Cover Story: Mind Your Head

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Attention employers: It’s OK to not be OK


If the idea of talking about your feelings scares you, perhaps you’ll want to open up after looking at the facts.

Poor mental health costs the British economy between 74 billion and 99 billion pounds a year, according to a 2017 independent review commissioned by the government entitled Thriving at Work. While there’s no comparable figure for Hong Kong, the take home message for our city is the same: Ignoring mental health isn’t just bad for our wellbeing, it’s also bad for business.

To mark World Mental Health Day on October 10, charity groups, healthcare experts and industry professionals gathered at Linklaters’ Hong Kong office to exchange insights and stories on workplace mental health in the city.

The event was organized by the City Mental Health Alliance – Hong Kong (CMHA HK), a collaborative venture founded and led by businesses and experts in the field to raise awareness around the issue of mental health at work and enable businesses to take practical steps.

David Cruikshank, Asia-Pacific chairman of BNY Mellon and AmCham board member, represents one of CMHA HK’s 10 founding member companies.

Cruikshank has seen examples in New York where individuals have struggled with mental health issues and were able to get the help they needed. “Had these people worked in an environment where awareness and access to adequate support were limited, the prognosis might have been much worse,” he says.

Due to the stigma it faces in Asian cultures generally, mental health in Hong Kong isn’t consistently recognized as a “real” illness by society, let alone in the workplace.

“In the U.S. there is more of a culture of speaking up when there’s a problem. In Hong Kong and many parts of Asia, the concept of saying that you are ‘not okay’ or discussing mental health issues could make you an outcast from your own family,” he says.

The first step for Hong Kong is to accept mental health as the serious issue that it is. The next step is being able to talk about it without fear of being judged or stigmatized.

In a survey of 394 working professionals jointly carried out by management consultancy Oliver Wyman, CMHA HK and The University of Hong Kong, over 30 percent of respondents said they had experienced mental health issues while working in Hong Kong. Of those experiencing mental health issues, only 21 percent felt they could tell anyone. Fifteen percent of respondents knew of someone who experienced stigma in the workplace over a mental health issue.

The survey results validate assumptions that cultural support for mental health in Hong Kong and Asia generally lags behind other developed markets, says Cruikshank.

The survey also showed that over 75 percent of employees who had experienced mental health issues said they would still turn up for work. Workplace “presenteeism,” i.e. being present physically but not mentally, is what results, with productivity and quality of work taking a hit.

On World Mental Health Day, BNY Mellon rolled out an internal video awareness campaign with the theme “It’s OK to say I’m not OK.” These kinds of internal initiatives send the message that it’s acceptable to speak up, and hopefully encourage employees and managers to offer support to their peers when they notice something isn’t right, says Cruikshank.

Increasingly diverse workforces mean it is also important to recognize differences in background and knowledge, to ensure mental health awareness and support provided to employees is inclusive, Cruikshank adds. BNY Mellon offers an employee assistance program to all its employees and their families which is available in every language.

Every movement needs to start somewhere. In this case, it should start from the top. “Having senior people drive the change is important. Senior staff in the training room hearing the same message as everyone else also sends the right message to junior staff that they are valued and mental health is important,” says CMHA HK CEO Dr Zoe Fortune.

Asking senior people to stand up in front of their staff to share their own experiences can also be extremely helpful although she describes that in the initial stages of her work, many of those who were involved in the conversations were expats. However, she feels the situation is changing in Hong Kong as both staff and businesses become more aware of the issue.

The CMHA HK uses their research to ensure that their materials are directly applicable to the HK context and will also be expanding training sessions to be conducted in Cantonese.

Emma Pugh, Co-head of Employment & Incentives at Linklaters, says that from a legal perspective, there is a burden on employers in Hong Kong to provide reasonable accommodation to employees with disabilities (including mental health ailments) to help them meet the requirements of their jobs. This may be through more flexible work arrangements or providing additional support when requested.

She suggests companies formulate a visible mental health policy that includes a clear explanation of where employees can find support, and to “plan work with people in mind.”

What else can employers do?

“Encourage employees to switch off outside of work hours. People should not be expected to work round the clock just because we have the technology which enables us to do so,” suggests an anonymous survey respondent.


The Current Picture

Where can you go in times of need?

Hong Kong only has about 390 registered psychiatrists, compared with around 2,200 in New York and London’s 1,500. According to the Hospital Authority’s website, the waiting time for a non-urgent, “stable” case booking at a public outpatient mental health clinic can take up to three years. For urgent to semi-urgent cases, the wait can still be one to three weeks.

If a psychiatric outpatient clinic receives a suicidal or acutely mentally-ill patient who needs to be admitted to intensive care, Castle Peak hospital in Tuen Mun and Kwai Chung hospital are the only institutions with inpatient facilities for long-term rehabilitation and intensive care.

The only other option is voluntary or involuntary admission to a public hospital’s psychiatric ward, where physical restraint of patients is commonly practiced, even if unnecessary.

There are no private hospitals in Hong Kong now offering an acute psychiatric emergency service. Recently opened Gleneagles in Wong Chuk Hang has plans to be the first to open inpatient psychiatric facilities, but no date has been set at the time of writing. The planned facilities will cater to those who are chronically unwell, but in a stable condition.

One prominent healthcare professional who wishes to remain anonymous believes this isn’t doing enough to help. She thinks one area that needs addressing is acute inpatient psychiatric care for the expatriate and English-speaking community, as what ends up happening is that expats are admitted to the city’s already overburdened public system in which English-language standards leave much to be desired.

“For private hospitals to say they don’t have the facilities [for acute patients] is nonsense. The reality is that psychiatric care is not a big money spinner and it’s high risk, so they don’t want to get involved. Why are private hospitals allowed to pick and choose based on what makes them a lot of money?” she says.

Now what if you suffer from a minor mental health issue and want to see a clinical psychologist for cognitive behavioral therapy rather than a psychiatrist for medication?

Finding a psychologist for those who don’t know where to begin is much less straightforward here than in other developed economies, says Dr Hannah Reidy, CEO of Mind HK, a charity committed to improving awareness and understanding of mental health in Hong Kong.

The UK’s NHS for example adopts an interdisciplinary approach, where psychiatrists, psychologists and other health professionals work together to decide on the best course of action for the patient. By contrast, psychiatrists and psychologists in Hong Kong tend to work independently of one another, meaning it can take longer to identify the most appropriate treatment for patients, she says.

Also in Hong Kong, patients tend to turn to psychiatrists first simply because the cost of seeing a medical doctor is covered by most local insurance policies, whereas clinical psychologists’ fees typically are not.

“There will always be a place for drugs but they only treat the symptoms,” says Dr Reidy, who believes in a more holistic approach that starts with demystifying mental health within schools, the government and among the general public.

Progress is slow. When the government’s proposed Accredited Registers Scheme for Clinical Psychologists within Hong Kong comes into effect, psychologists not trained at either HKU or Chinese University will not be able to practice here. This will prevent most internationally trained psychologists from practicing within Hong Kong until further registration and requirements can be fulfilled, and might even put them off.

While this new regulation is intended to ensure rigorous standards for the profession, there is already a shortage of clinical psychologists catering to the international community.

“People with chronic mental health illnesses should not be allowed to come and work in Hong Kong. It’s too dangerous,” says one healthcare professional who asked not to be identified. “If that’s the message that will make the Hong Kong government sit up and take notice then that’s what needs to be said.”

Changing attitudes

Psychiatrist Dr Barry Connell says that when he moved to Hong Kong 28 years ago, there was a stigma attached to the discipline even within the medical profession itself. Psychiatry was widely considered to be “not real medicine.”

Addressing the global wellness trend, he says “we need to incorporate this part of our humanity into that term.”

A clinical psychologist in Hong Kong who asked to remain anonymous says that even her English-speaking Hong Kong Chinese patients with an international outlook tend to carry a fair amount of stigma around mental health. If not themselves then their families. Most turn up to see her with a GP referral based on physical symptoms – a fact she puts down to the propensity of eastern cultures to stigmatize and attribute mental health to physical wellbeing.

She says that for locals, having a mental health disorder is seen as something scary and serious, because it is not well understood. Within Hong Kong’s expat community however, the stigma is very different. “For expats here there is very much a ‘work hard, play hard’ culture, and having a mental health issue is a sign of weakness,” she says. 

There are some signs that local attitudes are gradually changing. More than half of the visitors to Mind HK’s website view its Chinese-language version, and frequently search for resources on how to support someone suffering from poor mental health.

The final message is positive yet realistic. “We’re never going to be able to eliminate stress, or mental health disorders. There will always be limitations. What we can wish for is more openness and communication, to limit the impact that poor mental health has on us,” says Dr Connell.


7 tips to start talking about mental health

1. Start simple
If having a face-to-face conversation about mental health feels hard, start simple: make a phone call, or send a message checking in so that they know you care

2. Avoid distractions
No matter the method of communication, find a time and place where you’re both comfortable and can talk

3. Use caring statements
Start the conversation with something that lets them know you care, like “I have noticed you seem down lately, is everything ok?” or even a simple “How are you?”

4. Let them set the pace
Opening up takes a lot of courage, show that you appreciate it. Let them lead the conversation at their own pace and decide how much they share. You might be the first person they’re speaking to about this

5. Don’t make assumptions
While you may be happy to support, try not to make assumptions on their diagnosis or thoughts. They are the experts about themselves

6. Focus on feelings
Providing an outlet for someone to express their feelings may be more helpful than trying to solve their problems

7. Treat them the same
If an individual opens up to you about their mental health condition, they are still the same person regardless. They don’t want to be treated differently. Be your usual self and act toward them in the same way you normally would

For more information and resources visit Mind HK’s website: https://www.mind.org.hk/