Our kids are in crisis: mental health 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 have symptoms of a mental health condition. Yet – 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.

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?

IMI play therapist Wing Wong notes that “Children may not express anxiety or depression like adults, often showing symptoms through behaviour or play rather than words. Shifts in your kid’s play style – whether that’s make believe, or the type of things they’re drawing, can indicate a shift in their mental health and provide a helpful prompt to pay closer attention to them.”

IMI clinical psychologist Daniela, adds that in her experience, “Sudden increases in emotional outbursts, especially irritability and anger – are key indicators. Additionally, changes in sleep patterns and sleep difficulties are important warning signs.”

Wing also notes that behaviours will depend on the ages of your kids – “Children are more likely to regress developmentally and start wetting the bed again, but in teens you might notice they disappear into their online world, chatting with AI friends.”

When kids are anxious, they might

-          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.

When kids are depressed, they might

-          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 puts kids at risk?

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.

Wing says that “Hong Kong’s competitive education system often ties self-worth to grades, leading to stress or burnout. By encouraging kids to focus more on effort than outcome, we can flip the script. Praise persistence by saying things like, 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.

Online time adds to stress – 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 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. 

How can we help our kids?

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.

“Use play as a bridge,” says play therapist Wing. “Engaging in play-based activities can encourage expression. Busy parental schedules in Hong Kong can limit quality time, but integrating small, meaningful interactions like 10 minute play sessions or bedtime chats and hugs can make a big difference.”

“Some cultural norms may discourage discussing emotions, which can make it difficult for kids to open up about their feelings,” she adds. “Sharing your own age-appropriate feelings with your child can help normalise emotions and challenges they may encounter in life. This can help them acknowledge their own feelings without judgement.”

Encourage your kids to express how they’re feeling, without getting drawn into problem-fixing mode immediately.

Daniela notes that “Active listening and reflecting their emotions by naming them helps children develop emotional awareness. Equally important is learning how to validate, rather than dismiss their feelings. 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 them 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.

Daniela shares, “There are two main challenges parents often face when supporting their children’s mental health. First, many parents struggle with their own emotional regulation and may take it personally when their child is upset – or if their child or teenager resists opening up about emotional challenges.”

“Second, encouraging kids to speak openly about their feelings can be hard. Building a secure attachment is essential – when a child knows their emotional needs will be met with understanding, they’re far more likely to engage in honest, meaningful conversations.”

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. Wing says that by encouraging a balance of play and hobbies alongside schoolwork, we can help reduce stress among children and teens.

When you’re stretched beyond your capacity

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.

Wing says it’s time to seek professional help when your child shows persistent signs of anxiety or depression. “Take note of statements like I don’t want to be here anymore. Take immediate action If there’s any indication of self-harm or suicide risk. One of the vital roles parents play is recognising the warning signs and seeking timely support.”

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.

“As a parent, your own mental health matters just as much as your child’s. If you find yourself struggling to regulate your emotions and it begins to interfere with your relationship with your child, it’s time to seek extra support,” says Daniela.

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 therapists, to clinical psychologists, counselling psychologists and psychotherapists, 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.