The International Journal of Psychosocial Rehabilitation

 Socio-economic Changes and Mental Health:
Setting a New Agenda for Prevention Strategies in Hong Kong
 

Daniel Fu Keung Wong
Assistant Professor
Department of Social Work and Social Administration
The University of Hong Kong
 

Wong, D.F.K.  (2000)  Socio-economic changes and mental health: Setting a new agenda for prevention
strategies in Hong Kong.  International Journal of Psychosocial Rehabilitation. 4, 111-134



Abstract
Recent economic crisis in Hong Kong leading to layoffs, closure of businesses and bankruptcies was used to account for the substantial increase in percentages of depressed moods, interpersonal relationship problems and vocational difficulties found among callers of a mental health telephone counseling service in Hong Kong. Socio-cultural factors were also put forward to explain the passive help-seeking behaviors of callers, as well as the relationships between the increase in vocational difficulties and depressed moods and anxieties observed in the male callers. Suggestions towards the provision of primary and secondary prevention programmes in mental health were made.

Introduction
Since the Asian economic crisis of 1997, the economy of Hong Kong has undergone substantial changes. Before the crisis, Hong Kong had been described as " a hard-earned success" (Hong Kong Government, 1995), with impressive economic performance figures of about 5% increase in Gross Domestic Products; very low unemployment rate of 2-3%; and increase in real wage of about 2% in the three years preceding 1997 (Table One). Indeed, this economic success had not only benefited the entrepreneurs in Hong Kong, but also the general population. Many people had invested their life-long savings into stock and property markets, and others had borrowed monies for investment. Many indicators had pointed towards a positive and ever-expanding economy of Hong Kong.
By late 1997, the financial turmoil in Asia had spread to Hong Kong, and triggered off major speculative attacks on the Hong Kong dollars, and then the stock markets. As a result, the values of stocks and properties in Hong Kong depreciated to as much as half of their values before the crisis. Export of services slackened to virtually zero growth, and the Consumer Price Index had also dropped significantly. Since then, negative economic growth, bankruptcies, closing down of businesses, budget cuts and frozen salaries have become issues that are of major concerns to the government and the general public.

One such thorny issue is that of unemployment. Unemployment has reached an unprecedented rate of about 6 % (Table One) in the last two years. These unemployed individuals are experiencing the frustrations of searching for a job, and may have to wait for months or even years before they can find another one. Those who have jobs are not necessarily feeling better because many are fearful of the possibility of being laid off, should their organizations undergo budget cuts or bankruptcies. In fact, their worries are justified. In the latest release of the reasons for unemployment, the Labor Department documents that, in the last six months, there were 171 incidents of layoffs, closing down of businesses and bankruptcies, involving a total of more than 9000 people (Hong Kong Government, June, 1999).

Table One: A Comparison of Some Indicators of Economic Performance in Hong Kong in 1995, 1996, 1997, 1998 and 1999
 
Indicators 1995 1996 1997 1998 1999
Gross Domestic Products 

(real terms)

+5.5% +4.6% +5.2% -5.1% Not yet known
Unemployment/under-employment (real terms) 2 / 1.5% 3.5 / 2.3% 2.5 / 1.3% 5.7% /

increased substantially

About 6%

Unemployment

Wages

(money terms / real terms)

11 / 2% 11 / 2% 7.1 / 1.7% 3% / only slightly higher than the inflation rate of 2.8% of the same year (i.e. no increase in wages in real term) Major companies impose frozen salaries or even cut salaries or benefits

These socio-economic changes have aroused the attention of the mental health professionals. First, since studies have found a strong link between adverse life events and mental illnesses, particularly depression and anxiety disorders (Herbert, 1999), the current socio-economic conditions may have been affecting the mental health of some individuals in Hong Kong. Secondly, official statistics from the Hospital Authority (1999) in Hong Kong show that there is a rise in the utilization of psychiatric services in Hong Kong. Thirdly, The Samaritan Befrienders Association of Hong Kong has reported in a press release that, within the financial year of 1998-1999, there were 868 people who had committed suicide. The unemployed took more than half of the share, and men exceeded women by a ratio of 2.5: 1. The majority of these individuals had been unemployed for more than six months, and were mainly middle aged (Samaritan Befrienders Association, June, 1999).

In spite of these possible mounting mental health needs of persons with minor psychiatric illnesses, the mental health care system in Hong Kong does not appear to be making any concerted efforts to respond to the mental health needs of these individuals. In Hong Kong, psychiatric services are specialized services that cater mainly for individuals with severe psychiatric illnesses such as schizophrenia (Ma, 1990, Wong, 1996). There are relatively fewer individuals with severe minor psychiatric illnesses like major depression and anxieties that are being treated in the psychiatric facilities. The rest are probably consulting private psychiatrists, and/or attending counseling services in the community. Yet, there are those who may not be aware of their own mental health problems and are not receiving any treatment for their conditions. Indeed, many may just be visiting their own general practitioners who do not necessarily have the skills in detecting and treating persons with minor psychiatric illnesses (Goldberg et al., 1993).

The importance of prevention in mental health
The relationship between life events and mental health has been extensively studied. Researchers like Herbert (1997) suggest that psychological stress is linked to both the onset and course of a mental illness. Particularly, there is empirical evidence suggesting that unwelcome changes in life circumstances, such as unemployment, relationship breakdown, bereavement and major physical illness or injury, were strongly linked to depression and anxiety disorders (Paykel & Cooper, 1992, Finlay-Jones, 1989). Some researchers further reveal that perceived loss of structured and normal pattern of living (Wanberg & Griffiths, 1997), and perceived threat to self-esteem (Furnham, 1985) associated with unemployment underscored the development of poor mental health.

The impact of changes in life circumstances on mental health of a population has clearly pointed to the importance of introducing prevention programs, particularly primary and secondary prevention programs, in identifying individuals who are at risk of developing minor psychiatric illness. Specifically, primary and secondary prevention programs in mental health may help to identify individuals who are at risk of developing poor mental health as a result of the changes in socio-economic circumstances. Prevention programmes can also reduce the suffering of those who have started to experience mental health problems, and prevent them from developing long-term and chronic mental illness (Shore, 1998). In the literature, Munoz et al. (1995) have demonstrated that prevention programs could prevent the development of a full-blown psychiatric illness such as depression. Llyod and Jenkins (1996) have also suggested that earlier prevention programs could be useful to prevent a minor psychiatric illness from developing into a chronic mental illness. Consequently, it may reduce the long-term costs incurred in the treatment and rehabilitation of a person with a chronic mental illness.

Socio-cultural factors in Hong Kong may have further hastened the needs to provide more preventive mental health programs for people who are at risk. First, resources for psychiatric services in Hong Kong have largely been allocated to rehabilitating persons with severe psychiatric illnesses (Ma, 1990). Secondly, evidence has shown that Chinese people have the tendency to somatize their mental health problems (Lin, 1985, Cheung, 1995), and may not recognize the fact that their mental health problems have been concealed under some medical labels. Thus, this issue of somatization has made it difficult for Chinese people to differentiate between genuine physical problems and psychosomatic problems resulting from the impacts of psychosocial difficulties. Lastly, Chinese culture ascribes a strong stigma to mental illness (Sue, 1994). Due to shame and face saving, individuals and their families will try to conceal their mental health problems from relatives and friends, lest the community will ostracize them. As a result, individuals suffering from mental health problems may delay seeking help from the mental health professionals.

A mental health telephone hotline and counseling service as a primary and secondary prevention program

A mental health telephone counseling service has been set up by the Mental Health Association of Hong Kong to provide assessment and referrals for those who are at risk of developing minor psychiatric illness in Hong Kong since 1995. This self-funded telephone counseling service has two major components. It has a 24-hours hotline service providing recorded messages containing information about stress, characteristics of some common types of mental illnesses such as anxiety disorders and depression, and psychiatric and social services available in Hong Kong. The second component involves having callers make direct telephone contact with the mental health social workers who are on duty. Social workers conduct brief examination of callers’ mental state, provide specific information on psychiatric illnesses and social and psychiatric services, and make referrals for callers. This is a "one-off" service and brief follow-up services will be provided to a limited number of callers. The nature of these follow-up services is to ensure that callers have received the needed services, particularly in the case of a psychiatric emergency. Due to a shortage of manpower, this service does not provide in-depth short-term counseling for callers.

This paper reports on a study of the psychosocial characteristics of callers who utilized the mental health telephone counseling service between April 1997 and March 1998. Specifically, this study attempted to compare this profile to the profile of callers who had used the service between 1995-1996. It was hoped that the study would highlight the changing patterns of mental health problems found among callers in the two periods. The study also tried to explore the relationships between changes in socio-economic conditions and the changing patterns of mental health problems of callers in Hong Kong.

Methodology
Callers were self-referred or encouraged by relatives and friends and social workers of other social service agencies to call us. Some callers were relatives and friends of individuals who had mental illnesses. They called to seek advice regarding the conditions of the ones with the illnesses. A total of 658 callers had spoken to the mental health social workers during the period between April 1997 and March 1998. Forty-six percent were males. There were 51% of callers who were holding jobs and 38% were unemployed. Eighty-three percent called to discuss their own mental health problems while seventeen percent called to discuss mental health problems of relatives and friends. About 80% of the callers were aged between 21 and 40. Lastly, more than 43% of callers claimed that they had experienced their mental health problems for more than a year before they approached the service.

Mental health social workers completed a record form that contained information on personal particulars of callers, presenting problems, duration and impact of problems on the callers, life events that might have been related to the presenting problems, and the services provided by the workers. The record form also asked for information regarding whether callers were receiving psychiatric services. Those who were receiving psychiatric services were encouraged to contact their own social workers or psychiatrists if their problems did not require any immediate interventions. The profile of this group of callers was not included in the present study.

The Rehabilitation Programme Plan Review (1996) of the Hong Kong Government has suggested an estimation of 680,000 persons to be suffering from minor psychiatric illnesses in Hong Kong. The number of callers who took the initiative to call the phoneline for counseling represented a very small portion of the population. Therefore, findings could not be generalized to represent the mental health conditions of the general public.

Also, this study did not use standardized psychological or psychiatric instruments to measure the mental health conditions of callers. This was purposefully done because the nature of phone counseling only allowed a very limited time for conversation. The primary task of a counselor was to provide assessment and counseling to the callers. However, this shortcoming was somewhat compensated by the fact that all phoneline counselors were mental health workers with professional training in mental health social work. They were familiarized with the use of Brief Psychiatric Rating Scale, and were asked to make reference to it when making an assessment on a caller.

Results
Table Two compares the frequencies of occurrence of the types of presenting problems of callers in the 95-96 and 97-98 samples. It reveals that callers in both samples had higher percentages of unmanageable anxieties, depressed moods, interpersonal relationship problems and vocational problems. However, there was a substantial increase in the percentages of presenting problems of depressed moods and vocational problems found in the 97-98 sample.

Table Two: Percentages of Presenting Symptoms / Problems of Callers in the 1995-1996 and 1997 1998 Samples
 
Category
Percentage / Number

1995 1996

Number of Callers

(864)

Percentage / Number

1997 1998

Number of Callers

(676)

Unmanageable Anxieties
37.8% (327)
32% (214)
Depressed Moods
21.2% (183)
32.1% (215)
Sleep Disturbances
13.9% (120)
12% (81)
Psychotic Relapse
8.8 % (76)
8.8% (33)
Difficulties with Medication Compliance 
7.8 % (67)
7.8% (45)
Problems in Adjusting to

Mental Illness

11.5 % (99)
15.5% (104)
Interpersonal Relationship Difficulties
27.4 % (237)
33.8% (226)
Vocational Problems 
13.9 % (120)
20% (134)


Table Three presents a comparison of demographic characteristics of callers from the two samples. Findings suggest that although there were still slightly more female callers than male callers in the 97-98 sample, there was a substantial increase in the percentage of male callers from that of the 95-96 sample. Correlational analyses were performed, with male and female callers as separate sub-samples, to explore the relationships among various presenting problems. It is observed that there was a significant correlation between depressed moods and vocational difficulties among male callers (r = 0.15, p<0.01) (Table Five). No such relationship was found among female callers.
 

Table Three: Percentages of Demographic Characteristics of Callers in 1995-1996 and 1997-1998 Samples
 
Type of Demographic Characteristics
Category
Percentage/ Number

(1997-1998)

Percentage/ Number

(1997-1998)

Sex Male
39.9 % (345)
46% (314)
Female
59.6 % (519) 
54% (362)
Age >20
11.2 % (97)
4.1% (28)
20-40
70 % (605)
74% (500)
40-60
14.5 % (125)
4.1% (28)
60 or over
4.3 % (37)
0.7% (5)
Economic 

Status 

Student
10.8 %
4.6% (30)
Employed
42.1 % (364)
50.8% (336)
Unemployed 
34.8 % (301)
37.3% (247)
Housewife
12.3 % (106)
7.4% (49)
Duration of Symptoms / Problems Less than 2 weeks
11.3 % (980) 
7.8% (52)
2 week 1 month 
6.5 % (560)
9.5% (62)
1 3 months
15.2 % (131)
15.7% (103)
3 6 months
10.2 % (88)
9.6% (63)
6 months 1 year
8.4 % (73)
12.7% (83)
Over 1year
42.4 % (366)
41.1% (278)
Unknown 
6 % (52)
3.5% (23)
Table Two also shows that both samples had higher representation of callers who were employed and unemployed. However, it is observed that there was a noticeable increase in the percentages of employed and unemployed callers in the 97-98 sample. Further analysis of the 97-98 sample uncovers that callers who were employed appeared to have significantly more anxieties than callers who were unemployed. However, the unemployed had significantly more depressed moods, and vocational problems than callers who were employed (Table Four). Correlational analysis of the relationships among various presenting symptoms of unemployed men suggests that there was a significant relationship between vocational difficulties and anxieties (r = 0.188, p< 0.034) (Table Five). No such relationship was found for female callers.


Table Four: Distribution of Types of Presenting Problems by Economic Status of Callers of the 97 98 Sample
 
Economic Status
***

Anxiety Symptoms

***

Depressed Moods

Sleeping Disturbances
***

Vocational Problems

Interpersonal Relationship Problems
Student
4.3% (9)
0.95% (2)
2.5% (2)
0% (0)
2.2% (5)
Employed
59.6% (124)
44.1% (93)
42.5% (34)
47.8% (63)
56.8% (126)
Unemployed
28.4% (59)
44.1% (93)
48.8% (39)
51.5% (68)
32.9% (73)
Housewife
7.7% (16)
9.5% (23)
6.2% (5)
6.7% (1)
8.1% (18)
N
208
211
80
132
222
(df = 3) *P>0.05, **P>0.01, ***P>0.001
 

Table Five: Correlations among Presenting Problems of Male Callers and Unemployed Male Callers
 
Symptoms
Callers Characteristics Problems of Callers Anxieties Depressed Moods Sleeping Disturbances
Male Callers Vocational Difficulties 0.073 0.15** 0.047
Interpersonal Relationship Problems  0.052 0.035 0.031
Female Callers Vocational Difficulties 0.002 0.001 0.103
Interpersonal Relationship Problems 0.041 0.032 0.014
Unemployed Male Vocational Difficulties 0.188* 0.139 0.098
Interpersonal Relationship

Problems

0.092 0.066 0.099
Unemployed Female Vocational Difficulties 0.057 0.08 0.043
Interpersonal Relationship Problems 0.094 0.011 0.013
*P>0.05, **P>0.01, ***P>0.001

 
Similar to the 95-96 sample, there were higher percentages of callers in the 97-98 sample whose ages fell into the 21 and 40 age bracket and had had presenting problems that existed for more than a year (Table Three). Distribution of types of presenting problems by age group of the 97-98 sample reveals that callers who were aged between 30 and 40 had significantly more presenting problems of depressed moods, sleeping disturbances and vocational problems (Table Six). Distribution of types of presenting problems by duration of problems, on the other hand, suggests that callers who had presenting problems that existed for more than a year had significantly more symptoms of anxieties, depressed moods and vocational problems
(Table Seven).


Table Six: Distribution of Types of Presenting Problems by Age of Callers of the 97 98 Sample
 
Age
Anxiety Symptoms
**

Depressed Moods

*

Sleeping Disturbances

Vocational Problems
*

Interpersonal Relationship Problems

20 or below
3.4% (7)
1.4% (3)
2.6% (2)
0.8% (1)
3.29% (7)
20-30
33.2% (68)
29.1% (60)
27.3% (21)
31.2% (40)
32.2% (70)
30-40
45.3% (93)
46.1% (95)
39% (30)
51.6% (66)
51.2% (111)
40-60
18% (37)
22.3% (46)
30% (23)
16.4% (21)
12.4% (27)
60 or over
0% (0)
1% (2)
1.3% (1)
0% (0)
0.9% (2)
N
205
206
77
128
217
(df = 4) *P>0.05, **P>0.01, ***P>0.001

Table Seven: Distribution of Types of Presenting Problems by Duration of Problems of Callers of the 97 98 Sample
 

Duration of Problems
          ** 
Anxiety Symptoms
          * 
Depressed Moods

Sleeping Disturbances
         * 
Vocational Problems

Interpersonal Relationship Problems
Less than 2 week 8.3% (17) 6.4% (13) 15.4% (12) 4.6% (10) 7% (9)
2 weeks 1 month 8.3% (17) 7.9% (16) 12.8% (10) 7.9% (17) 11.8% (15)
1-3 months 24.3% (50) 11.4% (23) 12.8% (10) 14.4% (31) 15% (19)
3-6 months 8.3% (17) 11.9% (24) 5.1% (14) 11.1% (24) 8.7% (11)
6 months 1 year 12.6% (26) 12.38% (25) 12.8% (10) 13% (28) 14.2% (18)
Over a year 38.3% (79) 50% (101) 41% (32) 49.1% (106) 43.3% (55)
N 206 202 78 216 127
(df = 5) *P>0.05, **P>0.01, ***P>0.001

Discussions
Findings in this study reveal that while the unemployed callers experienced more depressed moods, callers who were employed had more anxieties. There was also a link between vocational difficulties and anxieties found among unemployed men. Incidents of layoffs, bankruptcies and closing down of businesses in Hong Kong have certainly aroused a strong sense of job insecurity among those who are employed. Some individuals who are laid off may have to wait for months and even a year before they can find another job. Others may just have to have to experience long-term unemployment. It is therefore not surprising to find that this sample of callers expereinced depressed moods and anxieties. In fact, many studies have suggested that unwelcome life events that involve loss and threat were linked to the occurrence of depression and anxieties (Paykel & Priest, 1992, Turner, 1995). Specifically, unemployment was found to be related to depression and anxiety disorders (e.g. Hutchings & Gower, 1993).

These findings should set as a warning signal to the community, particularly among mental health professionals because, first, there may be a substantial number of individuals with symptoms or an established minor psychiatric illness who are living in the community without proper treatment. Secondly, it is also known that prolonged exposure to adverse psychosocial conditions without appropriate and early intervention may lead to the development and chronicity of minor psychiatric illnesses such as depression and anxieties disorders (Lester, 1999). Therefore, it is essential and pressing to introduce primary and secondary prevention programs to help the employed and unemployed persons in Hong Kong.

Findings also indicate that there was a substantial increase in the number of male callers to the telephone counseling service, and that vocational difficulties had aroused a great deal of anxieties among male callers. Traditionally, men are the breadwinners and have to provide financial support for their families (Ho, 1989). These deeply entrenched cultural expectations of men can become a stress factor for some adult males who are unemployed or are experiencing job insecurity. Moreover, there are far more males in the workforce than females and many men are the sole breadwinners in their families (Hong Kong Government, 1996). Therefore, unemployment or job insecurity can arouse a great deal of anxiety among some of these middle-aged men. The increase in the number of male callers to the phoneline certainly lends some support to the link between adverse life circumstances and poor mental health. These changing socio-economic conditions may also explain why there were more male callers in the 97-98 sample than the 95-96 sample.

This increase in the number of male callers is alarming and deserves much attention. Culturally and clinically speaking, Chinese men are less inclined to seek help from professionals for mental health problems than women (Ying & Miller, 1992). It is quite probable that they do so only when situations become rather serious. Remarks written in the record forms by workers indicated that some male callers were quite disturbed by their mental health problems and that some did require immediate psychiatric and/or psychosocial interventions. In view of this possible gender difference, it is important to find ways to address promptly the mental health needs of male callers.

Another worrisome finding is the time it took for callers to bring their mental health problems to the attention of the mental health professionals. Results show that about half of the callers had symptoms that existed for more than a year, and that they had not sought treatment elsewhere before contacting the phone line mental health social workers. This tendency to engage in passive help-seeking behaviors may be related to the issue of somatization of mental health problems among Chinese. According to Cheung (1995), somatization means the presence of one or more physical complaints that has no basis in no organic pathology or the physical complaints are grossly in excess of what would be expected from the physical findings. This tendency to somatize may be related to the ways in which Chinese people conceptualize the causation of mental illnesses such as depression and anxiety disorders. Traditional Chinese beliefs suggest that abnormal functioning of our internal organs are responsible for the occurrence of psychological and mental health problems (Lin, 1981). For example, abnormal functioning in the heart and small intestine and in lung and large intestine correspond respectively to the occurrence of depressed moods and anxieties (Lin, 1981). Therefore, Chinese people tend to look for biological causes to account for their mental health problems. Beside, social stigma of mental illness is so strong that Chinese people will try to exhaust all alternative explanations before acknowledging the fact that they have a genuine mental illness such as depression or anxiety disorder.

Recommendations
The Department of Health in Hong Kong is responsible for providing prevention services for the general public, including prevention in mental health. There are several characteristics that can be extracted from the types of prevention programmes being funded by the government. Many of these programmes are public education programmes that aim to help the general public to be more accepting of the presence of persons with mental illnesses in the community. Pamphlets are also made to impart basic knowledge on different types of mental illnesses. However, results of this study point to the needs to create more primary and secondary prevention programmes that can address the mental health needs of these at-risk groups of employed and unemployed persons in Hong Kong.

Primary prevention programmes:
Primary prevention programmes attempt to reduce the occurrence of a disorder. These programmes generally target at the general population rather than at a personal level. The objectives are to raise the overall awareness of mental health issues within a community, and put issues on the ‘agenda for public discussion’ (Hornblow, 1986). Moreover, these programmes may also help to identify those who are at-risk of developing mental health problems.

The use of a mental health telephone hotline and counseling service is a useful primary prevention strategy in fostering better mental health among the general population. There are several obvious advantages for using a mental health phoneline to identify the mental health needs of the general public. First, callers can access the phoneline easily. Secondly, they can remain anonymous and have more control over the process of the interview. Thirdly, the service is less threatening to callers who are unfamiliar with the services. Indeed, this phoneline may counteract the cultural issues of passive help-seeking behaviors, particularly of men, and of social stigma. At present, there is only one agency that offers taped information about stress, mental illness, psychiatric and social services to the general public. Those who want to seek more specific information can speak directly with the telephone counselor who is on duty. However, at present, there is only one service in Hong Kong which offers a very limited information hotline on mental health issues, and the service is funded by an agency through funding raising activities. The government has not yet recognized the functions of this type of prevention services. In view of the popularity and proven usefulness of a telephone hotline and counseling service in other countries and in Hong Kong (e.g. Lynch et. al, 1997, and Wong, 1996), the Hong Kong government should consider providing funding for the establishment of this telephone hotline service.

Another possible primary prevention program could target general practitioners working in the public and private clinics in the community. Since Chinese people have the tendency to somatize their mental health problems, they probably visit their doctors frequently. Therefore, it is useful to educate general practitioners in the clinics to identify individuals who may have genuine minor psychiatric illnesses that have gone undetected. Indeed, this is an important strategy because "the low rate of reporting on emotional features may thus be a reflection of the insensitivity of the health professionals, especially those in general practice who may not be aware of the concomitant psychological aspects (Cheung, 1995, p. 160). Seminars and pamphlets about cultural issues of somatization and passive help-seeking behaviors, and training in identifying and communicating with persons with possible minor psychiatric illness can be organized for general practitioners working in the government and private clinics. This set of prevention strategies has been used with success in other countries. For example, Roterr and Hall (1991) has found that training programmes for general practitioners were effective in increasing detection of psychological difficulties and in providing more relevant advice to patients.

A third possible primary prevention strategy is the use of mass media and new technologies to disseminate information on mental health and mental illness to the general public. With the ever-growing popularity of these mediums, social workers must try to use these mediums to promote public awareness of mental illness and mental health. For example, it is now quite fashionable to create internet website or homepage for a social service agency. In the homepage, mental health agencies can display information on mental illness, mental health and psychiatric and social services available in Hong Kong. Moreover, it can answer individual enquiries about personal mental health concerns through e-mails or ICQ. Besides internet, agencies can also consider creating video CDs on information about mental health and mental illness.

Secondary Prevention Programmes
Secondary prevention programmes attempt to identify and treat as early as possible so as to reduce the length and severity of a disorder (Hornblow, 1986). In other words, this type of programs aims to help individuals who have symptoms of or a fully developed mental illness such as depression or anxiety disorder to resolve their mental health problems before these problems or illnesses develop into chronic conditions. One major type of secondary prevention programmes that can fulfil these objectives is counseling services. On the one hand, counseling services perform valuable listening, information giving and referral roles. On the other hand, counseling services can help the individuals resolve their psychosocial difficulties that have been linked to the occurrence of mental health problems. Yet, an added value of these counseling services is their possibility in reducing the long-term cost incurred in rehabilitating individuals with chronic minor psychiatric illnesses. These counseling services can be in the forms of face-to-face, or telephone, and individual or group counseling. Many mental health counseling services, in fact, have been found to be effective in helping people with mental illnesses such as depression and anxiety disorders (Hornblow, 1986, Bright et. al, 1999). They can also prevent some people from being admitted into the hospitals or develop into chronic mental illnesses.

At present, there are inadequate secondary prevention programs in the community in Hong Kong, particularly mental health counseling services. As mentioned, psychiatric services in Hong Kong are mainly rehabilitative in nature and cater to the psychiatric needs of those who have already been diagnosed as persons with severe mental illnesses. There are very few counseling services addressing the mental health needs of those who have symptoms of minor psychiatric illnesses, but who do not need immediate inpatient or outpatient medical treatment. These individuals will certainly benefit from in-depth individual and group counseling to help them deal with their mental health problems. The lack of funding support from the Hong Kong government certainly accounts for this inadequacy. Indeed, the government should provide funding for mental health service agencies to establish a mental health counseling team to address the needs of those with minor psychiatric illnesses. The team can provide assessment and individual and group counseling for persons who are at risk or have developed minor psychiatric illnesses.


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