‘Actually I am not happy’: Hong Kong seeks new strategies to stem rise in student suicides

In the studio of Hong Kong art therapist Gigi Leung, recent visitors were met with an arresting spectacle — a wall full of well over 100 handwritten cards. These cards contained anonymous answers which earlier visitors had given to two questions:

“What troubled you when you were growing up?” and, “What did you do at the time to make the trouble go away?”

A 36-year-old wrote that they had suffered from severe headaches and bouts of vomiting because of immense academic pressure. A 26-year-old said their classmate had thrown bubble gum at them and shoved rubbish into their drawer. They tearfully begged their parents to put them in a different school, the card read, but the response they received was: “Just ignore [the bullies]!” 

Similar cards were displayed on an adjacent wall, but each of these was placed inside an envelope, showing only the respondent’s age on the edge of the paper. The cards – filled out by students – also posed two questions: 

“What troubles you and makes you unhappy?”

“What do you want the people around you to do for you?”

An 18-year-old said they felt distant from their family and were only able to find companionship from their stuffed toys. A seven-year-old said a classmate had said “bad things” about them, leaving them feeling very “upsad.” 

Rising youth suicides

These personal responses were part of a small exhibition which Leung curated last month called “I want to tell you, actually I am not happy.” The project, which lasted one and a half months, came at a time of growing alarm over rising youth suicides since the academic year began last September.

“The main theme of our exhibition was to provide emotional support for students. As an adult, if we want to learn more about students’ emotions, we have to take more initiative and take an extra step,” the 35-year-old therapist told HKFP in Cantonese last month. 

Hong Kong last year saw a decade-high number of suspected student suicides, with the Education Bureau receiving 31 reports in the first 11 months of 2023. Local health authorities revealed that more than 1,800 Hongkongers under the age of 18 had been diagnosed with depression at public healthcare facilities in 2022-23.

The government cited “greater challenges” faced by students after the full resumption of classes following the Covid-19 pandemic as one of the factors contributing to the trend.

Academic pressure

Clarence Tsang, executive director of the Samaritan Befrienders Hong Kong, told HKFP that intermittent class suspensions had slowed students’ progress, and many schools were eager to catch up on the syllabus. 

Pressure also comes from the top of the education system, with school principals and decision makers under pressure to keep schools afloat amid a shrinking student population due to a low birth rate and an emigration wave, Tsang said. 

According to government figures, Hong Kong recorded 333,551 primary school students in 2022, the lowest since 2015. The decline in the number of secondary school students was sharper still, with the 2022 figure of 321,162 a 10-year low. 

More than 70 primary schools in Hong Kong had to cut primary one classes in the 2023-24 academic year, local media reported last September. Schools unable to meet student enrolment targets ultimately face closure.

“The survival of each school is dependent on the number of students they have. How does a school get more students? They usually try to boost academic performance to make parents want to place their children there,” Tsang said in Cantonese. 

Emily, a social worker based in a primary school, echoed Tsang’s remarks, telling HKFP in Cantonese that both teachers and students were under tremendous pressure as schools sought to improve their rankings. 

“The principal has made it very clear: there’s no student who can’t be taught well. In other words, the principal thinks it’s because the teachers didn’t do enough,” she said, requesting to be identified only by her first name for fear of retribution.

Bullying

Tsang said the pandemic meant children had limited interaction with their schoolmates over the past few years. Some struggled to fit in on their return to school, causing them to wonder why they were not accepted by their peers.

“Adults may think that psychological bullying is not a big deal. To students, however, not being accepted creates a lot of stress,” he said. 

Several students identified as high suicide risks have been referred to Emily since the beginning of this school year. Some had engaged in self-harm, while others had expressed thoughts of ending their lives to parents, teachers and social workers, she said. 

3-tier response system

In response to the upward trend in student suicides, the government rolled out a cross-departmental effort in December to help schools identify students at higher risk of suicide and provide early support. 

According to the first layer of a three-tier response mechanism, schools should review the mental health needs of students and give priority to caring for and counselling students with a high risk of suicide. Schools should provide timely assistance and help students in need find professional counselling or treatment, the authorities said. 

The reliance on schools to spot students with emotional distress may be “unfair” to teaching staff who already have an intense workload, said Tsang of the suicide prevention group. He questioned whether the mechanism was suggesting that teachers were to blame if they could not identify students with emotional issues. 

“Schools put a lot of pressure on teachers to handle academic matters, they don’t have much energy and time to take care of the emotional needs of students. It’s not that they don’t want to, it is whether they have the time to do so,” he said.

See also: Hong Kong parents and schoolchildren learn a harsh lesson from Covid closures

Some schools also saw a frequent change in teachers, which made it difficult for students to build trust and share their worries with educators. 

The wastage rate of primary school teachers in Hong Kong stood at 8.9 per cent in the academic year of 2022-23, more than double the four per cent in 2017-18, data from the Education Bureau showed. 

Secondary schools saw a teacher wastage rate of 9.9 per cent in the last academic year, a major increase from 4.9 per cent in 2017-18. 

Tsang also cast doubt on the training teachers received for handling students with mental health needs. On top of theoretical training, guidance and regular consultation with organisations that have frontline experience dealing with youth suicides is crucial, he said. 

More social workers at school

In 2019, Hong Kong vowed to earmark HK$130 million to hire an additional 370 school-based counsellors. The aim was to increase the number of social workers stationed at each government-funded secondary school from one to two. 

Still, Tsang said more school-based social workers were needed, as the process of helping students experiencing suicidal ideation was time-consuming. Students also preferred speaking to personnel they saw frequently on campus, as opposed to off-campus professionals – whom the government sought to engage in the second layer of its response system if schools did not have enough manpower to tend to the needs of students.  

“The most ideal ratio is one social worker to 100 students,” Tsang said. 

Under the third tier of the response system, students with severe mental health needs may be referred to specialist services at the Hospital Authority (HA). Their cases would be given priority, the government pledged, while a consultation hotline was set up for principals to seek professional advice. 

As of mid-January, the HA’s psychiatric department had received a total of 50 referrals from school principals, local media reported last month. 

Gov’t subsidy

Tsang urged the government to consider subsidising schools and students to seek professional help at private healthcare centres, as there was already overwhelming demand for public psychiatry services. 

Eric Chen, chair professor of the Department of Psychiatry at the University of Hong Kong, told Ming Pao last June that most follow-up consultations at the HA would last just five or six minutes. Patients also saw a frequent change in doctors, as the HA’s psychiatry department struggled with a manpower shortage. 

In a bid to widen students’ access to professional help, art therapist Leung offered services at a “pay as you can” rate to more than 30 students, most of them at university. They paid around HK$100 for each session, she said. 

Many of her clients reached her through social media instead of being referred by schools or their parents. The therapist said money was the last thing students should worry about. 

“Perhaps my therapy doesn’t suit them, or they want to seek other services eventually and that’s okay. I just want them to remember their intention of wanting to seek help,” she said. 

The idea of collecting people’s childhood traumas and how they overcame them stemmed from a workshop Leung held with the director and an actor of Hong Kong film Time Still Turns the Pages. 

Directed by Nick Cheuk, the film revolves around a Hong Kong secondary school teacher trying to identify the student who penned an anonymous letter conveying suicidal thoughts. In the process the teacher, played by Lo Chun-yip, relives his own painful childhood memories that left him traumatised for years. 

The film has made a splash in the city since its public release in mid-November last year and fuelled debate about the rising youth suicide rate. Leung’s separate workshop for adults, which discussed childhood trauma with around 30 participants, made her wonder if an early intervention would have helped them better handle their pain.

Next exhibition

The therapist and her team are preparing for a second phase of the exhibition, which will ask participants to respond to the emotional distress expressed by others. The exhibition entitled “I know you are unhappy, but I want to tell you…” is set to be held in May or July, around the school examination period. 

Asked whether she would be open to bringing her therapy to school campuses, Leung said it would depend on the school’s policy on confidentiality. She always made sure the drawings her clients produced were kept confidential, even from parents. 

When asked if the services of an outside therapist in school may create labelling and stigma, Leung said such practices were common in Britain, where she obtained her qualification. Students may need time to get used to these professionals on campus, but it would help alleviate the burden on teachers and school-based social workers – described by some students as having “no headspace” to care for their emotional needs.

“I think any means that can allow students to have access to professional help is a good measure,” she said. 

Additional reporting: Hans Tse

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