A decade ago, one in seven Hong Kong residents had a common mental health disorder; that figure is now one in six. And the figure for children and adolescents is even more alarming.

A recent university study seen by Mind HK’s chief executive, Candice Powell, found that one in four primary and secondary school students are affected.

“We are really seeing the impact of the pandemic. Last year we were still in the pandemic and couldn’t see the impact; right now it’s very obvious,” says Powell.

Mental health services in Hong Kong were already seriously stretched before the pandemic, and now the situation is critical.

The city has 550 psychiatrists and 515 psychologists, but needs 700 more psychiatrists and 3,000 more psychologists, says Powell.

Raising those numbers is essential, but that shortfall is not going to be made up in the near term, so Mind HK’s strategy is to increase access to community therapy.

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“We wanted to expand the workforce because we know it’s not enough. There are a lot of potential people interested in contributing to mental health,” said Powell.

The first group to take part in the YWP programme comprised psychology graduates, counsellors, people who wanted a career change and some early retirees.

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Drawing inspiration from successful stepped-care models in the United Kingdom and Australia, the participants underwent rigorous in-person training and a nine-month supervised clinical placement.

Through the programme, the YWPs delivered 3,336 free mental health support sessions to more than 400 individuals aged between 12 and 24 within their placement period.

The programme also taught young people skills to manage their negative thoughts and emotions.

“Young people don’t have a lot of understanding about emotions. It’s not taught and they don’t have the vocabulary to talk about it. Many of them think that having emotions or crying is bad,” says Chow Chung-yan, a graduate of the recent programme.

The common problems that young people bring to therapy are academic stress and issues with friends, family and dating, Chow says. While these are the sources of their issues, she says that doesn’t capture what is really concerning them.

“What bothers them is what they think about these situations – related to thinking they are worthless or a failure. There is a lot of pressure on them, comparing them to their classmates,” says Chow, 24.

The YWP programme is based on acceptance and commitment therapy (ACT therapy), a type of mindful psychotherapy that helps clients stay focused on the present moment and accept thoughts and feelings without judgment.

With practice, the skills learned can be applied to different life situations to improve psychological flexibility and resilience.

Natalie Tyrwhitt-Drake, another recent YWP graduate, worked at a Buddhist monastery after she graduated from university with a degree in philosophy and politics. She sees parallels between Buddhism and ACT.

“In Buddhism there is the idea of not being so attached, and in ACT we talk about being not being ‘hooked’ or ‘fused’ to things, especially if those attachments are unproductive or aren’t in line with our values or what we want our lives to be about,” says Tyrwhitt-Drake.

She says many of her young clients have issues around self-esteem and confidence and are concerned with the way others perceive them. Tough Asian parenting, with emphasis on criticism over praise, often fuels feelings of poor self-worth.

She encouraged her clients to “unhook” from negative thoughts about themselves with a simple exercise that involved writing ‘I am having the thought’ in front of the thought. For example, ‘I am having the thought that I’m useless’.

“Being able to take a step back, and see that maybe this is just one of many thoughts in this moment, gives them some distance. They learn to recognise that thoughts come and go and change,” says Tyrwhitt-Drake.

“It was a light-bulb moment for me, realising that I can’t keep working and working, sometimes I just have to accept that this day is like that.”

Powell believes the ACT model is especially well suited for use in this programme because it is transdiagnostic – it can be applied to different emotional disorders, from anxiety to depression, which means practitioners won’t be overwhelmed making a diagnosis – and because the component of acceptance is in line with Chinese Taoism.

“It’s about how we relate to our thoughts and emotions. What is your relationship with that thought? Also, the commitment component is good for modern society with the stress on life values and if your action is in line with your values,” said Powell.

The programme was especially effective for young adults aged 18 to 24 who saw a recovery rate of up to 70 per cent. For adolescents, the figure was 34 per cent, which Powell says speaks to the need for more time for these teens to become engaged.

Chow and Tyrwhitt-Drake are among six of the recent YWP practitioners to receive funding to work part-time in local schools.

Mind HK will set up a practitioner network to offer a pro bono service, and practitioners will have the chance to volunteer, Powell says. The group is also speaking with the government to see if its YWP practitioners can provide support in the primary health sector.

The group has received funding to train 100 more practitioners. The next session will begin in May 2024 and recruitment will start soon. Those interested in joining should keep an eye on the Mind HK website for details.

“ACT and the programme is a great way for students to learn about their emotions. They learn that emotions are helpful and necessary, there are calls to action and it points us to our values,” says Chow.

“Clients start to learn practical techniques to work with their emotions instead of fighting against them.”