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Mental disorders have been documented to be detrimental to personal and public
health. A leading contributor to global disability, mental disorders have also been
shown to strongly affect one’s quality of life while bringing high social and economic
costs. The COVID-19 pandemic has unleashed a mental health crisis across the
globe and in June 2022, the World Health Organization (WHO) published the World
Mental Health Report to address increasing needs for mental health support. This
report put forward the importance of integrating mental health support into health
systems and beyond, with particular emphasis on the need for mental health service
provision in community settings.

The mental health status of the Hong Kong population has been worsening over
recent years, as illustrated by the decreasing WHO-5 Well-being Index Score; this is
underscored by a local study conducted in March 2022, wherein nearly half of the
1,000 adult respondents reported depressive symptoms (Mind HK, 2022). While
ongoing efforts are in place to continuously evaluate and improve Hong Kong’s
mental health service landscape, as aptly demonstrated by the Mental Health Review
Report (Review Report) published in 2017, the emerging mental health crisis points
to a pressing demand for ongoing review and enhancements to achieve a reoriented
mental health system that adheres to a “fit-for-purpose” vision.

Strengthening the role of primary care to
enable timely access to mental health
support

While Hong Kong’s approach to mental health support has become less
institutionalised over the last century, reform has been slow and care still largely
remains at the specialist level. Accordingly, formal cross-sectoral collaboration
between medical and social care has been inadequate, and the focus of care is
still generally targeted initiatives for persons with SMI, with less attention given to
supporting persons with CMD or the general population.

Although improvements have been shown in past decades, Hong Kong is still
challenged by mental health stigma which has been identified as a barrier to
help-seeking (Chung et al., 2019). Even when people seek help, support from
medical specialists is often preferred, particularly psychiatrists. Such preference
contributes to the overload of the Hospital Authority (HA) psychiatric specialist
out-patient clinics (PSY SOPCs), which is reflected in the long waiting times for
the intake of new cases, ranging from 14 to 64 weeks for stable cases (HA, 2022).
Also contributing to the heavy bottleneck of service provision is the practice of case
referral to PSY SOPCs by different medical practitioners in the system, although
at the time of writing, 77% of all PSY SOPC patients are persons with CMD.
Among these, stable and less complex cases, after careful assessment, could
potentially be handled at the primary care level in non-specialist settings and
provided with more timely mental health support.

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