to be heard. 

Remember that you are not alone. 

Learn and know what your rights are and how to report abuse if necessary. This can help you feel empowered and remind you that what you are experiencing is not okay and no one should believe that it is.

What should I do if I witness someone being discriminated against?

Try your best to provide them with a safe space in which they can express themselves and their experiences, and let them know they are not alone. Depending on the context, work with them to reach out to relevant support systems (such as a teacher or a parent).

Where to Get More Support

A List of Community Resources (click the name of the resource to visit its website)

Government Departments: 

Support Service Centres for Ethnic Minorities – a list by the Race Relations Unit of the Home Affairs Department. 

Integrated Children and Youth Services Centres – provide social work intervention for children and youth 6-24. 

Integrated Community Centres for Mental Wellness – provide community support, social rehabilitation services, clinical assessment and treatment for those aged 15 or above and their family members or carers.

Government-funded Non-Profit Making Organizations (NPOs):

Christian Action SHINE Centre: Self-help and Mutual-help Groups for ethnic minorities who encounter social and economic problems. 

Hong Kong Christian Service CHEER Centre: Counselling, guidance and referral services are provided by registered social workers for all ethnic minorities in Hong Kong and all organisations serving ethnic minorities, to facilitate their swift settlement in Hong Kong. 

Hong Kong Community Network LINK Centre: Registered social workers offer counselling or referral to appropriate government department or agencies. Specially trained ethnic minority staff offer translation services. 

International Social Service: Counselling and Guidance services for ethnic minorities with HKID cards. 

New Home Association HOME Centre: Individual and mutual support for all ethnic minorities in Hong Kong. 

Yuen Long Town Hall Support Service Centre for Ethnic Minorities: Provides counselling and referral service to pertinent organizations, offers emotional support, and gives sessions on problem-solving and stress management skills for Hong Kong ethnic minority residents aged 9-27.

The Zubin Foundation – Ethnic Minority Well-being Centre (EMWC) 

The EMWC serves those in the ethnic minority community who would like to talk to a counsellor about their mental well-being. All counsellors are able to speak English plus Hindi/ Urdu. Counselling service is only available for individuals aged 16 or above. If you have not reached 18 yet, you are required to get your parents’ consent in order to receive our counselling service.

  • Address: 5/F, Unit F-J, Block 2, Kwai Tak Industrial Centre, 15-33 Kwai Tak Street, Kwai Chung, Hong Kong 
  • Contact number: 9682 3100 (for enquiries on EMWC and making appointments) / 2540 9588 (general enquiries on The Zubin Foundation) 
  • Email: info@zubinfoundation.org

Yang Memorial Methodist Social Service – Yau Tsim Mong Family Education and Support Centre

Mutual help groups, individual and family counselling are provided for all ethnic minorities in Hong Kong.

  • Address: 5/F, 396 Shanghai Street, Yaumatei, Kowloon 
  • Contact number: 2781 2921/ 6821 9115/ 6821 9114 
  • Email: ytmfesc@yang.org.hk

Christian Action (Woo Sung Street Centre)

Self help and mutual help groups for ethnic minorities who encounter social and economic problems.

  • Address: 4/F., Lee Kong Commercial Building, 115 Woo Sung Street, Jordan, Kowloon 
  • Contact number: 3422 3820 
  • Email: emisc@christian-action.org.hk

The Salvation Army Yau Ma Tei Integrated Service for Young People

Focuses on growth and counselling, to foster a sense of belonging to Hong Kong among the ethnic minority group and help them adapt to life in Hong Kong.

  • Address: 1/F Block 4, Prosperous Garden, 3 Public Square Street, Kowloon 
  • Contact number: 2770 8933 
  • Email: ymtis@ssd.salvation.org.hk

Emergency support

If you are experiencing strong levels of distress or trauma which are interfering with your life, remember that you do not have to face it alone, and that help is available.

For emergency support, please contact the hotlines below:

Emergency hotline: 999

The Samaritans 24-hour hotline (Multilingual): (852) 2896 0000

Samaritan Befrienders Hong Kong 24-hour hotline (Cantonese only): (852) 2389 2222

Suicide Prevention Services 24-hour hotline (Cantonese only): (852) 2382 0000

OpenUp 24/7 online emotional support service (English/Chinese): www.openup.hk

More support services can be found here: https://www.coolmindshk.com/en/emergency-hotlines/

More non-urgent support services can be found here: https://www.coolmindshk.com/en/communitydirectory/ 

Resources

Voices of Youth: Stigma, discrimination and mental health

Interviews with Khadeeja Khan and Zuhaa Khan, Coolminds Youth Summit Ambassadors, and Zita Marie Puentespina, a Year 10 student

What are your thoughts on how ethnic minorities view mental health, and how is this topic discussed?

Zita: Sadly, many ethnic minorities come face to face with the idea that mental health may be a taboo subject in their upbringing. Moreover, umbrella terms such as “being difficult” or “dramatic” may come into play. This helps delay an individual’s understanding of “mental health” and how they can healthily overcome it.

Khadeeja: I think ethnic minorities lack awareness when it comes to mental health. For many, if you cannot see it then it is not there. It is easier to visit a doctor for a bruise you have on your arm than visit the doctor for bruised emotions. In the ethnic minority community, mental health is seldom talked about and that only worsens it further. Common issues like post-natal depression in women are hardly ever discussed because the majority do not even know what it is and many do not know how to deal with it. Although the youth are a lot more open to this, parents can be ignorant to talk or even learn about mental health.

Name-calling and shaming with words like ‘mad’ , ‘crazy ’ , ‘attention-seeker’ are common in the minority community. Whilst doing my Psychology degree, I was faced with the same issues as it was considered a subject with ‘no future’ and ‘a waste of time’. So, while the youth are learning about mental health and are opening themselves up, the older ones are still closed off and driving the generation gap further apart. This is mainly because in the countries where the ethnic minority immigrants come from, mental health is a taboo, making it difficult for them to comprehend.

Zuhaa: Unfortunately it’s not prioritised and thrown under the radar for the most part, in my opinion. Until it becomes a visible issue (e.g. drug abuse and dependency). Depression, trauma, anxiety are often viewed as “excuses” and “acts of laziness” so the ones struggling from these challenges are far from receiving help in their own community. Success and making a name out of yourself is constantly deemed significant. As painful and discouraging as this may be, your status and success are measured by your bank balance and the number of properties you own in the EM community. There isn’t much talk about what’s going on in your head and the significance of emotional discomfort.

Issues with racism and discrimination reflect back to one’s identity. In the case of an immigrant child, the “sense of belonging” and “need for assurance ” are parts of life that the “average” local is provided with but immigrant children struggle to find. The use of labels and a lack of acceptance, appreciation, and respect can harm mental health and cause long-term detrimental effects on individuals.

As for personal experience, fortunately mine have been subtle compared to what others may have experienced. That said, hearing about troubling tales in your community can hurt your own mental health too. It adds to the emotional stress of constantly thinking “what this place, what do people presume of me” simply based off appearance, ethnic features, clothing etc.

What are some barriers for ethnic minorities who want to seek help?

Khadeeja: The main barrier is independence – many people live with their parents until they get married, so wanting to seek help under the guardianship of their parents would be difficult especially when the parents are not willing to agree or accept their mental health. Additionally, there is the issue of acceptance. Seeking help and being vulnerable would mean that they accept they are going through something and would have to be vocal about it, yet they have been taught to do the opposite their whole lives. Confidence plays a barrier too. When parents, family and society have told them to stay quiet and avoid their feelings, finding the confidence to speak out is hard and will need a lot of perseverance and support. Finally, confidentiality and trust is a huge barrier. Many ethnic minorities in Hong Kong are usually somehow acquaintances, friends or related to each other in other ways. The insecurity of information being ‘leaked’ to their parents, relatives etc discourages the youth and minorities as a whole about speaking up.

Zita: A barrier I believe is quite evident is the “communication barrier” as this does have an instant strain in one’s ability to express themselves and be fully understood. Although an EM may try their best to express their need for help, the receiving person may not understand them, despite the effort the EM may be showing. Due to prevalent language, cultural and inter-generational barriers, I believe acts of compassion and love should be shown louder.

How can we best support mental health for everyone despite cultural differences?

Khadeeja: We can make the ethnic minority community a safe place for them to open up. We can provide a platform for them which would empower them and help them. When other people from different backgrounds come together and speak out, it helps to de-stigmatize mental health and they can feel accepted and validated. We need to realise that although we may have different cultures, backgrounds and religions, the one thing that we can all connect with is our emotions and feelings. Education is vital too, and this should start from schools, which would then be brought to homes. Before I started my Psychology degree, I had minimal information about mental health. My education means that I can help others to get educated too. If we target 100 people, for example, we might not reach out to all of them but even if 50 parents can be educated on mental health, it may be enough to increase support around mental health for at least some people in our community.

Zita: We must have a constructive foundation in which a collection of knowledge about mental health is addressed and shared, this may be in different forms of media. This may be a place where individuals can share their own ideas and tailor the given resources to their own cultural backgrounds, as mental health should not take away from one’s culture but should be understood positively in the context of their culture.

Zuhaa: It’ s crucial to place significance on an individual’s culture since cultural influence does play a role in shaping one’s life. But we need to just set our differences aside and provide a set of ears to those who come to seek help. The fact is that there’s little to no emphasis on mental health in the community, all that there is is the constant denial of mental health as a health issue. This makes it so hard to speak up.

How can youth support other youth who have been victims of racism or discrimination?

Zuhaa: Remind them that it’s not their fault. Often times the discriminatory words and phrases used are a reflection of the racist himself. It’s a problem that is bred in the racist’s mind instead of the victim. At the end of the day, the victim needs to accept that it’s impossible to change one’s ethical features, the culture and custom they were born in. Spending more time in understanding one’s own culture and dwelling on its importance to the advances of the world are far better alternatives than constantly being hard on oneself because of an unfortunate encounter with racism. If possible, also advise the victims to be patient and try their best to spread awareness on what’s wrong and what shouldn’t be said to people from a different race, etc.

Khadeeja: Youth can support other youth who have been victims of racism and discrimination by speaking up about their own experiences. It’s that simple! We need advocates, ambassadors and supporters who can speak up about their own mental health experiences and this will encourage others to do the same. We need societies, groups and events by youth for youth and mental health Coolminds Youth Summit is a prime example of that! The youth can also just contribute their time to mental health charities and organisations and attend the events. The presence of youth at such occasions is enough to encourage other youth to get involved.

Zita: We must acknowledge their experiences, create a safe place for self-expression, and use these experiences to inform the immediate people around them in order to spread awareness. We must create a platform of understanding where people can become informed and then empowered to make a difference.

The lives of people with mental health conditions are often embedded by stigma as well as discrimination. 

Stigma is a reality for many people with a mental illness, and they report that how others judge them is one of their greatest barriers to a complete and satisfying life.

Where to Get More Support

A List of Community Resources

Government Departments: 

Support Service Centres for Ethnic Minorities – a list by the Race Relations Unit of the Home Affairs Department. 

Integrated Children and Youth Services Centres – provide social work intervention for children and youth 6-24. 

Integrated Community Centres for Mental Wellness – provide community support, social rehabilitation services, clinical assessment and treatment for those aged 15 or above and their family members or carers.

Government-funded Non-Profit Making Organizations (NPOs):

Christian Action SHINE Centre: Self-help and Mutual-help Groups for ethnic minorities who encounter social and economic problems. 

Hong Kong Christian Service CHEER Centre: Counselling, guidance and referral services are provided by registered social workers for all ethnic minorities in Hong Kong and all organisations serving ethnic minorities, to facilitate their swift settlement in Hong Kong. 

Hong Kong Community Network LINK Centre: Registered social workers offer counselling or referral to appropriate government department or agencies. Specially trained ethnic minority staff offer translation services. 

International Social Service: Counselling and Guidance services for ethnic minorities with HKID cards. 

New Home Association HOME Centre: Individual and mutual support for all ethnic minorities in Hong Kong. 

Yuen Long Town Hall Support Service Centre for Ethnic Minorities: Provides counselling and referral service to pertinent organizations, offers emotional support, and gives sessions on problem-solving and stress management skills for Hong Kong ethnic minority residents aged 9-27.

The Zubin Foundation – Ethnic Minority Well-being Centre (EMWC) 

The EMWC serves those in the ethnic minority community who would like to talk to a counsellor about their mental well-being. All counsellors are able to speak English plus Hindi/ Urdu. Counselling service is only available for individuals aged 16 or above. If you have not reached 18 yet, you are required to get your parents’ consent in order to receive our counselling service.

  • Address: 5/F, Unit F-J, Block 2, Kwai Tak Industrial Centre, 15-33 Kwai Tak Street, Kwai Chung, Hong Kong 
  • Contact number: 9682 3100 (for enquiries on EMWC and making appointments) / 2540 9588 (general enquiries on The Zubin Foundation) 
  • Email: info@zubinfoundation.org

Yang Memorial Methodist Social Service – Yau Tsim Mong Family Education and Support Centre

Mutual help groups, individual and family counselling are provided for all ethnic minorities in Hong Kong.

  • Address: 5/F, 396 Shanghai Street, Yaumatei, Kowloon 
  • Contact number: 2781 2921/ 6821 9115/ 6821 9114 
  • Email: ytmfesc@yang.org.hk

Christian Action (Woo Sung Street Centre)

Self help and mutual help groups for ethnic minorities who encounter social and economic problems.

  • Address: 4/F., Lee Kong Commercial Building, 115 Woo Sung Street, Jordan, Kowloon 
  • Contact number: 3422 3820 
  • Email: emisc@christian-action.org.hk

The Salvation Army Yau Ma Tei Integrated Service for Young People

Focuses on growth and counselling, to foster a sense of belonging to Hong Kong among the ethnic minority group and help them adapt to life in Hong Kong.

  • Address: 1/F Block 4, Prosperous Garden, 3 Public Square Street, Kowloon 
  • Contact number: 2770 8933 
  • Email: ymtis@ssd.salvation.org.hk

Emergency support

If you are experiencing strong levels of distress or trauma which are interfering with your life, remember that you do not have to face it alone, and that help is available.

For emergency support, please contact the hotlines below:

Emergency hotline: 999

The Samaritans 24-hour hotline (Multilingual): (852) 2896 0000

Samaritan Befrienders Hong Kong 24-hour hotline (Cantonese only): (852) 2389 2222

Suicide Prevention Services 24-hour hotline (Cantonese only): (852) 2382 0000

OpenUp 24/7 online emotional support service (English/Chinese): www.openup.hk

More support services can be found here: https://www.coolmindshk.com/en/emergency-hotlines/

More non-urgent support services can be found here: https://www.coolmindshk.com/en/communitydirectory/ 

Resources

Discrimination and Mental Health – A Guide for Young People

Introduction

Hong Kong is a very multicultural city with a melting pot of cultures. In the last 10 years, the number of non-Chinese ethnic people living in the city has increased by over 70%.

Did you know that ethnic minorities constitute 8% of Hong Kong’s population?

There are over half a million ethnic minorities living in Hong Kong.

72.2% of ethnic minorities aged 14 and below and 51% of ethnic minorities aged 15-24 were born in Hong Kong.

It’s important to understand that not everyone shares the same views and upbringing. What we see in the news, movies, social media, or books may present a very narrow or one-sided view of specific cultures. Diversity can help us work more productively in teams and foster creativity as there are lots of positive things we can learn from each other.

Learning about other cultures helps us understand different perspectives within our communities. It helps us challenge harmful stereotypes and personal biases about different groups. We can grow in understanding and learn to respect other “ways of being” that are not necessarily our own.

Unfortunately, not everyone fully understands and supports cultural diversity. Discrimination, racism, and stigma are still huge issues we face. This can take a toll on our mental health and the wellbeing of those around us.

What is discrimination?

Discrimination 

Discrimination is unfavourable treatment based on underlying prejudice. It is referred to as unfair treatment due to a person’s identity, which can include the following:

  • Age 
  • Sex 
  • Race
  • Gender
  • Colour
  • Creed 
  • Religion 
  • Ethnicity 
  • Physical disability 
  • Family background
  • Ancestry 
  • Gender identity
  • Political belief
  • Place of origin 
  • Mental illness 
  • Mental disability 
  • Nationality 
  • Family status 
  • Social status 
  • Citizenship 
  • Linguistic background 
  • Sexual orientation 
  • Monetary status 
  • Education level 

Stigma is the negative stereotype and discrimination is the behaviour that results from this negative stereotype.

How does discrimination effect MENTAL HEALTH?

Impact of negative public attitudes

  • Public misconceptions and increase in fear 
  • Justification of stereotypes 
  • Denial of jobs, friendships, relationships 
  • Loss of self-esteem, confidence 
  • Feeling weak 
  • Increase in stress levels 
  • Social exclusion and isolation 
  • Unwilling to seek help or speak to friends/family about problems 
  • Remains one of the greatest barriers to a satisfactory life

The lives of people with mental health conditions are often embedded by stigma as well as discrimination.

Stigma is a reality for many people with a mental illness, and they report that how others judge them is one of their greatest barriers to a complete and satisfying life.

Is discrimination a problem in Hong Kong?

What are some challenges ethnic minorities face in HK?

  • Language barriers
  • Lack of career opportunities
  • Cultural differences
  • A recent survey conducted by local universities revealed that 6 in 10 Hongkongers believe there is a prejudice against these ethnic minorities.
  • Between 2013-2018, the Equal Opportunities Commission received a total of 397 complaints lodged under the Race Discrimination Ordinance.
  • A study by the World Values Survey Association has shown that many Hongkongers would not want to live next to people of a different race.

Racial stereotypes are widespread in Hong Kong. They may be used in to discriminate in a range of areas, like law enforcement, renting accommodation, school admissions and opportunities for employment.

Due to discrimination, many ethnic minority youth feel that they are negatively perceived by the wider community. This may lead to over racism or micro-aggressions.

A study from the Zubin Foundation has found that due to discrimination and negative perceptions of ethnic minorities, many youth have felt “invisible”. For example, ethnic minorities are under-represented in advertisements and pop culture in Hong Kong. When they are featured, it is often in sources like the news where they may be portrayed as “criminals”.

“When I open the school doors in the morning, I would see some unpleasant faces. I guess some parents don ’t feel comfortable having me teach their kids.”

Lebo Mhlongo, a South African kindergarten teacher in HK, faces racism on a daily basis

References:

  • South China Morning Post, “Is Hong Kong racist? Prejudice against ethnic minorities, especially Africans, undermines city’s claim to be truly international”, 21/7/2018 
  • South China Morning Post, “Racial discrimination is still an issue in HK”, 13/12/2019 
  • Zubin Foundation, “The Status of Ethnic Minorities in Hong Kong”, 2015

Where to Get More Support

A List of Community Resources

Government Departments: 

Support Service Centres for Ethnic Minorities – a list by the Race Relations Unit of the Home Affairs Department. 

Integrated Children and Youth Services Centres – provide social work intervention for children and youth 6-24. 

Integrated Community Centres for Mental Wellness – provide community support, social rehabilitation services, clinical assessment and treatment for those aged 15 or above and their family members or carers.

Government-funded Non-Profit Making Organizations (NPOs):

Christian Action SHINE Centre: Self-help and Mutual-help Groups for ethnic minorities who encounter social and economic problems. 

Hong Kong Christian Service CHEER Centre: Counselling, guidance and referral services are provided by registered social workers for all ethnic minorities in Hong Kong and all organisations serving ethnic minorities, to facilitate their swift settlement in Hong Kong. 

Hong Kong Community Network LINK Centre: Registered social workers offer counselling or referral to appropriate government department or agencies. Specially trained ethnic minority staff offer translation services. 

International Social Service: Counselling and Guidance services for ethnic minorities with HKID cards. 

New Home Association HOME Centre: Individual and mutual support for all ethnic minorities in Hong Kong. 

Yuen Long Town Hall Support Service Centre for Ethnic Minorities: Provides counselling and referral service to pertinent organizations, offers emotional support, and gives sessions on problem-solving and stress management skills for Hong Kong ethnic minority residents aged 9-27.

The Zubin Foundation – Ethnic Minority Well-being Centre (EMWC) 

The EMWC serves those in the ethnic minority community who would like to talk to a counsellor about their mental well-being. All counsellors are able to speak English plus Hindi/ Urdu. Counselling service is only available for individuals aged 16 or above. If you have not reached 18 yet, you are required to get your parents’ consent in order to receive our counselling service.

  • Address: 5/F, Unit F-J, Block 2, Kwai Tak Industrial Centre, 15-33 Kwai Tak Street, Kwai Chung, Hong Kong 
  • Contact number: 9682 3100 (for enquiries on EMWC and making appointments) / 2540 9588 (general enquiries on The Zubin Foundation) 
  • Email: info@zubinfoundation.org

Yang Memorial Methodist Social Service – Yau Tsim Mong Family Education and Support Centre

Mutual help groups, individual and family counselling are provided for all ethnic minorities in Hong Kong.

  • Address: 5/F, 396 Shanghai Street, Yaumatei, Kowloon 
  • Contact number: 2781 2921/ 6821 9115/ 6821 9114 
  • Email: ytmfesc@yang.org.hk

Christian Action (Woo Sung Street Centre)

Self help and mutual help groups for ethnic minorities who encounter social and economic problems.

  • Address: 4/F., Lee Kong Commercial Building, 115 Woo Sung Street, Jordan, Kowloon 
  • Contact number: 3422 3820 
  • Email: emisc@christian-action.org.hk

The Salvation Army Yau Ma Tei Integrated Service for Young People

Focuses on growth and counselling, to foster a sense of belonging to Hong Kong among the ethnic minority group and help them adapt to life in Hong Kong.

  • Address: 1/F Block 4, Prosperous Garden, 3 Public Square Street, Kowloon 
  • Contact number: 2770 8933 
  • Email: ymtis@ssd.salvation.org.hk

Emergency support

If you are experiencing strong levels of distress or trauma which are interfering with your life, remember that you do not have to face it alone, and that help is available.

For emergency support, please contact the hotlines below:

Emergency hotline: 999

The Samaritans 24-hour hotline (Multilingual): (852) 2896 0000

Samaritan Befrienders Hong Kong 24-hour hotline (Cantonese only): (852) 2389 2222

Suicide Prevention Services 24-hour hotline (Cantonese only): (852) 2382 0000

OpenUp 24/7 online emotional support service (English/Chinese): www.openup.hk

More support services can be found here: https://www.coolmindshk.com/en/emergency-hotlines/

More non-urgent support services can be found here: https://www.coolmindshk.com/en/communitydirectory/ 

Resources

Seeking Help and What to Expect

Who to seek help from 

Congratulations! If you are reading this section, that means you’re ready for change. But we know that seeking help can be confusing and overwhelming so let’s start by understanding what different mental health professionals do and how they can help. Here’s a guide on the range of mental health professionals that you may find:

General practitioner (GP)

General practitioners, also known as family doctors, are medical doctors specializing in general medicine. They are also the doctors you see when you are feeling physically unwell. Your GP is often the first professional you would see when you are struggling with your mental health. They are trained to assess, diagnose and treat mild to moderate mental health conditions. GP’s can prescribe medications and provide preventative care and health education. They can also refer and direct you to the appropriate specific mental health professionals. Seeing your GP is the best first step to getting help.

Psychiatrists

Psychiatrists are licensed medical doctors who specialize in mental health. They are trained to assess, diagnose and treat mental health disorders, primarily through prescribing and monitoring medication treatment, they often do not provide “talk therapy”. Your visit with a psychiatrist may include a blood test, a physical assessment and a risk assessment. Psychologists can work at hospitals, private offices, or community health centres.

Mental health nurse

A psychiatric nurse is a registered nurse with specialised training in mental health. A psychiatric nurse assesses, supports and advocates for care. They typically assist and work with psychiatrists working in the public health care system. As part of their role they follow up with patients regarding medications, and needed supports.

Social workers

Social workers are dedicated to helping people navigate and solve issues in their lives which may be caused by relationship problems, adjustment issues, traumatic events, or disabilities, etc. Through case management, they redirect clients to resources that best support them. Social workers can be found in a variety of settings, such as schools, private offices, hospitals, community health centres, and non-profit organisations.

Counsellors

Counsellors are masters-level professionals. They aim to help people to understand the complex social welfare system and help to access resources which support a person’s wellbeing. They also receive basic counselling training and may be able to provide counselling to people in distress. Counsellors can be found at schools, hospitals, community health centres, and in private practice.

So what’s the difference between a counsellor and a psychologist?

Psychologists often have more formal education who are trained to diagnose and treat specific mental illnesses, whereas counsellors help people to process and cope with their mental health struggles.

Clinical psychologists

In general, psychologists have doctoral training qualifications; however, they are not medical doctors and do not prescribe medication. Clinical psychologists are specially trained to diagnose and treat mental illnesses through talk therapy, and they are the most common type of psychologist you would see for a mental health issue.

Educational psychologists

Educational psychologists are trained in teaching and education, focusing on learning-related issues. They work with students, parents, teachers, and support professionals to help students in the school setting. Psychologists can be found in places such as private offices, hospitals, and schools.

Where to seek help 

When seeking help for mental health issues, it can be intimidating or bothersome if we don’t understand how the system works. We gathered all the resources and made it as simple as possible to help you understand the differences between public and private healthcare systems when seeking help for mental health issues.

Public system

  • Public clinics/hospitals have clinicians who are primarily local, with many who have completed their education and training in HK.
  • Public services also tend to employ more short term therapists.
  • Procedure: Based on Hospital Authority, the below is the general routine to find the right mental health professional help:
    • Register an appointment to visit a general practitioner (GP). 
    • GP will refer you to a specialist as needed; assessments will be used to determine the urgency of the client’s case.
  • Cost: It is very affordable to get the help you need through the public sector as the government does subsidise heavily. However, it is compromised with long wait times. See the next section for waiting time.

Private system

  • From a cultural perspective private care is more aligned with western practices and culture.
  • Private clinics/hospitals are more likely to have clinicians who have completed their education and training abroad.
  • Procedure: You may get a referral from your GP OR you could also find a therapist on your own and schedule a consultation. If you decide to find your own therapist you will need to do some research to find a qualified therapist.
  • Cost: Private is significantly more expensive, a reason why the majority of the population cannot seek help as they believe it is unaffordable. A 1-hour session can range from $1500 – $3000.

What to expect

So what should I expect before I head for my first session?

Before you head to your first session, remember this initial visit to a professional is no different than a first appointment with a new general practitioner (or family doctor). It may be uncomfortable to talk about some of your concerns and experiences but it is an important first step to getting better.

What will we talk about during first session?

However, a small detail that could cause anxious feelings is the fact that your relationship with a therapist is important to help your recovery journey. It could be intimidating to spill all your deepest and “darkest” secrets to a stranger you barely know and the thought of bailing might even cross your mind. Just know that every therapist actually understands the nerves of your feelings and they’ll try their best to soothe you and make you feel comfortable. Regardless, whether you’re full of nerves or can’t wait to start blabbing away on that couch, your new therapist will be ready for you and perfectly able to meet you where you’re at. And if all you want to talk about during that first session is how nervous you are or how much you don’t want to be there, then that’s totally fine.

How does talking with a professional help my condition?

There are many types of “talk therapies” available depending on the mental health issues you are struggling with. One of the most commonly used one is Cognitive Behaviour Therapy (CBT), which focuses on challenging and changing unhelpful thought and behaviour patterns, while improving emotional regulation and developing helpful coping strategies.

So what will happen in the first session?

In your first session, you may be asked about:

  • Your mood, thoughts and behaviours 
  • Your lifestyle (friendships, school, intimate relationships, family relationships) 
  • Any recent events in your life that might be affecting your wellbeing 
  • Any changes to your sleep, diet and daily activities 
  • Your medical history 
  • If you are seeing a GP or a psychiatrist they may take your blood pressure, listen to your heart, as well as doing blood tests to explore any physical issues that may contribute to your emotions and behaviours

What about with a specific mental health professional? What questions do they ask?

With a specific mental health professional you may be asked:

  • How long have you been experiencing these problems or issues? 
  • What have you tried to do to cope with it? 
  • What do you think the trigger could be? 
  • How often are you suffering from it? 
  • What was your life like before this issue or problem was present?

Are there any other questions they would ask? What should I do if I don’t want to answer certain questions?

There are many other questions that a therapist will ask once you start talking about your presenting problem. They’ll start out pretty general and get more detailed as the sessions move forward. 

You’ll be asked to think about what’s going on and how you’re experiencing it. Some of it will feel really personal. A therapist needs to try to understand the triggers and causes of your struggles in order to figure out how they can help. If you ever feel like you don’t want to answer a question quite yet, speak up and say so.

With certain types of therapies or cases it may involve some homework. Just be aware that often therapy is most effective when you also put in the work outside of the office as well.

Often, a therapist will ask you what your goal is for therapy. It’s helpful to figure that out upfront. But it’s also okay if you don’t have a specific goal in mind when you start. There won’t be any pressure to try and define it early on.

  • Types of therapy
  • Confidentiality
    • Your conversations with your therapist are confidential. However, if they are concerned about your safety or the safety of others they will talk to you about disclosing to a trusted supporter (usually your parent/guardian if that is safe).
  • Goals of therapy
    • Give you the tools and strategies for navigating whatever is going on in your life — from stress or relationship issues to managing a mental health diagnosis
  • Process of therapy journey
    • Length of treatment 
    • Touch on it may get worse before it gets better
    • Mention every case is different, just because you are diagnosed with a psychological disorder does not indicate you can be generalised and treated like any other client that has the same condition as you.
  • Relapse 
    • We don’t expect recovery to happen overnight, and sometimes it’ll bounce back, making you think you haven’t made any progress. But this is certainly not the case. One thing we want you to take away from reading this booklet is to take the first step of speaking up and seeking help.

Emergency support

If you are experiencing strong levels of distress or trauma which are interfering with your life, remember that you do not have to face it alone, and that help is available.

For emergency support, please contact the hotlines below:

Emergency hotline: 999

The Samaritans 24-hour hotline (Multilingual): (852) 2896 0000

Samaritan Befrienders Hong Kong 24-hour hotline (Cantonese only): (852) 2389 2222

Suicide Prevention Services 24-hour hotline (Cantonese only): (852) 2382 0000

OpenUp 24/7 online emotional support service (English/Chinese): www.openup.hk

More support services can be found here: https://www.coolmindshk.com/en/emergency-hotlines/

More non-urgent support services can be found here: https://www.coolmindshk.com/en/communitydirectory/ 

Resources

Signs of Depression

We would like to acknowledge the Charlie Waller Memorial Trust (CWMT) UK for these resources and for allowing us to adapt this. For the original version of this resource, please refer to the CWMT website: www.cwmt.org.uk

Resources

Social Media and Teenagers

A practical approach

Dr John Coleman

This resource booklet has been localised for the Hong Kong context and translated to Traditional Chinese by Coolminds, a mental health initiative run by Mind HK and KELY Support Group. For more information on Coolminds, please visit www.coolmindshk.com

We would like to acknowledge the Charlie Waller Memorial Trust (CWMT) UK for these resources and for allowing us to adapt this. For the original version of this resource, please refer to the CWMT website: www.cwmt.org.uk

Is social media damaging the mental health of young people? It’s important to look behind the headlines.

There is no doubt that today social media is seen by adults as representing a major threat to young people. There is much debate in the press and in public about the so-called “evils” of the digital world, and the [British] Government has tasked medical experts with drawing up advice on the maximum amount of time young people should spend on social media.

Parents and professionals worry about the time spent online, about the content that is seen by teenagers, and about the possible temptations that abound in the online world. Newspaper headlines such as ‘Social media fuels rise in self-harm’ (Evening Standard), and ‘Girls unhappy, stressed and addicted to web’ (The Times) are commonplace.

The striking thing is that this anxiety is not experienced in the same way by young people themselves. By and large they are aware of the risks in the online world and believe that they are able to manage them. In my work with young people I ask them whether they see themselves as experiencing stress. They agree that the teenage years are a time of high stress, but not because of social media. The things they identify as stressful are tests, exams and pressure from school. They also talk about parental expectations, and sometimes pressure from friends. The digital world comes low down in their list of things that create stress and anxiety.

Mental health and social media

As indicated by the [British] newspaper headlines, many adults link the rise in mental health problems to the use of social media but it is really important to note that there is no reliable scientific evidence to support this link. It does appear to be the case that, certainly among teenage girls, mental health problems such as depression are on the rise, but there is no clear link between this and the use of social media.

Of course we cannot ignore the fact that there are teenagers who are vulnerable. These individuals may be isolated, they may have to deal with difficult family situations, or they may have experienced trauma of one sort or another. For these young people the internet may provide an outlet, or a safe place to go for support. The online world may provide a way of sharing experiences with others who are facing similar adversity. These individuals may be less able to manage the risks of the digital world, or they may more easily be drawn to some of the more dangerous internet sites. Professionals should be alert to these vulnerabilities, and do all they can to provide extra support in the use of social media and other internet activities for this group.

Threats and opportunities

It is important to be clear that the internet provides many positive experiences, not just for teenagers, but for those of all ages. These include:

  • Instant access to information
  • Ease of communication
  • A means of sharing and networking with groups of friends
  • A medium for an extraordinary range of creative activities, including art, music, design, and a multitude of other possibilities
  • A way of meeting new people
  • Access to the buying and selling of goods

These are just a few of the many positive opportunities that have been made possible by the internet and the online world. Of course it is also possible to construct a list of the opposites, the threats posed by the digital world. These [may] be familiar to readers, but they include such things as access to pornography, excessive gaming, sexting, gambling, being groomed, and so on. We must be clear that, as with any new technology, there are both positives and negatives. The online world is not going to go away, so the challenge for us is to do all we can to make it as safe a world as possible for our young people.

The role of parents

The first thing to say is that parents do have a role, and this role does not stop when the child moves to secondary school. Many parents believe that once the teenage years kick in, they are no longer important. This is partly because the young person appears to be more interested in their friends than in their parents, and partly because it is more difficult to find a role if a teenager is being rude, disrespectful and uncommunicative. However, the parent’s role is as significant during the teenage years as it is in the early years; it is just significant in a different way. All the evidence shows that outcomes for teenagers are better when the family remains involved, continuing to offer support and guidance during these sometimes difficult years.

There is another reason why parents are especially important at this time, and this is because it is not just the teenagers who are using social media! Parents too want to look at their phones at all times, they want to share images, purchase goods online, and generally access all the good things that the internet provides. Parents are digital role models, and their online behaviour is going to have an effect on the behaviour of their children and young people. You cannot expect your teenager to manage the digital world well if you are constantly looking at your phone!

Consider what is age appropriate

It goes without saying that the needs of children and young people will vary depending on their age. As a parent you are not going to treat a 16-year-old in the same way as you treat a 10-year-old. Broadly speaking we can say that the younger the child, the more support and guidance they need. However appealing online activities are, do try and restrict the use of screens for all ages, but particularly for the younger age groups. Do find alternative, non- technological activities, for children to enjoy.

It is useful to consider that there are particular ages where extra support may be necessary. One such group is the 10- to 13-year-olds as they first start to negotiate the online world on their own. Professionals have pointed out that the pressure to be popular, and to obtain as many “likes” as possible, is hard to resist at this stage when peer relationships are becoming especially important.

Although older teenagers may attempt to push adults away, it is critical that parents keep an eye on what is going on for this group. New and tempting games, sexual or violent content, pressure from certain websites, all these can in some circumstances lead to excessive use of the internet. Parents may feel it is hard to monitor online activities in this age group, but this should not hinder proper oversight. Even the most mature teenagers may sometimes find themselves pulled into behaviour that is not helpful. Parents should remain alert for any signs of inappropriate use of the digital world.

Screens at night

One of the most difficult challenges for parents relates to screens at night. However much the teenager protests, all the reliable advice is for parents to make sure that phones and other devices are switched off at night. In the best of circumstances all devices will be left outside the bedroom, and turned off about a half hour before bedtime. This gives the teenager time to wind down and prepare for sleep.

Scientific evidence shows clearly that good quality sleep is hugely important for young people. We now know that sleep is a time of memory consolidation, so that the quality of sleep will be directly related to the individual’s capacity to learn and memorise. We have also learnt that the body clock works slightly differently in teenagers than in adults, so many young people become sleepy later in the evening than their parents. Yet sleep is essential at this stage. The more parents can do to encourage good sleep routines, the better for the young person’s health and school work.

“Scientific evidence shows clearly that good quality sleep is hugely important for young people.”

A family digital strategy

Any approach by parents to the use of social media by young people has to involve the whole family. As I have noted, parents are role models, and it is no use making rules (such as no phones at mealtimes) if parents do not respect the rules themselves. It can be extremely helpful if the family as a whole works out some rules that everyone can get behind. Children and teenagers are more likely to accept structures that have been negotiated than ones that have been imposed.

Parents will make more progress if they accept that the online world has many opportunities to offer. Parents should work with their children to manage it sensibly. Many families find it helpful to have some non- technology time, sometimes called “digital detox”. Do try it – you may be surprised by the results.

Finally, remember the phase “digital resilience”. Too many adults think about the digital world as a threat. Yet this is not how it is seen by young people. It is the responsibility of adults, both parents and professionals, to help children and teenagers develop the skills they need to navigate the online world in safety. They need help to develop digital resilience. If we try we can all contribute to this. Good luck!

“It can be extremely helpful if the family as a whole works out some rules that everyone can get behind.”

Ten top tips for a digitally healthy household

  1. Remember – the younger the child, the more support and guidance they’ll need
  2. Be aware that extra support may be needed at certain ages, such as 10 – 13
  3. Find non-technological activities for children to enjoy
  4. Stay alert for any signs of inappropriate use of the digital world
  5. Make sure devices are switched off at night and for half an hour before bedtime
  6. Work out some rules together…
  7. …and respect the rules yourself!
  8. Be aware of the positives as well as the negative side of technology
  9. Have a regular family digital detox
  10. Aim for ‘digital resilience’

Dr John Coleman is a distinguished psychologist and co-author of the book ‘Parents and Digital Technology’.

Resources

Perfectionism: When Striving for Excellence Becomes Unhealthy

By Professor Roz Shafran

This leaflet is based on work conducted by Prof. Roz Shafran in collaboration with Prof. Tracey Wade and Dr Sarah Egan.

This resource booklet has been localised for the Hong Kong context and translated to Traditional Chinese by Coolminds, a mental health initiative run by Mind HK and KELY Support Group. For more information on Coolminds, please visit www.coolmindshk.com

We would like to acknowledge the Charlie Waller Memorial Trust (CWMT) UK for these resources and for allowing us to adapt this. For the original version of this resource, please refer to the CWMT website: www.cwmt.org.uk

Some years ago Jessica Lahey wrote in the New York Times: “We all know perfection is an unreasonable burden to place on our children but we also reward them when they strive for that perfection.” Her article was an attempt to understand the complex nature of perfectionism in today’s world where achievement is valued at almost any price.

So what does unhealthy perfectionism look like and what is the distinction between such perfectionism and ‘healthy striving for excellence’? People with a healthy striving for excellence have very high standards but the standards are potentially achievable; when they do not reach their goals, people with healthy striving for excellence are able to stand back and reflect objectively on their mistakes so that they can learn from them. They are able to tolerate uncertainty and don’t react to their failure with intense self-criticism.

“People with unhealthy perfectionism react to mistakes in an extreme and highly self-critical manner and are very uncomfortable with uncertainty.”

“People with a healthy striving for excellence have very high standards but the standards are potentially achievable”.

‘Tyranny of the Shoulds’

People with unhealthy perfectionism often have the same very high standards but the standards are not realistic or only attainable with significant negative consequences; such people react to mistakes in an extreme and highly self- critical manner and are very uncomfortable with uncertainty. The self-esteem of such perfectionists is almost exclusively dependent on striving and achievement but they constantly perceive themselves to have failed and live in fear of such failure and what it means for them. Such perfectionism was described almost seventy years ago as the “Tyranny of the Shoulds” (Horney, 1950). A few years later, Hollender (1965) painted the following clinical picture of perfectionism:

“The perfectionist finds it difficult to sort out items in order of their importance or to maintain a sense of proportion. A small detail that has been missed may deprive him of gratification from a job otherwise well done. He is constantly on the alert for what is wrong and seldom focuses on what is right. He looks so intently for defects or flaws that he lives his life as though he were an inspector at the end of a production line.” (p. 95)

Spotting unhealthy perfectionism

It is not always easy to detect this unhealthy perfectionism and very often people themselves do not consider it to be a problem. Instead, it can cause difficulties for those around them. The area in which the perfectionism is expressed is also very important.

Unhealthy perfectionism applied in the domain of work may lead to someone being labelled as a ‘workaholic’ but the same type of perfectionism applied in the domain of dieting and weight loss may lead to an eating disorder. Typically such perfectionism is applied across many areas of life and can cause multiple difficulties. We know that perfectionism of this sort is associated with depression as well as other difficulties such as eating disorders, anxiety, chronic fatigue syndrome, obsessive compulsive disorder and low self-esteem. Unlike depression, ‘perfectionism’ is not a diagnosis and it can sometimes be difficult for an outsider to spot. Some questions to help spot when perfectionism is a problem are:

“Unhealthy perfectionism applied in the domain of work may lead to someone being labelled as a ‘workaholic’.”

  • How hard are you pushing yourself to meet your goals?
  • Do you tend to focus on what you have not achieved rather than what you have achieved?
  • Do other people tell you that your standards are too high?
  • Do you feel a failure as a person because you have not succeeded in meeting your goals?
  • Are you afraid that you might not reach your standards?
  • Do you raise your standards after meeting them?
  • Do you judge yourself on your ability to meet your standards?
  • Do you repeatedly check how well you are doing at meeting your standards (for example, by comparing yourself to others?)
  • Do you keep on trying to meet your standards even if you miss out on other things?
  • Do you react to small mistakes with intense self- criticism?
  • Do you avoid tests of your performance in case you fail?

These questions can help detect when perfectionism is interfering with functioning and is likely to be associated with low mood and anxiety.

Other types of perfectionism

There are other types of perfectionism that might also be posing a problem such has having high standards for other people and constantly feeling let down. Similarly, some people erroneously believe that other people have high standards for them and that they feel they are constantly letting other people down. In some cases, people are focused on the need to appear perfect and in others their perfectionism may predominantly be focused in an area such as sport or religion.

Treating perfectionism

Until relatively recently, no treatment for perfectionism had been developed, partly due to the suggestion that perfectionism was an unchangeable personality characteristic. However, in 2002 the Oxford Centre for Eating Disorders (where I was fortunate to be working) proposed a cognitive-behavioural approach to perfectionism (Shafran, Cooper & Fairburn, 2002). Although it was controversial, it paved the way for research and multiple studies have now shown that the treatment based on this approach is effective both in terms of reducing perfectionism but also with respect to the impact that the treatment has on other difficulties such as depression and anxiety.

The treatment can be delivered individually, in groups, using a self-help book or over the internet. Some of the key treatment strategies are:

  • Understanding what maintains the perfectionism. It is helpful to understand the causes of the perfectionism but, like other cognitive behavioural approaches, the focus is on the factors that keep the perfectionism going.
  • Dispelling myths. For example, many people believe ‘the harder I work, the better I will do’ but there comes a point at which over-working may backfire and cause a deterioration in performance due to tiredness (for example).
  • Conducting surveys to be able to get information about others’ standards to enable benchmarking.
  • Testing out beliefs using ‘behavioural experiments’. For example, if a person thinks that they will fail an assignment if they do less than eight hours work, he/she would be encouraged to do seven hours work and to use that extra hour to do something enjoyable instead; gradually the amount of work would be reduced and the person would learn that three to four hours is sufficient for that type of assignment.
  • Addressing ‘all-or-nothing’ thinking by helping the person realise the shades of grey between ‘success’ and ‘failure’.
  • Trying to rebalance attention so that it isn’t always focused on the negative.
  • Helping with self-criticism by increasing compassion towards oneself and having the same expectations for themselves and others.
  • Dealing with avoidance, procrastination and other related problems such as poor time management; problem-solving strategies such as the ones described by Christine and Arthur Nezu can be particularly helpful (and problem-solving is also an effective intervention for depression!)

The future

We have come a long way in our understanding of perfectionism and in developing interventions that work. However, there remains a great deal of work to do so that we can help people with a wide variety of forms of perfectionism and to see whether the interventions work for children and young people. We also need to make sure that people can access the treatments that they need in a timely way. I am hopeful that such ambition reflects healthy striving for excellence and an achievable goal, but only time will tell….

Further reading

Nezu, A. M., Nezu, C. M., D’Zurilla, T. J. (2007) Solving Life’s Problems: A 5-step Guide to Enhanced Well- being.

Shafran, R., Egan, S., & Wade, T. (2018). Overcoming Perfectionism 2nd Edition: A self-help guide using scientifically supported cognitive behavioural techniques. Robinson.

Shafran, R., Egan, S. & Wade, T. (2012) Changing Perfectionism: This booklet describes ‘clinical perfectionism’ and its link with how people evaluate themselves.

References

Hollender, M. H. (1965). Perfectionism. Comprehensive psychiatry, 6(2), 94-103.

Horney, K. (1950). The Collected Works of Karen Horney: Self analysis. Neurosis and human growth (Vol. 2). WW Norton.

Shafran, R., Cooper, Z., & Fairburn, C.G. (2002). Clinical perfectionism: A cognitive–behavioural analysis. Behaviour research and therapy, 40(7), 773-791.

About the author

Roz Shafran is a Professor of Translational Psychology at University College London and a Chartered Clinical Psychologist. She is a Trustee of the Charlie Waller Memorial Trust and founded the Charlie Waller Institute of Evidenced Based Psychological Treatment at the University of Reading.

She is also co-author of ‘Overcoming Perfectionism: a self-help guide using scientifically supported cognitive behavioural techniques’.

Resources

Bipolar Disorder Symptoms

This resource booklet has been localised for the Hong Kong context and translated to Traditional Chinese by Coolminds, a mental health initiative run by Mind HK and KELY Support Group. For more information on Coolminds, please visit www.coolmindshk.com

Thank you to the Black Dog Institute for donating their resources and for allowing us to adapt this. For the original version of this resource, please refer to the Black Dog Institute’s website: www.blackdoginstitute.org.au

What this fact sheet covers:

  • What is bipolar disorder
  • Sub-types of bipolar disorder
  • Symptoms of bipolar disorder
  • When to seek help for bipolar disorder
  • Key points to remember
  • Where to get more information

What is bipolar disorder?

  • Bipolar disorder is the name used to describe a set of ‘mood swing’ conditions, the most severe form of which used to be called ‘manic depression’.
  • The term describes the exaggerated swings of mood, cognition and energy from one extreme to the other that are characteristic of the illness.
  • People with this illness suffer:
    • Recurrent episodes of high, or elevated moods (mania or hypomania) and depression.
    • Most experience both the highs and the lows.
    • Occasionally people can experience a mixture of both highs and lows at the same time, or switch during the day, giving a ‘mixed’ picture of symptoms.
    •  A very small percentage of sufferers of bipolar disorder only experience the ‘highs’.

People with bipolar disorder experience normal moods in between their mood swings.

  • The mood swings pattern for each individual is generally quite unique, with some people only having episodes of mania once a decade, while others may have daily mood swings.
  • Bipolar disorder can commence in childhood, but onset is more common in the teens or early 20’s.
  • Some people develop ‘late onset’ bipolar disorder, experiencing their first episode in mid-to-late adulthood.

Distinguishing between bipolar I and bipolar II

  • Bipolar I disorder is the more severe disorder, in the sense that individuals are more likely to experience ‘mania’, have longer ‘highs’ and to have psychotic episodes and be more likely to be hospitalised.
  • Mania refers to a severely high mood where the individual often experiences delusions and/ or hallucinations. The severe highs which are referred to as ‘mania’ tend to last days or weeks.
  • Bipolar II disorder is defined as being less severe, in that there are no psychotic features and episodes tend to last only hours to a few days; a person experiences less severe highs which are referred to as ‘hypomania’ and depression but no manic episodes and the severity of the highs does not usually lead to hospitalisation.
  • Hypomania literally translates into ‘less than mania’. It describes a high that is less severe than a manic episode and without any delusions and/or hallucinations.
  • These highs don’t last as long. While they are officially diagnosed after a four-day duration, research has shown that they may only last a few hours to a few days.
  • Both women and men develop bipolar I disorder at equal rates, while the rate of bipolar II disorder is somewhat higher in females.

Symptoms of bipolar disorder

  • Diagnosing bipolar disorder is often not a straightforward matter.
  • Many people go for 10 years or more before their illness is accurately diagnosed.
  • It is important to note that everyone has mood swings from time to time. It is only when these moods become extreme and interfere with a person’s personal and professional life that bipolar disorder may be indicated and medical assessment sought.
  • There are two starting points for considering whether you might have bipolar disorder.
    • Firstly, you must have had episodes of clinical depression.
    • Secondly, you must have had ‘highs’, where your mood was more ‘up’ than usual, or where you felt more ‘wired’ and ‘hyper’.
  • If both depression and ‘highs’ have been experienced, then the next thing to consider is whether you also experienced any of the six key features of mania and hypomania outlined below.

Key features of mania & hypomania

While it can be difficult to identify what separates normal ‘happiness’ from the euphoria or elevation that is seen in mania and hypomania, researchers at the Black Dog Institute, have identified the following distinguishing features:

  • High energy levels – feeling ‘wired’ and ‘hyper’, extremely energetic, talking more and talking over people, making decisions in a flash, constantly on the go and feeling less need for sleep.
  • Positive mood – feeling confident and capable, optimistic that one can succeed in everything, more creative, happier, and feeling ‘high as a kite’.
  • Irritability – irritable mood and impatient and angry behaviours.
  • Inappropriate behaviour – becoming over involved in other peoples’ activities, engaging in increased risk taking (i.e. by over indulging in alcohol and drugs and gambling excessively) saying and doing outrageous things, spending more money, having increased libido; dressing more colourfully and with disinhibition.
  • Heightened creativity – ‘seeing things in a new light’, seeing things vividly and with crystal clarity, senses are heightened and feeling quite capable of writing the ‘next great novel’.
  • Mystical experiences – believing that there are special connections between events, that there is a higher rate of coincidence between things happening, feeling at one with nature and appreciating the beauty and the world around, and believing that things have special significance.
  • More extreme expressions of mania (but not hypomania) may have the added features of delusions and hallucinations.
  • A number of other symptoms can indicate whether there is a likely diagnosis of bipolar disorder, particularly for those under the age of 40. These include:
    • Racing thoughts (for example, feeling like you are watching a number of different TV channels at the same time, but not being able to focus on any)
    • Sleeping a lot more than usual
    • Feeling agitated, restless and/or incredibly frustrated.

When to seek help for bipolar disorder

  • If you have experienced an episode of mania or hypomania, or have taken the Black Dog Institute’s Bipolar Disorder Self-Test, linked under the resources at the end of this fact sheet, and are concerned about your results, it is advisable to seek professional assessment by a mental health practitioner.
  • The first step is to arrange a consultation with your doctor. They will provide an assessment and, where necessary, refer you to a psychiatrist for further treatment.
  • Bipolar disorder is not an illness which goes away of its own accord, but one which often needs long-term treatment. Accurately diagnosing bipolar disorder is a task for the mental health professional.
  • Some people with bipolar disorder can become suicidal. It is very important that talk of suicide be taken seriously and for such people to be treated immediately. In an emergency you can go straight to your local hospital’s emergency department for help, or dial 999.

Key points to remember

  • Bipolar disorder is an illness involving exaggerated swings of mood and energy from one extreme to the other, usually involving alternating periods of depression and mania or hypomania.
  • The pattern of mood swings for each individual is quite unique.
  • The six features of mania and hypomania are:
  1. High energy levels
  2. Positive mood
  3. Irritability
  4. Inappropriate behaviour
  5. Heightened creativity
  6. Mystical experiences
  • For people under the age of 40, other symptoms of bipolar disorder may include sleeping a lot more than usual, feeling agitated, restless and/or incredibly frustrated.
  • Accurately diagnosing bipolar disorder is a task for a skilled mental health practitioner.
  • If symptoms of bipolar disorder are suspected it’s best to first see a doctor, who will likely refer you to a psychiatrist.
  • People with bipolar disorder can become suicidal. Talk of suicide should be taken seriously and immediate help should be sought from a doctor or other mental health professional.

Contact Us

Coolminds

Email: hello@coolmindshk.com

Black Dog Institute

Email: blackdog@blackdog.org.au

Where to get more information and support

Black Dog Institute – “Bipolar Disorder Self-Test”

Mind Hong Kong – “What Is Bipolar Disorder?”

Bilingual Telephone Hotlines

Hospital Authority Mental Health 24-hour Hotline: 2466 7350

Social Welfare Department Hotline: 2343 2255

Chinese-Only Telephone Hotlines

Youth Outreach 24-hour hotline service: 90881023

The Hong Kong Federation of Youth Groups “Youthline” hotline (available Mon-Sat, 2pm-2am): 27778899

Resources

Seeking Help for Anxiety

This resource booklet has been localised for the Hong Kong context and translated to Traditional Chinese by Coolminds, a mental health initiative run by Mind HK and KELY Support Group. For more information on Coolminds, please visit www.coolmindshk.com

Thank you to the Black Dog Institute for donating their resources and for allowing us to adapt this. For the original version of this resource, please refer to the Black Dog Institute’s website: www.blackdoginstitute.org.au

What this fact sheet covers:

  • Why seek help for anxiety?
  • Who to talk to
  • Treatment available

It’s important to get treatment for anxiety

Anxiety is physically and emotionally exhausting. Getting help early means you can start to get relief and recover sooner. There are many professionals who treat all kinds of anxiety.

There is a wide range of effective treatments for anxiety, e.g.

  • Cognitive behavioural therapy (CBT)
  • E-mental health tools
  • Relaxation techniques
  • Medications

There are also lots of things you can do to help yourself.

Often, it’s a combination of things that help us get better, such as:

  • A well-informed health professional you feel comfortable talking to
  • The right psychological and medical therapies
  • Support from family and friends
  • Exercising and healthy eating
  • Learning ways to manage challenges and stress, such as structured problem solving, meditation and yoga

How do I know it’s anxiety?

Severe anxiety can appear in ways that feel like other health issues, e.g.

  • Chest pain
  • A racing heartbeat
  • Dizziness
  • Rashes

Sometimes, anxious people think they’re having a heart attack.

When we’re anxious, we can also become hyper-aware of:

  • Our body
  • Aches and pains
  • Perceived threats and danger

Sometimes, once we’re aware of a problem, we can become ‘hyper-vigilant’ in checking on all the discomforts and pains we feel. This can spiral into feeling more concern and worry, making the anxiety more severe.

You should always see a doctor, so they can make a thorough check of your symptoms and rule out any other medical condition.

Who can provide help for anxiety?

As well as your doctor, there are other health professionals who can help with anxiety, including:

  • Psychologists
  • Psychiatrists
  • Counsellors
  • School and university counsellors
  • Social workers and occupational therapists trained in mental health
  • Mental health nurses

What type of treatment is available?

There are three broad categories of treatment for anxiety:

  • Psychological treatments (talking therapies)
  • Physical treatments (medications)
  • Self-help and alternative therapies

Psychological therapies are the most effective way to treat and prevent the recurrence of most types of anxiety. Depending on the type of anxiety, self-help and alternative therapies can also be helpful. They can be used alone or combined with physical and psychological treatments.

A thorough assessment by your doctor is needed to decide on the best combination of treatments for you.

Psychological treatments

Psychological treatments can be one-on-one, group-based or online interactions. Psychological treatments are sometimes called ‘talking therapies’ as opposed to ‘chemical therapies’ (i.e. medications).

Talking therapies can help us change habits in the way we think, and cope better with life’s challenges. They can help us address the reasons behind our anxiety, and also prevent anxiety from returning.

There are a wide range of psychological treatments for anxiety, including:

  • Cognitive behaviour therapy (CBT)
  • Exposure therapy (behaviour therapy)
  • Interpersonal therapy (IPT)
  • Mindfulness-based cognitive therapy
  • Positive psychology
  • Psychotherapies
  • Counselling
  • Narrative therapy

Some of the above treatments can be accessed online. Evidence-based online treatments can be as effective as face-to-face treatments. These online treatments are often referred to as e-mental health programs.

Physical treatments

Your doctor should undertake a thorough health check before deciding whether medication is a good option for you. Taking medication for anxiety must be supervised by a doctor. If medication is prescribed as part of your treatment, your doctor should explain the reason for choosing the medication they’ve prescribed.

Your doctor will:

  • Discuss the risks and benefits, side effects, and how regularly you need check-ups.
  • Advise what treatments can work together with the medication, such as psychotherapy, lifestyle changes (e.g. exercise) and other support options.

Anti-anxiety medications are used for very severe anxiety in anxiety types such as:

  • Panic disorder
  • Generalised anxiety disorder (GAD)
  • Social phobia

Anti-anxiety medications, such as benzodiazepines, can:

  • Be addictive
  • Become ineffective over time
  • Have other side effects such as headaches, dizziness and memory loss

Anti-anxiety medications are not recommended for long-term use.

It’s important to know that not all anxiety needs medication. Many people respond well to lifestyle changes and psychological treatments.

Self-help and alternative therapies

There are a wide range of self-help measures and therapies that can be useful for anxiety. It’s good to know that there are things you can do for yourself to feel better.

Self-help and complementary therapies that may be useful for anxiety include:

  • Exercise
  • Good nutrition
  • Omega-3
  • Meditation
  • De-arousal strategies
  • Relaxation and breathing techniques
  • Yoga
  • Alcohol and drug avoidance
  • Acupuncture

Different types of anxiety respond to different kinds of treatments. Severe anxiety may not respond to self-help and alternative therapies alone. These can be valuable adjuncts to psychological and physical treatments.

e-mental health programs

e-mental health programs can be used in conjunction with a mental health professional or as a stand-alone option. e-mental health programs (also called ‘e-therapies’ or ‘online therapies’) are online mental health treatment and support services. You can access them on the internet using your smartphone, tablet or computer. The programs can help people experiencing mild-to- moderate depression or anxiety.

Some e-mental health tools, such as myCompass developed by the Black Dog Institute, have been found to be as effective in treating mild-to- moderate depression as face-to-face therapies.

e-mental health treatments are based on face-to-face therapy, positive psychology and behavioural activation. These therapies mainly focus on reframing thoughts and changing behaviour.

Key points to remember

  • Lots of professionals can help you with anxiety
  • There are many types of treatments for anxiety, and you can get better
  • Many people who have had anxiety have been able to seek help and live active, fulfilling lives

Contact Us

Coolminds

Email: hello@coolmindshk.com

Black Dog Institute

Email: blackdog@blackdog.org.au

Where to get more Information and Support

Black Dog Institute – “myCompass”

Student Health Services – “Understanding Anxiety Disorders”

OCD & Anxiety Support Hong Kong

Mind Hong Kong – “Anxiety and Panic Attacks”

The Mental Health Association of Hong Kong:

Phone: 2528 0196
Website: www.mhahk.org.hk

Resources

Helping Someone Who Has a Mental Illness: For Family and Friends

This resource booklet has been localised for the Hong Kong context and translated to Traditional Chinese by Coolminds, a mental health initiative run by Mind HK and KELY Support Group. For more information on Coolminds, please visit www.coolmindshk.com

Thank you to the Black Dog Institute for donating their resources and for allowing us to adapt this. For the original version of this resource, please refer to the Black Dog Institute’s website: www.blackdoginstitute.org.au

What this fact sheet covers:

  • How to tell if someone has a mental illness
  • What to do if you are concerned about a family member or close friend
  • How to behave with someone who is depressed
  • What to do if someone is suicidal
  • Self care for carers
  • Key points to remember
  • Further information and support

Someone with a mood disorder is like anyone with any other illness – they need care and support.

Family and friends can provide better care if they are informed about the illness, understand the type of treatment and are aware of the expected recovery time.

How to tell if someone has a mental illness

Even if you know someone well, you will not always notice when they have changed. You are more likely to notice big or sudden changes but gradual changes can be easy to miss. It’s also true that people will not always reveal all their thoughts and feelings to their close friends and family.

For these reasons, family and friends cannot expect to always know when someone has a depressive illness and should not feel guilty that they ‘did not know’.

The best approach is to acknowledge that mental illnesses are common and to learn how to recognise the signs and how to offer help.

What to do if you are concerned about a family member or close friend

If you are worried that a family member or close friend has a mood disorder, try talking to them about it in a supportive manner and either suggest that they consult their doctor or another mental health professional.

Sometimes they may be reluctant to seek help. You might need to explain why you’re concerned and provide specific examples of their actions or behaviour that are worrying you. Providing them some information such as a book, fact sheets or helpful pamphlets might also help.

You could offer to assist them in seeking professional help by:

  • Finding someone that they feel comfortable talking to.
  • Making an appointment for them on their behalf.
  • Taking them to the appointment on the day
  • Accompanying them during the appointment if appropriate.

This level of help may be particularly appropriate if the person has a severe mood disorder such as psychotic depression or mania.

Young people, adolescents in particular, are vulnerable to mental health problems. If you are concerned about someone, try:

  1. Gently let them know you have noticed. changes and explain why you are concerned
  2. Find a good time to talk when there are no pressures or interruptions.
  3. Listen and take things at their pace
  4. Respect their point of view.
  5. Validate what they are experiencing, but don’t offer reassurance or advice too quickly
  6. Let them know that there is help available that will make them feel better.
  7. Encourage them to talk to a doctor or other health professional, and to find a trusted friend or family member that they can confide in.

There are also a range of services (e.g. telephone counselling and online resources) that are specifically designed for young people. You can find out more about what is provided in Hong Kong on the Coolminds website.

How to behave with someone who is depressed

Patience, care and encouragement from others are vital to a person who is experiencing depression. Someone experiencing depression is very good at criticising themselves and needs support from others, not criticism.

Clear and effective communication within the household or family is also important. Partners or families might find it helpful to see a psychologist during this time for their own support.

An episode of depression can provide an opportunity for family members to re-evaluate the important things in life and resolve issues such as grief or relationship difficulties.

Some Tips:

  • Avoid suggesting to the person that they “cheer up” or “try to get over it”. This is unhelpful as it is likely to reinforce their feelings of failure or guilt.
  • Another important part of caring is to help the treatment process – if medication has been prescribed, encourage the person to persist with treatment and to discuss any side effects with their prescribing doctor.
  • The person may also need encouragement and help to get to their therapy appointments or complete any online therapy exercises they have been asked to do.
  • During a depressive illness, counselling or psychotherapy often results in the person working through their life events and relationships; while this can be difficult for all concerned, friends and family should not try to steer the person away from these issues.

What to do if someone is suicidal

If someone close to you is suicidal or unsafe, try:

  • Talking to them about it and encourage them to seek help.
  • Remembering that if someone is feeling like their life is not worth living, they are experiencing overwhelming emotional distress.
  • Helping the person to develop a safety plan involving trusted close friends or family members that can keep the person safe in times of emergency.
  • Removing risks (e.g. take away dangerous weapons or items if that person is angry or out of control and threatening to disappear).

Self care for carers

(A carer is someone who provides support to a friend, family member, or neighbor in need of help because of their age, disability, or physical or mental health.)

  • Carers are also likely to experience stress. Depression and hopelessness have a way of affecting the people around them.
  • Therapy can release difficult thoughts and emotions in carers too. So, part of caring is for carers to look after themselves to prevent becoming physically run down and to deal with their internal thoughts and emotions.
  • Treatment has a positive time as well; when the person starts to re-engage with the good things in life and carers can have their needs met as well.

Key points to remember

  • If you are worried that someone is depressed or has bipolar disorder, try talking to them about it in a supportive manner and suggest that they see a mental health professional.
  • If they don’t want to seek help, explain the reasons for concern and perhaps provide them with some relevant information.
  • Young people are particularly vulnerable to depression.
  • Patience, care and encouragement from others are all vital to the person who is depressed.
  • If a loved one talks of suicide, encourage them to seek help immediately from a mental health professional.
  • Depression can take a toll on carers and close family members – it is important for these people to take care of themselves as well.

Contact Us

Coolminds

Email: hello@coolmindshk.com

Black Dog Institute

Email: blackdog@blackdog.org.au

Where to get more help and support

Bilingual Web Resources

Mind Hong Kong – “Am I A Carer?”

Mind Hong Kong – “What Can Friends and Family Do To Help?”

Student Health Service – “Understanding Depression”

Student Health Service – “Emotional Health”

English-Only Web Resources

Reach Out: a web-based support for adolescents

Headspace online: help for young people

Bilingual Telephone Hotlines

Samaritans Hong Kong 24-hour hotline: 28960000

Samaritan Befrienders Hong Kong 24-hour hotline: 23892222

Suicide Prevention Services 24-hour hotline: 23820000

Suicide Prevention Services “Youth Link” hotline (available 2pm-2am): 2382 0777

Hospital Authority Mental Health 24-hour Hotline: 2466 7350

Social Welfare Department Hotline: 2343 2255

Chinese-Only Telephone Hotlines

Youth Outreach 24-hour hotline service: 90881023

The Hong Kong Federation of Youth Groups “Youthline” hotline (available Mon-Sat, 2pm-2am): 27778899

Resources

Depression in Adolescents & Young People

This resource booklet has been localised for the Hong Kong context and translated to Traditional Chinese by Coolminds, a mental health initiative run by Mind HK and KELY Support Group. For more information on Coolminds, please visit www.coolmindshk.com


Thank you to the Black Dog Institute for donating their resources and for allowing us to adapt this. For the original version of this resource, please refer to the Black Dog Institute’s website:
www.blackdoginstitute.org.au

What this fact sheet covers:

  • Signs of depression in adolescence
  • Where to get help for an adolescent
  • Key points to remember
  • Where to get more information

Introduction

  • A 2017 study by the Hong Kong Federation of Youth Groups found that of the 3,441 secondary school and university students surveyed, 51% displayed symptoms of depression and close to 40% experienced high levels of stress (7 on a scale of 10).
  • According to research done by the University of Hong Kong, more than two-thirds of Hong Kong’s university students experience symptoms of mild to severe depression.
  • The HKJC Centre for Suicide Research and Prevention observed that suicide rates for full-time students increased by 76% between 2012 and 2016.
  • Onset of depression is typically around mid-to-late adolescence, and it is important to recognise the early warning signs and symptoms. Early intervention can often prevent the development of severe depressive illness.

Developmental Impact

  • The teenage years are a time when individuals develop their identity and sense of self.
  • If depression is left to develop, it can lead to isolation from family and friends, risk-taking behaviours such as inappropriate sexual involvements and drug and alcohol abuse.
  • It can also impact on school performance and study, which can have downstream effects on later career or study options.
  • Both biological and developmental factors contribute to depression in adolescence. If bipolar disorder or psychosis is suspected, an assessment by a health professional is recommended. See our Fact Sheet “Symptoms of Bipolar Disorder” for more information.

Signs of depression in an adolescent

  • An adolescent who is depressed may not show obvious signs of depression.
  • It is often hard to distinguish adolescent turmoil from depressive illness, especially when the young person is forging new roles within the family and struggling with independence, and having to make academic and career decisions.
Signs of a depressed mood include:
  • Lowered self-esteem (or self-worth)
  • Changes in sleep patterns, that is, insomnia (inability to sleep), hypersomnia (excessive sleep) or broken sleep
  • Changes in appetite or weight
  • Inability to control emotions such as pessimism, anger, guilt, irritability and anxiety
  • Varying emotions throughout the day. For example, feeling worse in the morning and better as the day progresses.
  • Reduced capacity to experience pleasure: inability to enjoy what’s happening now, not looking forward to anything with pleasure such as hobbies or activities.
  • Reduced pain tolerance: decreased tolerance for minor aches and pains
  • Poor concentration and memory
  • Reduced motivation to carry out usual tasks
  • Lowered energy levels

Where to get help for an adolescent

  • If you think someone you are close to might be depressed, you should encourage them to seek advice from a professional. (At school – school counsellor, social worker. Outside school – doctor, counsellor, psychologist)
  • The first step is to speak to a professional who can conduct an assessment, provide options and discuss the next steps to take.
  • Other initial sources of help are school counsellors and trusted close family members to whom the young person feels comfortable talking.
  • If the young person does not want to seek help, it is best to explain your concerns and to provide them with some information to read about depression.
  • There are also some excellent websites designed for young people, as well as confidential online and telephone counselling services in both English and Chinese. Please see our list of services at the end of this fact sheet.
  • It’s important for young people to know that depression is a common problem and that there are people who can help.
  • If there is any mention of suicide this should be taken seriously, and immediate assistance is available by calling 999 or going directly to the nearest hospital.

Key points to remember

  • A 2017 study by the Hong Kong Federation of Youth Groups found that of the 3,441 secondary school and university students surveyed, 51% displayed symptoms of depression and close to 40% experienced high levels of stress (7 on a scale of 10).
  • Depression in young people is associated with social withdrawal, drops in performance at school, drug or alcohol use and engaging in risky behaviours.
  • It can be hard to distinguish depression from adolescent turmoil; if depression is suspected, an assessment should be sought from a doctor or other mental health professional.
  • Immediate help should be sought if a young person talks of suicide.

Contact Us

Coolminds

Email: hello@coolmindshk.com

Black Dog Institute

Email: blackdog@blackdog.org.au

Where to get more Information and Support

Mind Hong Kong – “What Is Depression?” 

Student Health Service – “Understanding Depression”

Student Health Service – “Emotional Health”

Bilingual Telephone Hotlines

Samaritans Hong Kong 24-hour hotline: 28960000

Samaritan Befrienders Hong Kong 24-hour hotline: 23892222

Suicide Prevention Services 24-hour hotline: 23820000

Suicide Prevention Services “Youth Link” hotline (available 2pm-2am): 2382 0777

Hospital Authority Mental Health Direct hotline: 24667350

Chinese-Only Telephone Hotlines

Youth Outreach 24-hour hotline service: 90881023

The Hong Kong Federation of Youth Groups “Youthline” hotline (available Mon-Sat, 2pm-2am): 27778899

Resources

Causes of Depression

This resource booklet has been localised for the Hong Kong context and translated to Traditional Chinese by Coolminds, a mental health initiative run by Mind HK and KELY Support Group. For more information on Coolminds, please visit www.coolmindshk.com

Thank you to the Black Dog Institute for donating their resources and for allowing us to adapt this. For the original version of this resource, please refer to the Black Dog Institute’s website: www.blackdoginstitute.org.au

What this fact sheet covers:

  • Factors involved in developing depression
  • Key points to remember
  • Where to get more information

Introduction

Unlike other illnesses or disorders, there is no simple explanation as to what causes depression.

In general, depression can be due to a number of factors including stresses which can range from mild to severe, combined with vulnerability or predisposition to depression that can result from biological, genetic or psychological factors.

Each type of depression is associated with different mixtures of causes. For psychotic or melancholic depression, physical and biological factors are relevant. In contrast, for non-melancholic depression, the role of personality and stressful life events are important.

Genetic factors

There is strong evidence that genetic factors play a significant role in a person’s predisposition towards developing depression, especially melancholic depression, psychotic depression and bipolar disorder. No single gene is likely to be responsible, but rather a combination of genes.

The predisposition to develop depression can be inherited. The genetic risk of developing clinical depression is about 40% if a biological parent has been diagnosed with the illness, with the remaining 60% being due to factors within the individual’s own environment. Depression is unlikely to occur without stressful life events, but the risk of developing depression as a result of such an event is strongly genetically determined.

Biochemical Factors

Our knowledge of the human brain is still fairly limited, therefore we do not really know what actually happens in the brain to cause depression. It is likely that with most instances of clinical depression, neurotransmitter function is disrupted. Neurotransmitters are chemicals that carry signals from one part of the brain to the next. There are many neurotransmitters serving different purposes. However, three important ones that affect a person’s mood are serotonin, noradrenaline and dopamine.

In normal brain function, neurotransmitters interact with a series of nerve cells, with the signal being as strong in the second and subsequent cells as it was in the first. However, in people who are depressed, mood regulating neurotransmitters fail to function normally, so that the signal is either depleted or disrupted before passing to the next nerve cell.

Physical Illness

In a simple sense, physical illness can lead to depression through the lowered mood that we can all experience when we are unwell, in pain or discomfort, confined and less able to do the things we enjoy.

Illness can also change the body’s functioning in a way that leads to depression. Even if the illness isn’t making us feel down we can still suffer from depression. For example:

  • It is known that certain cancers can produce a depressive illness – in these cases a person might be quite unaware that they are suffering from depression.
  • Compromised immune functioning might play a part in the emergence of depression, although further research is needed to establish this link.
The ageing brain

As we age, our brain’s general functioning can become compromised and this can affect the neurotransmitter pathways which influence mood state. Three reasons for these changes are worth mentioning in relation to depression:

  • Late onset depression: Elderly people who develop dementia may also develop a severe depression for the first time; this type of depression is commonly of a psychotic or melancholic type and reflects the disruption of circuits linking certain basal ganglia and frontal regions of the brain.
  •  These brain changes can reflect an ageing process, particularly in people who are vulnerable to this kind of ‘wear and tear’.
  • In others however, high blood pressure or mini-strokes (often unnoticed by the individual and their family) may contribute. Good blood pressure control can reduce the chance of depression in some people.
Gender

Gender is a partial but incomplete explanation of why people may develop depression. Equal numbers of men and women develop melancholic depression. However, studies have shown that there is a much greater likelihood of women developing non-melancholic depression than men. Some of the explanations for this are:

  • Women are more likely than men to ‘internalise’ stress, thereby putting them at greater risk of developing depression.
  •  Women with unsatisfactory marriages or who are caring for a number of young children are also highly over represented among samples of depressed people.
  • Hormonal factors commencing in puberty may account for the increased chance in women of developing anxiety (a precursor to depression) or depression.
Stress

It is important to recognise that nearly every individual can be stressed and depressed by certain events. Most people get over the stress or depression within days or weeks while others do not. Ways that stress can lead to depression include the following:

  • Past or long-standing stresses can increase the chances of an individual developing depression in later years e.g. growing up in an abusive or uncaring family may increase the risk of developing depression in adult life.
  • Events that affect a person’s self-esteem such as the break-up of a close relationship or marriage
  • Feelings of ‘shame’ for example, thinking they have not lived up to their own or others’ expectations.
Personality

Our research has shown that people with the following personality types are more at risk of developing depression than others. Those who are high on the first four factors are at distinctly greater risk to depression (especially non-melancholic depression):

  1. High levels of anxiety, which can be experienced as an internalised ‘anxious worrying’ style or as a more externalised ‘irritability’.
  2. Shyness expressed as ‘social avoidance’ and/or ‘personal reserve’.
  3. Self-criticism or low self-worth.
  4. High interpersonal sensitivity.
  5. Perfectionism is somewhat protective against the onset of depression but if depression occurs, it can result in longer episodes.
  6. A ‘self-focused’ style is likely to be at greater risk for brief depressive episodes only

Key points to remember

  • There is no single cause for depression; rather it’s a combination of stress and a person’s vulnerability to developing depression.
  • The predisposition to developing depression can be inherited.
  • Other biological causes for depression can include physical illness, the process of ageing and gender.
  • Stress can trigger depression but understanding its particular meaning to the person is important.
  • Certain temperament and personality styles pose risks for developing non-melancholic depression.

Contact Us

Coolminds

Email: hello@coolmindshk.com

Black Dog Institute

Email: blackdog@blackdog.org.au

Where to get more information and support

Mind Hong Kong – “What Is Depression?”

Student Health Service – “Understanding Depression”

Student Health Service – “Emotional Health”

Cheer Centre: Interpretation services for Ethnic Minorities for use of public services

Bilingual Telephone Hotlines

Samaritans Hong Kong 24-hour hotline: 28960000

Samaritan Befrienders Hong Kong 24-hour hotline: 23892222

Suicide Prevention Services 24-hour hotline: 23820000

Suicide Prevention Services “Youth Link” hotline (available 2pm-2am): 2382 0777

Hospital Authority Mental Health Direct hotline: 24667350

Chinese-Only Telephone Hotlines

Youth Outreach 24-hour hotline service: 90881023

The Hong Kong Federation of Youth Groups “Youthline” hotline (available Mon-Sat, 2pm-2am): 27778899

Resources

Mental Health Problems in Children and Young People: Guidance for Parents and Carers

This resource booklet has been localised for the Hong Kong context and translated to Traditional Chinese by Coolminds, a mental health initiative run by Mind HK and KELY Support Group. For more information on Coolminds, please visit www.coolmindshk.com

We would like to acknowledge the Charlie Waller Memorial Trust (CWMT) UK for these resources and for allowing us to adapt this. For the original version of this resource, please refer to the CWMT website: www.cwmt.org.uk

Looking after a child or young person who has emotional or mental health problems can be very hard. You may feel challenged, isolated, scared and deeply upset and wish you knew where to turn for help.

What is this leaflet for?

This leaflet offers guidance on how best to support your child and where to find further advice and help with their mental health.

Be assured, things can improve for your child. Mental health, like physical health, is relevant to all of us, including children and young people. Problems are often temporary and, with support, can change for the better.

Seeking help

You are not alone. Many parents and carers have similar concerns and stresses, although they may not feel able to discuss them openly. There is good support and guidance, through national and local organisations. On the back of this leaflet is a list of reliable organisations that offer information based on sound evidence. Do have a look to find out which sources of support might be best for you.

The sooner you seek help, the better. Every local area is different but the three places listed below are a good place to start.

Talk to your GP

Your GP will listen, begin to understand your child’s needs and suggest the most appropriate course of action or support for your child, including referral to mental health specialists, if necessary.

So, make an appointment for your child and explain your concerns when you do so. You might also find it helpful to make a second appointment with the GP, for yourself, to discuss the “ripple effects” of your child’s difficulties on the rest of the family.

“[I spoke] about my hopelessness and sadness to a teacher, who called my Mum, and arranged for us to see my GP. A year later, I have just turned 16 and am in a completely different place to where I was a year ago.”

Help at school

School is an important part of the picture when it comes to children’s mental health. It’s a good idea to stay in communication with the school about the issues your child is experiencing. There may well be sources of help and support within the school, so do encourage your child to talk to a trusted teacher or member of support staff.

“The younger generation will hopefully grow up where mental health is not something that is ignored but something that should have everyone’s attention.” Teacher

Integrated Family Service Centre

Funded by the Social Welfare Department, IFSC’s are located all across Hong Kong. You can approach to receive support for your child, young person of family. Their social workers can provide counselling services or refer you out to a psychologist if necessary. You can call 23432555 to locate the IFSC for your family.

What you can do to help your child

As a parent you can have a crucial role in your child’s recovery. The more you can understand about mental health and your child’s difficulties, the more confident you will be in supporting them. Getting professional help can be important but there is a great deal you can do as a parent too. Every case is individual, but these general tips might help you to help your child:

Encourage them to talk

Try ‘open-ended’ questions like, “How are things for you?” “What’s happening with you?” “What do you think or feel about…?” or “What’s on your mind?”, rather than questions that have “yes/no” answers.

When discussing their problem, don’t try to ‘fix’ it. For the most part, young people simply need to know you are there to support them.

Listen and be understanding

Listen calmly and try not to judge your child. Let them know you are happy to listen while they chat about anything and everything, whenever they want to. Never underestimate the importance of being an attentive, non-judgmental listener.

Remember, you don’t need to know all the answers, listening without responding is often enough.

Give your child reliable self-help information from trusted sources, based on sound evidence

They can read and use this at their own pace, allowing them some privacy, but at the same time you are showing you are there to help and they are not alone. Peer-to-peer support can be really useful. Self-help links include:

Tell them, and show them, how much you care and how important they are in the family

It is not easy when stress levels are high, but a peaceful, loving home life can really help recovery. Keep family routines as normal as possible and do simple things together – maybe watching a film, or having a meal, going for a walk or playing a game. Just doing simple everyday things together (like grocery shopping or cooking) can provide a really helpful distraction. This can bring everyone in the family closer.

Enjoy the time you spend together but understand that it might be a while before your child starts enjoying activities again. Try not to pressurise them and, if they need a little space, support them with that while not leaving them isolated.

Understand the problems

As with physical health, there are many different ways of experiencing mental health issues. Try to read up on your child’s specific problems. This will help you understand their experiences and what helps recovery, building their confidence for the future.

Encourage social contact with friends and family

Encourage your child to go out (if only for short periods) and to keep in touch with friends.

Simple physical activity

Taking regular exercise, such as going for walks, can help improve mood and reduce anxiety.

Know that recovery will not happen overnight

As a parent or carer, you want to make your child feel better immediately but, like physical health problems, mental health problems can sometimes take time to improve and some, such as eating disorders, may be complex and seem illogical. There will often be ups and downs in recovery.

Don’t be afraid to seek further advice from mental health professionals

Many of them have a great deal of experience and are generally an excellent source of guidance and support.

Don’t blame yourself

Parents or carers often feel guilty, thinking they have caused the problems, perhaps through genetics or the home life they have created. Usually, this is not the case.

Look after yourself

In order to support your child, you need to stay strong and well yourself. Often it helps to talk to someone, so don’t be scared about doing this, with friends, family or a parent helpline. For further resources and support for parents please visit the online helplines and resources on www.coolmindshk.com

Hong Kong organisations which help parents

Mind Hong Kong provides information and advice on a range of mental health topics, as well as a community directory of available resources.

New Life Psychiatric Rehabilitation Association provides a Family Support Service. They aim to build a holistic support network among carers to support them to face challenges with a positive mindset and to maintain family functions.

Caritas Family Crisis Support Center (in Chinese only) aims to manage family crisis at an early stage by providing integrated and easily accessible services to assist individuals or families in crisis or distress. Services provided include 24-hour hotline service (18288) and short-term emergency accommodation.

Youth Outreach (in Chinese only) has a 24-hour hotline for young people from ages 8 to 18. The organisation also provides support through emergency accommodation, individual and family counselling, academic and career advice, among others.

Hong Kong Eating Disorders Association
In addition to patient support groups and members gatherings, they host small group gatherings for caregivers to share and de-stress.

Baptist Oi Kwan Social Service has a family resource and service centre providing support and counselling for families of those recovering from mental illnesses.

Christian Family Service Centre provides education, counselling, groups, shelter and other services to children and families. They aim to help overcome family problems, provide quality learning environment, and build up their mutual support networks.

International organisations which help parents

Young Minds is an excellent source of information about all aspects of child mental health, including a Parent Helpline.

Minded for Families provides free, quality- assured advice which is easy to understand. It is helpful for any adults caring for children or teenagers with mental health problems.

Beat gives clear advice on all aspects of dealing with eating disorders, including helpful guidance to parents, carers and families.

Anna Freud Centre – a leaflet about mental health for parents of young children.