Hong Kong teachers on front line of spotting student suicide risks in ‘top priority’ push

Hong Kong schools have swung into suicide-prevention mode since more than 30 schoolchildren took their lives last year. In the second of a two-part series, the Post examines how teachers and school social workers are coping at the front line of looking out for children in distress, and the multiple other efforts under way to tackle the crisis. Read part one here.

English-language teacher Amy Chan* has been making an extra effort to look out for teenagers in distress since a girl at her Hong Kong secondary school killed herself last year.

Since the academic year began last September, she has referred two of her pupils to the school’s social workers.

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“No matter what we do, it seems impossible to prevent students from having negative thoughts. We don’t understand why so many think about suicide so readily,” she said.

After the student’s death, the school cut the number of assessments to reduce academic stress, and has been holding regular mental health activities including talks and mindfulness workshops.

“Finding out who has mental health needs has become the top priority,” Chan said. “The strategy is to identify potentially suicidal students as early as possible, because we don’t know what they might do when they are not under our supervision outside campus.”

Hong Kong schools have made their students’ mental health a priority following a surge of suicides and suicide attempts by young people since the Covid-19 pandemic, and especially after the current academic year began.

The Education Bureau recorded 32 suspected suicides among primary and secondary school students last year, more than double the figure in 2018.

With limited resources and manpower, some schools are struggling to cope and some teachers themselves are finding it hard to deal with the added burden of being part of the unanticipated suicide prevention drive.

Educators and social workers urged the authorities to make permanent a pilot project that shortens the waiting time for students to get help at psychiatric clinics, provide schools with more trained staff to deal with mental health issues and pay attention to teachers’ stress too.

What was most important, they said, was for Hong Kong to move away from its exam-based education system which had teachers racing to cover a packed curriculum, with a heavy load of homework and assessments piled on pupils.

Hong Kong has to move away from its exam-based education system, experts say. Photo: Handout

The suicide rate for those aged 15 to 24 hit 12.2 deaths per 100,000 people in 2022, almost double the 2014 rate of 6.2, according to the Centre for Suicide Research and Prevention at the University of Hong Kong (HKU).

The rising suicide rate among the young reflected the post-pandemic situation in other developed countries and regions, including the United States, Japan and South Korea, according to data from the World Health Organization.

Bureau data also showed that the number of students with mental illness tripled over the past five years from 600 to more than 1,900 last year.

A citywide survey by Chinese University of Hong Kong researchers found nearly one in four children and adolescents had at least one mental health disorder, and almost one in 10 secondary school pupils had suicidal thoughts.

‘Sometimes I feel powerless’

Hong Kong teachers at the front line of the city’s suicide watch told the Post they tried their best, but sometimes felt inadequate for the task.

Chinese-language teacher Jenny Wong* recalled the hours she spent accompanying a teenage boy to hospital after she discovered his wrist bleeding from a deep, self-inflicted cut.

Although she had some counselling training while at university, she has found it hard being constantly on the alert for troubled students while teaching in class, or looking for hints of distress in their essays.

“It is quite challenging if they do not seek help or show their self-inflicted wounds to me,” she said.

Whenever she identifies troubled students, she speaks to them before referring them to the school’s guidance team to follow up, talk to the parents and, if necessary, initiate changes to allow flexibility in handing in schoolwork and have more realistic academic targets to reduce their stress.

With mental illness categorised as a special education need in Hong Kong, it is common practice for schools to offer these students not only counselling support but also flexibility with schoolwork and assessments, including extra time during exams.

Educational psychologists who visit schools every few months also carry out assessments and make relevant suggestions for the schools.

But students’ needs were complex, Wong said. Many became mentally distressed as they struggled to keep up with schoolwork after full-day classes resumed early last year, while also dealing with family conflicts.

More realistic academic targets are needed to reduce pupils’ stress, experts say. Photo: Jelly Tse

Almost three years of learning at home during the pandemic had also affected their interpersonal relationships and problem-solving skills.

“Sometimes I feel powerless,” Wong said. “They may feel a bit better after I talk to them, but they become distressed again very quickly as the cause is still unresolved, especially those facing family problems.”

She said she tried to spend as much time as she could with these students, and encouraged them to see social workers.

“My role is to seek them out and be a listening ear, but counselling is not my profession.”

A survey of more than 1,200 teachers by the Hong Kong Federation of Education Workers last year found that their happiness index fell to 4.3 out of 10, the lowest level in a decade.

Dealing with students’ emotional problems emerged among the stressors, along with teachers’ heavy administrative and teaching workload and handling learning differences.

Professor Paul Yip Siu-fai, director of HKU’s Centre for Suicide Research and Prevention, agreed there was a need to support teachers.

“Some teachers are developing mental health issues because they hardly have time for themselves given the busy and stressful work, but they are always the first line of support and we need to ensure there is sufficient manpower and training,” he said.

‘High-risk, but largely invisible’

School social worker Peter Yeung* said teachers played a crucial role in identifying troubled students, but many had only a superficial understanding of suicide.

“Most of the attention is paid to those with imminent signs, like those who have harmed themselves, but the most high-risk ones are largely invisible – they might appear to be fine, or even able to care for others,” he said.

Noting that most students who took their own lives went unnoticed and did not not receive any support, he added: “You need to be very observant to spot subtle signs, such as a chaotic state of mind and lack of appetite.”

There were also challenges helping students identified as potentially suicidal, especially those grappling with complex trauma and relationship problems.

Medication could help in some cases and needed time, but many parents would not accept this, Yeung said.

Professor Paul Yip says there is a need to support teachers. Photo: Harvey Kong

To support those students better, he said, schools could purchase clinical psychology or counselling services from external bodies, but this was costly. Government mental wellness community centres, which were for people of all ages and all kinds of mental issues, hardly met the specific needs of adolescents.

Yeung said Hong Kong needed more mental health professionals to support schools and family based services to better address students’ needs.

And when it came to helping students, he said: “No matter how much money is allocated for wellness activities as prevention, a system change is needed to improve the study environment.”

The long hours and heavy workload affected both students and teachers, he added.

‘Caring for teachers helps students too’

Since the 2019-20 academic year, the authorities doubled the number of social workers for each school from one to two.

Still, social workers in some schools handled up to 100 cases each.

School social workers were often overwhelmed juggling everything from accompanying students to hospital to speaking with pupils’ families, providing counselling services and negotiating to adjust the curriculum requirements for some, said Law Wing-yan, a veteran social worker who spent 10 years in schools.

She agreed that outsourcing some tasks to NGOs could ease the load on school social workers.

Law Wing-yan says school social workers are often overwhelmed juggling everything. Photo: Sun Yeung

As a social work fellow at the JC InnoPower Fellowship for Social Workers, which supports innovative projects, she introduced a mindfulness pilot project called “Let’s Pause” at five schools in May.

It creates opportunities for teachers and students to relax together and build rapport, something neglected during the pandemic. It runs wellness activities such as meditation and art workshops, as well as summer retreat camps for them to unplug, connect with nature and bond.

Law said having a closer relationship with teachers would encourage students not only to seek help when troubled, but also to work harder academically.

“The emotions of students and teachers are indeed interconnected,” she said. “If teachers are given the time and space to take care of themselves, they will be more sensitive to their students’ emotions.

“If we do not engage teachers as well, students will immediately return to a stressed state once the activities are over.”

‘Give kids quicker access to psychiatrists’

Last year’s surge in suicides led the authorities to give primary and secondary schools a grant of HK$80,000 each to promote mental health and they were also told to review their students’ workload.

A three-tier emergency mechanism was also introduced in schools last December to identify and support distressed students.

The first two tiers did not add new measures, but the third one allowed principals to refer students with severe mental health needs to receive priority at public psychiatric services.

As of March 31, 168 students had been referred to the Hospital Authority. Only 3 per cent were considered urgent cases, and two-fifths were semi-urgent.

Secondary school principal Esther Ho Yuk-fan, chairwoman of the Hong Kong Association of Careers Masters and Guidance Masters, said she hoped the scheme could be made permanent, as she found the third-tier support helpful for pupils with urgent needs.

“It was not easy to persuade them to see a doctor in the past because the waiting time for public psychiatric services was too long,” she said.

However, when it came to reducing the risk of suicide among students, she felt it was more important to promote well-being on school campuses rather than buy the “canned services” of NGOs that could not take care of students’ underlying needs.

“Ultimately it’s teachers who spend the most hours with the students, so schools need to invest in this effort,” she said.

Secondary school principal Li Kin-man, previously a youth social worker, said he hoped more could also be done to help parents understand the need for their children to seek medical help, for example by engaging health professionals in the negotiation process.

He also stressed the need to review the current education system and offer more flexibility in lesson time, to lighten the workload of teachers and students and allow more time for bonding.

He said it was currently almost impossible for teachers to balance their work and their students’ mental health needs.

“The more they dig in, the more they will identify cases of students in need,” he said. “This is not only about the number of teachers and their years of experience, but also the relationship between teachers and students.”

Dr Lam Ching-choi, chairman of Hong Kong’s Advisory Committee on Mental Health, which advises the government on policy, said he saw signs of hope.

He said the three-tier mechanism and other efforts had already proven effective, as the suicide situation appeared to have stabilised this year.

Dr Lam Ching-choi says the three-tier mechanism and other efforts have proven effective. Photo: Sammy Heung

Provisional data from HKU showed there were 20 suicides and 16 attempts by people aged below 25 as of mid-May, based on media reports. There were 67 suicides and 50 attempts by this age group over the whole of last year.

He said more system changes were coming up, including promoting a “setting approach” to screen, detect and provide early intervention within the schools themselves.

But this would require schools to adopt an open-door policy, allowing external collaborators to support them, for example, by conducting gatekeeper training for students to look out for troubled schoolmates.

Lam said such training could also be provided to sports coaches and instructors who spent considerable time with students.

This would lessen the burden on teachers, and let psychiatrists focus on the most complicated cases, he added.

He was also looking into a Jockey Club project to support schools in creating wellness hubs where pupils could take a break and release their emotions in a safe space, and establishing wellness clubs to train students to be good listeners.

If successful, the project could be extended to all schools, he said.

“We need to open everything up, including schools, campuses and students, to have a bigger shot in resolving this mental health challenge.”

*Names changed at interviewees’ request.

If you have suicidal thoughts or know someone in distress, help is available. In Hong Kong, dial +852 2896 0000 for The Samaritans or +852 2382 0000 for Suicide Prevention Services.

In the US, call or text 988 or chat at 988lifeline.org for the 988 Suicide & Crisis Lifeline. For a list of other nations’ helplines, see this page.

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