The increasing mental health crisis among children and teens in Hong Kong

Over the past few years we’ve watched teenage suicides rise, and research shows that 39% of primary and secondary school age children in Hong Kong have symptoms of a mental health condition. We're in the midst of a mental health crisis and mainstream mental health services are simultaneously undersubscribed and overwhelmed.

The median wait time for children to get mental health support was as high as 113 weeks in 2020 – which was longer than those for adults.

According to the WHO’s standards, Hong Kong needs 60% more mental health practitioners to serve our population’s needs.

Despite long waiting times, studies show that not enough kids are asking for help. More than 9 in 10 kids were not willing to ask for help, and of those, 15% were in emotional distress and at higher risk of suicide. 5% needed serious mental health intervention.

Why don’t children reach out for help when they’re struggling with their mental health?

As well as lacking the understanding that they need help, children and teens may not seek out mental health services because they worry what others think, they don’t know where to look for help, or don’t trust adults at school or doctors, who could provide support.

Mental health support is life-saving care. In recent years, we’ve seen teen suicides rise to record highs – with 32 suicides in 2023. That’s almost tripled over the course of a decade. Hong Kong has the highest rates for suicide among young people in any developed country.

Kids and adults alike are likely to hope emotional difficulties will simply go away – but just as a broken bone needs medical support to mend, mental health conditions do too.

David Cheng, COO of the Young Samaritans stated that young people require the intervention of adults on their behalf. Most children lack the self-care skills and the autonomy to advocate for their mental health needs on their own.

What are the signs of anxiety or depression in children and teens?

Kids express anxiety and depression differently from adults. Rather than telling you how they feel, you’re more likely to witness changes in their behaviour. 

Your child’s emotions are a clue to their internal world, and sudden increases in outbursts of anger can indicate something’s wrong. Sleeping problems, or changes in their sleep also provide a warning sign. 

“Children and adolescents don’t always tell their parents when they’re anxious, overwhelmed, or depressed. They may not have the words, or they may simply not want to talk about it,” says IMI counsellor Angela Kaur. 

“Often, parents first notice changes in mood, behaviour, or daily routines. Younger children may show distress through regression – losing skills they had recently learned. Teenagers may pull away from the family and spend more time alone – frequently online. Not every change signals a problem, but it’s worth noticing patterns and making space for a gentle check-in,” she adds. 

Mental health concerns show up differently in kids depending on their age. Some kids, especially neurodivergent kids might regress developmentally or start bedwetting again. 

“In children of all ages, anxiety and depression can show up physically as well as emotionally. These signs are easy to explain away—as a busy term or a difficult friendship—so it can take time to recognise them as distress. The question to keep in mind isn’t whether a child has one particular symptom, but whether they’ve stopped seeming quite like themselves,” says Angela. 

8 signs of anxiety in kids
-          find it difficult to focus.
-          struggle with their sleep or have nightmares.
-          eat more or less than usual.
-          be quick to anger, cry a lot or struggle to regulate their emotions.
-          be fidgety, tense or clingy.
-          often be worried, or have negative thoughts.
-          need to use the bathroom often, or wet the bed at night.
-          have a tummy ache, or feel ill frequently.

9 signs of depression in kids
-          be sad, grumpy, or tired all the time.
-          no longer be interested in hobbies they used to enjoy.
-          isolate themselves from loved ones.
-          struggle to focus, relax or make decisions.
-          have disrupted sleep patterns – sleeping more or less than usual.
-          eat more or less than usual. Their weight may oscillate dramatically.
-          lack confidence, have low self-esteem, feel worthless or numb.
-          self-harm, which can take a variety of forms, from cutting to biting, pinching, hitting themselves or pulling out the hair from their eyebrows, eyelashes or head.
-          have suicidal thoughts, or think about self-harm.

It can be hard to see your kids struggle, but it’s important to address it as soon as possible, rather than avoiding the topic, or hoping it will get better in silence.

What affects children’s mental health in Hong Kong?

Studies show that both very high expectations and very low expectations from parents can put kids at risk for developing mental health conditions.

Save the Children name authoritarian parenting (a common style in Hong Kong), limited warmth from parents, high levels of control from maternal figures and conflict between parents and kids as associated with mental health conditions and suicidal ideation among Hong Kong teens.

In Save the Children’s 2019 focus groups, family and school performance were the highest ranking stressors. Feeling uncertain about their futures and upcoming exams were additional drivers for stress among kids and teens. In Hong Kong, students’ self-worth is often tied up in their academic achievement and hard work can lead to chronic stress or burnout. 

“The pressure parents feel around their children’s grades is real and often beyond their control. But they can help ensure their child knows they’re valued for more than their results—and that the adults around them are sending the same message,” says Angela. 

“It can also help to let the school know when something significant is happening at home, so teachers can better understand changes in a child’s mood or performance and offer support. When parents and schools talk about a child’s wellbeing, not just their grades, the child is more likely to get the support they need,” she adds.

You can support your kids by focusing on the effort they put into their work, rather than the outcome of their work. Praise their persistence by saying I’m so proud of how hard you worked on that.

Recent years have revealed a new stressor for kids – society and politics. Kids are engaging with discourse online and in some instances, even joining demonstrations. Politics is a key point for conflict between kids and their parents, creating divides within the home.

Screen time affects your brain and mental health – with 70% of secondary school kids acknowledging that time spent online is leading to more arguments with their parents and not enough time spent sleeping. 30% of primary school kids and 68% of those at secondary school spend more than two hours on the internet each day.

The decline in mental health among parents also contributes. Kids can pick up ways of thinking from their parents, or people who are close to them. When kids have parents with mental health conditions, it can increase their risk of developing anxiety or depression.

Other factors include social difficulties, bullying at school and neurodivergence. Over half of kids in the care of the Hospital Authority’s mental health services have autism or ADHD – and both conditions carry a higher risk of anxiety or depression.

Trauma is another key factor. Adverse childhood experiences (ACEs) affect approximately 60% of people 17 and under. People with one or more ACE are 1.5 – 2.5 times more likely to develop a mental health condition. ACEs are stressful, potentially traumatic events. There’s a broad variety in them – from bullying to sexual abuse, or witnessing a car crash.

What do you do if your child is struggling with their mental health?

David Cheng has said that mental health isn’t ‘cool’ in Hong Kong like fitness is. Making time at home to talk about your feelings can help foster an environment of emotional safety.

“Parents don’t need to have all the answers. What matters is making the space for meaningful moments of connection. For a young child, that might mean playing or reading together. For a teenager, it would be casual conversation while walking the dog or doing something side by side. Even 10 minutes of uninterrupted time in an otherwise busy day can help build trust and show children their feelings are welcome,” says Angela.

“In some families, talking openly about emotions may feel unfamiliar. Parents can help by sharing their own feelings in an age-appropriate way and making space for their child to do the same. This can help children see that emotions are a normal part of life and can be expressed without judgement,” she adds. 

Encourage your kids to express how they’re feeling, without getting drawn into problem-fixing mode immediately. Naming emotions can help increase their awareness of what they’re feeling, giving them the tools to communicate.

Learning how to validate can help too. Instead of saying, You’ll be fine, it’s not a big deal, try something like, That sounds really hard. I can see that your schoolwork is stressing you out, would you like to talk more about it?

Let them express the full breadth of their feelings – allow them to cry or feel angry.

Try not to make their pain about you - it can be easy to feel defensive in response. But I’m doing my best as a parent – why don’t they feel happy? Pain is a natural part of life, and experiencing that doesn’t reflect on your parenting abilities.

If their pain is about you – they cry because you’ve disciplined them, normalise taking a moment to allow both of you to calm down and regulate before you talk again. Let them express difficult feelings – even if they’re about you, while maintaining firm boundaries.

If your child or teenager resists opening up about their emotional challenges, focus on creating a secure environment for them to lean into. Validate the emotions you witness and show them that they’ll be met with understanding.

Ask them questions and take interest in their lives outside of the classroom. Encouraging them to nourish their friendships can also help – research shows that kids at secondary who have three close friends or more were at a lower risk of mental health conditions. Encouraging a balance of play and hobbies alongside schoolwork can help reduce stress among children and teens.

When should parents seek professional help for their children’s mental health?

50% of people with probable depression try to manage on their own or lean on their family or friends. But the reality is that while family and friends may love us and want to help – they’re not equipped to give the full breadth of support needed.

It’s not shameful to ask for help.

We may feel as parents that we should be able to support our kids through any issue – but the reality is that we’re only human.

Hiring a therapist for our kids doesn’t mean we’ve failed, it means we’ve recognised their need and are able to acknowledge when we’ve met our limit and need some extra support.

Seek professional help when your child shows persistent signs of anxiety or depression. ““There are two things to look out for: persistence and urgency. Signs that last for weeks rather than days, or that are affecting sleep, school, or relationships, are worth discussing with a professional. But some situations call for immediate action: any talk of not wanting to be alive or of suicide, of self-harm, or concern that a child is unsafe,” says Angela.

Therapy isn’t just helpful for your kids – it can help you regulate if you’re struggling to support them. If you’re suffering with a mental health condition, looking after yourself is key – just like putting on your oxygen mask on first when flying. When you’re in balance, you’re better equipped to support your kids. If you’re struggling to regulate your emotions and that’s interfering with your relationship with your child, then it’s time to seek some extra support.

Acknowledging that our kids need help (or that we need help) can feel scary – but it’s the first step in getting them the support that they need, and equipping them with emotional literacy skills that will last them a lifetime.

From play therapy, to clinical psychology, counselling psychology and psychotherapy, our practitioners are equipped to support you and your children through mental health challenges.

We’re stronger together when we allow space for vulnerability and all feelings – including anxiety and depression.

References
HKU Med, HKUMed reports real-time population data on depression and suicidal ideation: a ten-year prospective cohort, 2019
Save the children, Protect Children’s Wellbeing in Hong Kong, 2020
Hong Kong Free Press, Sharp rise in suicide rates among teen girls in Hong Kong, study finds, 2024.
SCMP, Hong Kong youth suicides among highest in the developed world; calls for more action rise, 2024.
J Huang et al, Factors associated with mental health among Hong Kong children: A population-based study of 4884 individuals, 2023.
Legislative council of Hong Kong, Mental health of local students, 2024.