Seven out of 10 people with symptoms of depressive illness in Hong Kong are suffering in silence and not seeking help, according to a major study being prepared by the Chinese University of Hong Kong. Provided to China Daily

Nearly one in six adults in Hong Kong suffer from depression, a major new study has found, but less than one-third of them seek the help they need. Simon Parry reports on a hidden epidemic that can have tragic consequences.

To work colleagues and his many friends, David Tait seemed to have the world at his feet. An accomplished rugby player and team captain, he had come to Hong Kong with his long-term girlfriend and carved out at promising career with a top international financial company.

At just 25, it appeared he had everything to live for. But days before he was due to fly home to Britain for Christmas, the expatriate took the Star Ferry across Victoria Harbour and jumped to his death into an empty swimming pool from the top of an apartment block in Kowloon.

Friend and work colleague Anson Bailey, president of the Kowloon Rugby Club of which David was captain, said the death of the young man known as "Taity" had come completely out of the blue. "He had a very bright future ahead of him," Bailey said.

"He was a high achiever. He had everything going for him. He was genuinely a well-liked and popular guy - tall, handsome. He had everything. In the office he would walk around and smile and talk to people and was always friendly and polite. It is just so tragic that it happened and perhaps we'll never know why.

"David was the first team captain and you have to have certain qualities as a captain. You have to be inspiring. You have to galvanize all the guys behind you and he was a true captain. That's what makes this whole thing even more awful."

What emerged in the aftermath of his death is that David appeared to have been suffering from depression, although he showed no outward sign of the illness. "It just seems he was perhaps in a dark place that we didn't realise and we didn't know about," Bailey said.

Dave Whiteford of the Hong Kong Scottish Rugby Club which David also played for said in an email to members: "Taity was a close friend of a number of us at the club and was one of the nicest people you could ever wish to meet. It is so very tragic to hear that he chose to take his own life.

"Mental health is something that is continually overlooked and unfortunately an incredible person has been unable to battle his demons and feel comfortable enough to speak to those close to him to overcome things."

Whatever demons David was battling in the days leading to his apparent suicide, it seems that like too many people suffering from depression, he may have been confronting them largely on his own, unwilling or unable to seek the help that might have saved his life.

A major study currently being prepared by the Chinese University of Hong Kong has found that nearly one in six Hong Kong adults suffers from symptoms of depressive illness but less than 30 percent receive treatment.

Lack of awareness, the stigma of suffering from a mental illness and a shortage of mental health professionals trained to help victims of depression mean Hong Kong is failing to adequately address an often deadly illness, according to the expert leading the study, Professor Linda Lam.

From a preliminary analysis of what is the biggest study of its kind in Hong Kong involving interviews with 5,700 people, Lam said around 15 percent of Hong Kong people showed symptoms of depressive disorders, anxiety or mixed anxiety and depression disorders.

Of those, however, only 29 percent had received any treatment or counselling in the year prior to being interviewed - meaning that 71 percent of people suffering symptoms had received no treatment or help at all.

Such a low figure was clearly a cause for concern, said Lam who heads the university's Department of Psychiatry. In developed cities worldwide, the percentage of people suffering from depressive disorders who receive treatment is usually 40 to 60 percent, significantly more than in Hong Kong.

"We cannot expect the figure to go up to 100 percent - it is not possible," she said. "But a figure of less than 30 percent means that for every 10 people with a mental disorder, seven are suffering from symptoms without seeking help."

Many sufferers do not even realise they are ill or that treatment is available, Lam said. "They know they are unhappy but they do not know it is a disorder. Some of them do not think that any (treatment) could help them," she said.

"Some people actually have expressed that they do not know how to seek help and we have a follow up for those who agree to seek services. They do not know they can seek service from the clinic or hospital authority. They do not know that a doctor can write them a referral. They do not know this is the procedure.

"Many people either do not know they have a problem or even if they know they have a problem, they have a very negative outlook on the prognosis. They do not think they can improve. Even the family members have difficulties appreciating these conditions are actually treatable.

"They don't know that drugs help a lot and they do not think that even if they think drugs help, they think they are probably not for them and they prefer to use other methods like getting more fresh air. These things would help, but there needs to be a mainstay treatment."

For many sufferers, however, the biggest deterrent to seeking treatment is the stigma. "They think 'Oh, I do not want to see mental doctors'. They are not sure which family physician could help them with their mental problems. There is a lack of knowledge about the (available) service as well as stigmatization. They try to avoid seeking help."

The failure to seek help can have sometimes appalling consequences, Lam said. "For most of the patients, depression causes functional disturbances and affects their relationship with their family. It can lead to the risk of tragic events.

"If more people were willing to accept help and more able to perceive that these are highly treatable conditions, the community morbidity (rate) would be much lower."

Tackling the problem will be a long-term project, said Lam, whose research team expects to finalize its study and make recommendations to the Hong Kong government in the summer.

"We want to report to the community and to the government how widespread common mental disorders are in Hong Kong," she said. "We need people to be aware that in Hong Kong, almost one-sixth of people have common mental disorders.

"We also know from our study that roughly 3 percent of people in the community have psychotic disorders but they rarely receive treatment unless the symptoms are obvious and disabling.

"There is a big gap between those who need treatment and those who receive or are willing to seek treatment.

"We definitely need more education. We want to inform the government that there should be a longer-term plan on how to train professionals to handle these problems.

"If we asked everybody who needs help to seek help, the professional support would not be enough. We don't have enough people who can help. These people need training and if you want to train a therapist who can handle mental health problems it takes at least five or six years."

Paul Yip, director of the University of Hong Kong's Centre for Suicide Research and Prevention, said Hong Kong's lifestyle emphasis on successful individuals made it harder for people to seek help for depression.

Reflecting on the case of David Tait, he said: "When you think about this guy, he is a rugby player, and he is well liked by people. If you tell people you are depressed suddenly, you will become a less welcome guy in the party. That is what people have to worry about.

"So there are a lot of people, especially those who seem to be successful, who are even more reluctant to go to seek help.

"In the US Army they are trying to break that code and tell people that seeking help is not a sign of weakness. Anybody can be unwell and everybody who is should simply go and get help. When you seek help, it is a sign of bravery because you are facing up to your problems rather than trying to escape from them."

Some companies in Hong Kong had begun to encourage employees suffering from depression to seek help by providing them with numbers for private doctors who would treat them without informing their managers, Yip said.

"It is a sign to people that they know this is the hurdle, the stigma that stops people from going to seek help so that is why they make it easier to remove this barrier for them to seek help," he said. "This provides a more conducive environment for them to seek help and that is very important."

With so many people appearing to suffer from depression and not receiving treatment, Hong Kong should reflect on its attitude to work and seek a better work-life balance for its citizens, Yip believes.

"I do not believe these long working hours and this work-hard, play-hard attitude works for everyone," he said. "There are people who are vulnerable We should not look at everything by the dollar signs.

"We should look at what the potential benefits are if people have sufficient rest and time for family members, or time to cultivate relationships if they are single. This kind of thing is good for people's mental health. These benefits should be factored into the whole equation when we consider maximum working hours."

Effecting such a transformation would require a major change in attitudes, Yip acknowledged. "The whole working attitude here is that we live to work," he said. "A more humane society should work to live. It is very unfortunate and highly unnecessary.

"If we reduce our GDP slightly, it won't mean a lot to us, but it will be good for the whole of Hong Kong to slow down a bit and enjoy life a bit more. But Hong Kong has so much emphasis on productivity but we never factor mental health degradation in the equation. It has never really had sufficient attention paid to it."

Meanwhile, the shock of David Tait's death has made everyone who knew him reflect on how a young life so full of promise could be prematurely extinguished in such a brutal and unexpected way.

In a poignant email to rugby club members the day after his death, Bailey wrote: "I am still suffering from the shock of this incredibly sad news and am sitting here in my office wondering if I could have done something and I know some of you are asking yourselves the same question but these things happen and sometimes there are no answers.

"I would ask all of you to remember the good times we had with Taity and should you ever feel in despair or in need of a shoulder to cry on, please, please reach out to someone and never let the sun go down on your anguish or anger."

The Kowloon Rugby and Hong Kong Scottish Rugby Club, the two clubs David Tait represented, will play each other in a memorial David Tait Cup match on Saturday, Jan 19. The game kicks off in King's Park, Kowloon, at 7 pm.

(HK Edition 01/15/2013 page4)