Suicide is a leading cause of death among young people in Hong Kong and Singapore. To help high schools identify at-risk students early on and connect them to professional help, psychologist Dr Jamie Chiu has developed a series of friendly, interactive digital screening tools.
(PART 4 of 5) Re:solve Global Health’s new Q&A series explores strategies to improve mental wellbeing. We asked five experts from diverse backgrounds (health promotion, social media strategy, public health, suicide prevention and international advocacy) to answer this key question: How can we prevent mental health problems at a population level?
How common is the incidence of mental health issues and suicide among young people in Hong Kong and Singapore?
Local research shows that up to about 30% of young people between the ages of 12 and 19 report moderate and above depression symptoms. For anxiety symptoms, that number gets closer to 40%. If you compare high-income countries, Hong Kong and Singapore are higher than average.
Suicide is a leading cause of death for young people in Hong Kong and Singapore. There are also young people who think about suicide and young people who attempt suicide, and those numbers will be even higher. Not all mental health issues end in suicide, but a lot of suicides stem from mental health issues.
Why do mental health issues and suicide affect young people disproportionately in these places?
There are many factors at play. For example, young people in Hong Kong and Singapore sleep less, exercise less and are online a lot more than young people in other places. Only about 10% of teenagers in Hong Kong meet the guidelines for physical activity.
Academic pressure is also very high. From our survey data, we see 12- and 13-year-olds saying that they worry about their future and getting into university. That pressure increases year after year as they get older.
Stigma and, more specific to Asian culture, shame are other important factors. If a young person has a suicide attempt, parents are often very reluctant to share that information. It can be very difficult for parents to talk about, and the secrecy and shame can lead the young person to think there’s something wrong and flawed in them.
How do your digital screening tools work?
When a young person begins to have thoughts of suicide, the changes can be subtle. In the day-to-day interactions with parents or teachers, early warning signs can be missed. Our digital mental health screening programme ‘Know My Students’, which was launched in 2018, helps struggling students get connected with school support.
Students use a friendly, interactive digital tool to answer questions about depression and anxiety symptoms, school stress, self-confidence, and things they’re worried about. Young people who report elevated signs of risk receive a follow-up assessment from school social workers or counsellors. We are very transparent and explain to the student what the tool is for, who will see the results and what kind of support they can expect.
During the pandemic and the switch to remote learning, we created another tool that makes it easy for young people to connect with their school social worker. A video introduces the school’s student support team—the counsellors, social workers and teachers involved in pastoral care—and we explain who these people are and how they can help.
After the video, students complete a survey that focuses on school stress and school culture, and then they’re asked if they would like to speak with one of the support people. If they say yes, the counsellor they select gets an immediate notification.
We’re not necessarily replacing the idea that teachers should look out for signs of risk, but using our tools can augment and facilitate the process because it gives young people the opportunity to reflect on questions that they normally wouldn’t encounter in their day-to-day interactions.
How have your programmes helped to reduce suicide risk and improve mental health outcomes among young people?
With mental health issues, the suffering and risk propagates the longer you're in that state without getting any sort of intervention, so it’s really important to create additional avenues of connecting with struggling teens and provide timely support.
We've had cases where, because of our screening programme, suicides have been prevented.[an2] In one case, during a follow-up assessment a student spoke about their plan to kill themselves over the upcoming school break. The school was able to intervene, get the parents on board and get the student additional support.
The response to our new programme has also been really promising. The number of students who indicate they want to connect with an adult from their school for support is fairly high, hovering at around 12%. It’s reassuring that our tools help students feel safe to share things that they otherwise may not have an opportunity to talk about.