ISE16/20-21

• Mental health is an integral and essential component of health. More than just the absence of mental disorders or disabilities, it is a state of well-being in which an individual realizes his or her own abilities, the ability to cope with the normal stresses of life, to work productively and to make a contribution to his or her community.^{1Legend symbol denoting See WHO (2018).} As such, promotion, protection and restoration of mental health are generally regarded as a vital concern of individuals, communities and societies throughout the world.
• Nevertheless, the Coronavirus Disease 2019 ("COVID-19") pandemic has interrupted the provision of mental health services in most of the places around the globe.^{2Legend symbol denoting According to a survey conducted by the World Health Organization during June to August 2020, the pandemic has affected the critical mental health services in 93% of 130 surveyed countries worldwide. See WHO (2020).} Besides, it has worsened the overall mental health situation by bringing different kinds of stressors including poor health, job losses and social isolation to people. To minimize the impacts of the pandemic, the United Nations ("UN") has recommended that governments should: (a) apply a whole-of-society approach to promote, protect and care for mental health; (b) ensure widespread availability of emergency mental health and psychological support; and (c) support recovery from COVID-19 by building mental health services for future.^{3Legend symbol denoting See the United Nations (2020).}
• In Hong Kong, the Government adopts an integrated approach in promoting mental health, encompassing prevention, early identification, timely intervention and rehabilitation. In 2017, it completed the latest review of mental health policy and established the Advisory Committee on Mental Health to assist itself to put forward various new measures of enhancing mental health services. With the emergence of the social incidents and the COVID-19 outbreak, various surveys have revealed that the public mental health had been deteriorating. For example, a survey conducted during February to July 2020 by the University of Hong Kong found that 36% of respondents had symptoms of post-traumatic stress disorder and depression;^{4Legend symbol denoting See 香港大學(2020年).} the mental health index for Hong Kong people gauged by another survey conducted by the government-supported Organising Committee of "Mental Health Month" had reportedly dropped to a record low since 2012.^{5Legend symbol denoting Organized by the Labour and Welfare Bureau in collaboration with various bureaux/departments, public organizations and non-governmental organizations, the Committee aims to promote public knowledge of mental health. Subsequent to the occurrence of social incidents, an additional survey was carried out in early 2020. See GovHK (2019a), SCMP (2020) and The Standard (2020).} Specifically, the average score fell to 45.12, with 52 set as passing score. In view of growing stress in society, some people have suggested that the Government should strengthen the efforts and implement more targeted measures to restore the public mental health.
• England of the United Kingdom, known to be an innovator of mental health care,^{6Legend symbol denoting See OECD (2012).} has a comprehensive mental health policy with a forward-looking view in promoting mental health. Over the years, the suicide rate (i.e. a proxy for the prevalence of mental health disorders) in England has stayed comparatively low among the developed places.^{7Legend symbol denoting For instance in 2016, the suicide rate was 7.3 suicides per 100 000 people, lower than that in Australia (12.1 suicides), United States (14.0 suicides) and South Korea (24.6 suicides). See OECD (2019).} To tackle the mental health issues brought by the COVID-19 epidemic, it has been launching various innovative initiatives and enhancing service support. This issue of Essentials begins with an overview on mental health policy and recent developments in Hong Kong, with a focus on community support services in the areas of prevention and early detection. It is followed by a discussion of the experiences and initiatives undertaken by England in promoting mental health amid the pandemic from which Hong Kong might draw reference.

Hong Kong

• In Hong Kong, the Food and Health Bureau is responsible for co-ordinating various multi-disciplinary and cross-sectoral services to persons with mental health needs among relevant bureaux/departments and other stakeholders (e.g. non-governmental organizations ("NGOs")) in the community.^{8Legend symbol denoting See Legislative Council Secretariat (2020).} While the Hospital Authority is a major medical service provider for people with mental disorders, the Social Welfare Department ("SWD") provides district-based community support services for different types of people such as discharged mental patients and persons with suspected mental health problems. In 2019-2020, the total estimated expenditure on mental health services of the statutory body and the government department was about HK$6 billion, equivalent to 0.2% of Gross Domestic Product ("GDP").^{9Legend symbol denoting See Food and Health Bureau (2020b) and Legislative Council Secretariat (2020).}
• In the face of growing stress in society over the past year, the Government has contacted some NGOs to provide free services through their ad hoc mental health programmes for people with mental health needs arising from the social incidents and the COVID-19 epidemic.^{10Legend symbol denoting See Food and Health Bureau (2020c).} In July 2020, it launched a territory-wide mental health promotion and public education initiative called "Shall We Talk" with an aim to promote mental health and eliminate stigmatisation towards persons with mental health needs. In addition to a series of promotional activities, it has launched a one-stop website to provide a wealth of relevant information (e.g. knowledge sharing and channels of getting help) to the public. To prepare for return of school life, the Education Bureau has organized some 20 regional workshops for school staff to enhance their capabilities in providing emotional support for students.^{11Legend symbol denoting See Education Bureau (2020).}
• Nevertheless, the prolonged COVID-19 pandemic has raised concerns about the adequacy of resources support for mental health services in Hong Kong.^{12Legend symbol denoting See Legislative Council Secretariat (2020).} Not only is this related to healthcare but also community care.^{13Legend symbol denoting In reviewing the mental health services of SWD, the Office of The Ombudsman has recommended to strengthen its community support services, such as making more joint efforts with other service agencies in the community. See Office of The Ombudsman (2018).} Some have suggested that the Government should enhance mental health services with more funding,^{14Legend symbol denoting See 香港01(2020年).} while some others are particularly concerned about specific groups of people who could be more vulnerable to mental health issues during the pandemic.^{15Legend symbol denoting See 團結香港基金(2020年).} In view of social distancing constraint, some have suggested a wider application of innovation and technology in society to reach out the needy.^{16Legend symbol denoting See 經濟日報(2020年).} Recently, the Chief Executive announced in her 2020 Policy Address that the Government would provide additional resources of HK$300 million under the Beat Drugs Fund to better support the needy in the community and raise public awareness of mental health.^{17Legend symbol denoting See 2020 Policy Address (2020).} The preparatory work is being undertaken by the Advisory Committee on Mental Health, and specific details have not been announced yet.

England of the United Kingdom

• In England, while the Department of Health and Social Care is responsible for formulating mental health policies and co-ordinating works with various departments and other stakeholders (e.g. local authorities), mental health services are mainly provided through National Health Service England ("NHS").^{18Legend symbol denoting There are Clinical Commissioning Groups (groups of general practitioners) responsible for commissioning mental health care services at the local level. See NHS (Undated) Clinical commissioning groups (CCGs).} In 2019, NHS published its Mental Health Implementation Plan to set out a five-year forward view for the provision of mental health services, specifying various mental health care targets and emphasizing digital innovations to deliver more personalised care, among others. In 2019-2020, the national spending for mental health services was £13.3 billion (HK$133 billion),^{19Legend symbol denoting See NHS (Undated) NHS Mental Health Dashboard.} equivalent to 0.6% of GDP. Similar to many other places, subsequent to the COVID-19 outbreak and consequential lockdown, there were growing stresses among people over social isolation, job insecurity and bereavement. In view of this, England has taken immediate actions by providing extra funding of £9.2 million (HK$92 million) to mental health organizations to strengthen their support services and rolled out various initiatives. Many of the initiatives are seen to be in line with the whole-of-society approach as recommended by UN, which are discussed in the ensuing paragraphs.

Prevention initiatives for targeted groups of people

• According to UN, young people are at higher risk of developing mental health problem, especially during the crisis. To better equip teachers with the knowledge and skills to support the students' mental well-being when they return to schools in September 2020, England launched the national programme called "Wellbeing for Education Return", under which (a) a training package with a focus on emotional response to the outbreak was developed by the government for schools; (b) an extra funding was provided to local authorities to engage mental health care experts in customizing the teaching materials for schools and offering advice/support for six months; and (c) each school was required to nominate a staff to receive training and coordinate the promotional works of mental health within the school.^{20Legend symbol denoting See GovUK (2020b) and SESLIP (2020).} Since mental health education has been made compulsory in all primary and secondary schools starting from September 2020,^{21Legend symbol denoting Mental health education is included as part of Health Education curriculum. See GovUK (2020c).} the "Wellbeing for Education Return" initiative has helped supplement the new curriculum.
• Medical staff, being on the frontline of providing healthcare support to society during the COVID-19 outbreak, have been under high stress of heavy workloads and risks of being infected. Against this, NHS has expanded the counselling services by proactively offering outreach and assessment services as a way of prevention;^{22Legend symbol denoting See NHS (2020c).} and also enhanced the staff benefits by providing flexible working arrangements, free car parking, free tea/coffee in pantry, etc. to keep up their spirit. Apart from healthcare workers, COVID-19 pandemic might also cause mental issues in other work sectors, especially when the work-from-home arrangement prevailed. In the West of England, the local government has launched the "Thrive at Work" programme to provide support for different levels of staff in workplaces. For instance, mental health management skill training was offered to managers in small and medium enterprises (i.e. with not more than 250 staff) while suicide awareness training was offered to general staff to look after their colleagues.^{23Legend symbol denoting See the West of England (2020b).}

Multi-pronged community-based caring and support

• In England, leisure activities such as arts activities and cookery are promoted as a non-medical help (referred to as social prescribing/community referral) to tackle loneliness and improve wellbeing from the COVID-19 outbreak. Against this, the National Academy for Social Prescribing (the dedicated national organization for promoting social prescribing) has launched various new initiatives with local organizations to support people to stay connected within their community.^{24Legend symbol denoting See GovUK (2020a).} These included collaborating with football clubs to encourage fans to talk about their mental health and get involved in the games, as well as partnering with art centres to care for patients with chronic health conditions to reduce their feelings of social isolation.
• In view of the continued stress arising from COVID-19, in September 2020, an extra funding was provided to bolster suicide prevention plans and bereavement support in the community.^{25Legend symbol denoting See NHS (2020d).} As part of the efforts to promote early detection of potential mental health problems, mental health first aid training was introduced to certain service professionals (e.g. barbers) for free, hoping that they can talk with their "customers" and direct them to necessary support as and when they spot symptoms. On the other hand, there are dedicated suicide bereavement liaison officers^{26Legend symbol denoting To provide the support, they will receive referrals from police and/or medical staff. See GovUK (2019).} available in some local areas who could offer emotional and practical support to those being affected by a family member or friend taking their own life.
• As the highly infectious nature of COVID-19 has been interrupting some in-person mental health services and bringing social isolation to the public, some places in England has strengthened the mental health support through a wider application of digital environment. For instance in Shropshire, all residents aged 16 and above are granted access to an online community platform called "Togetherall" for free. Monitoring by trained professionals on a 24/7 basis,^{27Legend symbol denoting To access the platform, they are required to register with a postcode and an email address. See Shropshire Council (2020).} the platform allows participants to share their feelings and communicate with others on group/individual basis anonymously.^{28Legend symbol denoting Specific behaviour on the platform (e.g. using the extreme wordings) will trigger a response by the professionals and an escalation process will be implemented. See Togetherall (2020).} Besides, there are also various tools/resources (e.g. self-guided courses and self-assessment tools) in the platform to empower their own emotional support.

Making available more manpower resources to recover from COVID-19

• According to the mental health and wellbeing surveillance report conducted by the government, both the anxiety level and the depression level of the general population have showed signs of improvement after relaxation of lockdown restrictions in June 2020.^{29Legend symbol denoting See GovUK (2020e).} However, with the second national lockdown announced in November 2020, some have called on the government to provide greater mental health support services.^{30Legend symbol denoting See Mind (2020).} Considering that the adverse impact on public mental health of the pandemic could be long-term, the UK government has committed to increasing the manpower for supporting on-going mental health service. For example, it has provided an extra funding to a charity organization to expand the training programme of social workers on mental health care. Under the initiative, it is expected that the number of the social workers will increase by 60%, serving at least 10 000 users over the next three years. Meanwhile, NHS is recruiting an extra 500 social prescribing link workers^{31Legend symbol denoting On average, they will meet the patients about six to 12 times (depending on their needs) over a three-month period. See NHS (Undated) Social prescribing - frequently asked questions.} (or called community connectors) to connect patients to community groups and help them develop skills, friendships and resilience.^{32Legend symbol denoting See NHS (2020b).} It is expected that the additional manpower could provide personalized support to extra 125 000 people per year.

Concluding remarks

• Mental health is an integral part of health. With the emergence of COVID-19 outbreak, enhancing support in mental health services to tackle the public mental health crisis is essential in every place. Amid the pandemic, people in Hong Kong have shown signs of deterioration in mental health. The Government has contacted some NGOs to provide free services to the public, and launched the "Shall We Talk" initiative. England, known to be the innovator of mental health care, has taken a proactive and whole-of-society approach to care for public mental health. It has on the one hand introduced additional support measures for different targeted groups of people, e.g. students and medical staff; and on the other hand promoted early detection of potential mental health problem in community by, for example, offering first aid mental health training. It has also created a digital platform to facilitate sharing of feelings under the monitoring of professionals and increased manpower support in view of the potential long term impact of COVID-19. All these initiatives may provide some reference for Hong Kong in devising strategies to relieve anxiety and depression among the public.

Prepared by Kent CHUNG
Research Office
Information Services Division
Legislative Council Secretariat
26 January 2021