Making “Happy Hong Kong” a genuine reality

One of the most widely heard slogans in the city this year has probably been “Happy Hong Kong”. The region is gradually returning to normalcy after the pandemic. In April 2023, the local government launched the “Happy Hong Kong” campaign to stimulate the city’s economy, lift people’s spirits, and bring joy to the community—with gourmet markets, carnivals, shopping festivals and many more fun events.

“Happy Hong Kong” should not be just a short-term campaign for economic recovery but a long-term pursuit, requiring a forward-looking agenda for social welfare and community development. In this issue, Prof. Hector TSANG Wing-hong, Interim Director of the Mental Health Research Centre (MHRC), shares insights into building a happier city.

Everyone has a right to be happy: Supporting the community integration of persons with mental health needs

Happiness is something we all desire, and yet many people find it hard to achieve. At least one in six people in Hong Kong experience common mental health disorders (e.g., depression, anxiety), a study found. The city’s suicide rate in 2022 was the highest in the last 15 years, as 14.73 out of every 100,000 people took their lives.

A number of shocking murder cases and knife attacks have occurred just days apart in the city this year, bringing mental health into the spotlight and pushing the city authorities to introduce measures enhancing local mental health support. These incidents reflect a lack of support for community integration of persons with mental health needs. Mental health assistance should go beyond clinical services, Prof. Tsang believes.

“There is a need to reallocate more mental health-related resources from public hospitals to the community, such as by including support services in district health centres, so that patients can be taken care of after being discharged. It is different from hospital settings where more emphasis is put on using medication to stabilise patients’ emotions,” Prof. Tsang said. “The current mental health policies are not comprehensive enough, and most of the resources have been directed towards public hospitals.”

Holistic team, holistic support

Academia has provided varying perspectives on the true nature of “mental health”. Marie Jahoda, an Austrian-British social psychologist, sees positive mental health as a state in which a person accepts his/her own strengths and weaknesses, fulfils human potential, resists stress, enjoys autonomy and freedom of choice, views the world without distortion, and achieves success in various social roles in life. Happiness (or mental health) is a simple term. However, it is actually quite complex, built on multiple factors such as self-esteem, work participation and relationships.

If mental health should include various dimensions, then so should mental health services. For true community integration of “mentally ill” persons, their various needs must be properly addressed. “There should be a team consisting of occupational therapists, social workers, community nurses and psychologists, who closely supervise people with severe mental illnesses and provide holistic help,” Prof. Tsang explained. “Doctors will not simply walk out of consultation rooms and reach out to the community.” He pointed out the government’s role in facilitating the coordination of mental health efforts in hospitals, rehabilitation and community care. These efforts have become greatly fragmented.

Sick cities: Urban stress brings unhappiness 

Stress can make people unhappy. City dwellers have a higher risk of developing depression, anxiety and psychosis than rural residents, according to a literature review. This finding is not surprising. Our resilience to stress, as Jahoda highlighted, is crucial for positive mental health.

Hong Kong is probably among the most stressful cities in the world. The city records the highest stress index in East Asia and ranks 74^th among the 150 countries surveyed in the 2023 World Happiness Index.

“Excessive stress, if left untreated, can lead to emotional changes such as grumpiness, tearfulness, depression, frustration, irritability, etc., and other signs of emotional instability. Stress can also lead to fear, panic and distrust of others. All of these can result in mental health problems that impact our mind, body and daily functioning, and can give rise to suicidal tendencies in severe cases,” Prof. Tsang said. Positive stress coping is the key to positive mental health, and thus happiness.

It is best to treat the disease early before it takes hold

Negative emotions in everyday life may not be very severe at first, but they can snowball into a mental health crisis. Seeking professional help at the earliest stage possible and paying attention to the early signs of emotional disturbances can put a halt to the crisis.

Affect, behaviour and cognition are the ABCs in the field of psychology. They essentially highlight the links among human capacities: feelings, actions and thoughts. Prof. Tsang advises the community to stay alert for signs of poor mental health, and this applies both to taking care of ourselves and caring for others. His mental health tips very much correspond to the ABCs of psychology.

“At the individual level, losing interest in and motivation for doing things we usually enjoy is one of the early signs. Other changes, such as getting quieter, becoming less patient, ruminating on negative things, and experiencing poor quality of sleep that lasts over two weeks, are common among persons with emotional problems. Among all the changes, however, character change is the one that is most easily observed,” said Prof. Tsang. 

“Poor mental health can also lead to cognitive impairment, including forgetfulness, slower reactions and work inefficiency. Bodily symptoms, such as fatigue, nausea, muscle tension, diarrhoea, stomach pain, insomnia, loss of appetite and overeating, may be experienced by some people,” he explained. 

He re-emphasised the need for healthy stress management and seeking help. “Inappropriate ways of handling stress, like excessive drinking and smoking, can impact social functioning.”

Reclaiming peace of mind: Mindfulness in daily life

As a health researcher and practitioner, Prof. Tsang has been helping the community achieve greater well-being through his scholarly, clinical and engagement work. However, life as an academic can be very busy. Currently, Prof. Tsang has several leadership roles at PolyU: he is the Chair Professor and Head of Department of Rehabilitation Sciences (RS), and the Interim Director of the Mental Health Research Centre at PAIR. Prof. Tsang’s knowledge in the field has helped him to take good care of himself. He has been practising mindfulness for two decades.

“Mindfulness exercises can train both mind and body, and help a person to achieve mind-body peace. I have been practising a 20-minute, self-developed routine during the daytime and nighttime to help regulate my breathing and bring peace of mind. The routine combines yoga, eight-section brocade (Chinese qigong) and tai chi. This mindfulness exercise trains my body and relieves stress, thus helping me to manage my busy schedule in teaching, research and administrative work,” Prof. Tsang shared.

He also believes in the importance of work-life balance for a healthy lifestyle. “It is easy to neglect personal well-being while constantly maintaining a high standard of work,” Prof. Tsang continued. “I do schedule time for social activities, sports and hobbies that bring me joy and relaxation. Incorporating habits like listening to music and practising mindfulness into my everyday routine can also contribute to my overall well-being.”

Unravelling the complex world of mental health with an interdisciplinary strategy

The year 2023 marks the second year of MHRC’s operation since its inception in October 2021. It is also the sixth month since Prof. Tsang took up the role as the Centre’s Interim Director. There have been several major developments at the Centre, especially in external engagements and interdisciplinary research.

The Centre achieved great success in its very first participation in a PAIR Conference, held in May this year, and its research symposium attracted an audience of over 680. This December, the Centre is organising a distinguished lecture by Prof. Thomas Südhof, winner of the 2013 Nobel Prize in Physiology or Medicine. The Centre was also awarded several large external grants for its interdisciplinary projects. One of these is a HK$12.9 million university-wide mental health promotion project supported by the Seal of Love Charitable Foundation. Dr Grace HO, Associate Professor in the School of Nursing (SN), will develop a Resilient Students Training Hub (ReST Hub) to teach Hong Kong university students practical resilience skills for navigating, adapting to and coping with challenges and adversities in life.

An interdisciplinary perspective can bring better understanding of and solutions to complex mental health issues, Prof. Tsang believes. “The combination of diverse disciplines, from basic sciences to applied sciences, provides a rich and comprehensive set of knowledge and skills. Interdisciplinary collaboration enables a holistic approach to mental health research,” he explained.

At MHRC, researchers from the Department of Applied Social Sciences (APSS), the RS Department, the Faculty of Science (FS) and others contribute their unique perspectives and expertise. Basic science provides a fundamental understanding of mental processes. Rehabilitation science focuses on therapeutic development and application. Social science provides insight into how mental health and intervention relate to the wider society. “This interdisciplinary approach bridges the gaps among research, practice, and policy, hence facilitating the effective and efficient translation of research findings into real-world solutions and policies.” Prof. Tsang added.

Digitalisation in mental health research

Technology-enabled mental health support solutions are one of the many examples of how disciplines fuse to bring new solutions. Tools like mobile/video games, networking sites, and social media can contribute to problems like gaming addiction, self-esteem issues and other mental health or clinical disorders. However, if the tools are used appropriately, the impact can be reversed.

Technological advancement is revolutionising mental health research. This trend is particularly noteworthy at PolyU. The Centre is now pursuing a number of government-supported projects on the development of e-mental health solutions and services. “Disciplines like rehabilitation, psychosocial science, and neuroscience and brain science can converge with technology and engineering to offer new opportunities for evidence-based digital solutions to mental health challenges,” said Prof. Tsang.

At MHRC, Prof. Tsang is working on a drug prevention programme for youth, integrating virtual reality (VR) to provide simulation experience in the side-effects of drug abuse, in order to raise anti-drug awareness. Prof. Sylvia CHEN, MHRC Associate Director, Associate Dean of the Faculty of Health and Social Sciences (FHSS), and Professor in the APSS Department, is developing a VR-assisted intervention for adolescents with special educational needs, aiming to reduce their socially avoidant behaviour and enhance prosocial behaviour. Dr Cynthia LAI, Associate Professor in the RS Department, and Prof. Shamay NG, Associate Head of the same department, are developing a digital learning platform which will use multi-media, Internet of Things tools and cloud technologies to assess and train children’s motor and cognitive functions, and to provide related online education programmes for parents and teachers.

Bringing an East-meets-West approach to mental health interventions

At its core, interdisciplinarity is about fostering innovation and challenging the status quo, by bringing disciplines together for collaboration. Prof. Tsang is one of the pioneering scholars using this approach. He has been fusing the Eastern and Western cultures to develop mental health interventions. A major focus of his research is the application of traditional Chinese health exercises in occupational therapy for stress management and body-mind wellness. The leading scholar has been reinvigorating the occupational therapy profession with his East-meets-West approach to rehabilitation.

“Occupational therapy is a kind of allied health service in Western medicine. Traditional occupational therapy treatments comprise rehabilitation activities targeted at physical, sensory, mental and communication functions. I take this to another level by using Chinese health exercises that develop and recover certain abilities of patients,” Prof. Tsang explained. His research has provided solid evidence for the anti-depressive and anti-anxiety effects of eight-section brocades, acupressure treatment and qigong.

In 1997, Prof. Tsang founded the Centre for East-meets-West Rehabilitation Sciences. He recalled that the RS Department was exploring the new approach at that time, and he was in a very supportive environment for pursuing research on Chinese martial arts, for which he was grateful. “The seed funding supported my research on the rehabilitation effects of these martial arts. The positive results were published in prestigious journals and gradually gained wider recognition in the field. Hence, I became more focused on this topic,” he recounted.

Over the years, Prof. Tsang has produced more than 270 publications, and his papers have been cited 10,210 times. He is among the top 2% of scientists around the world, according to Stanford University. In the past 10 years, he has been rated by Expertscape as one of the top 1% of published authors in exercise movement techniques.

Love for martial arts, love for others

The scholar’s foresight regarding the power of integrative East-meets-Western treatment probably stems from his childhood and adolescence. Prof. Tsang practised the Chinese martial arts known as Wing Chun and Hung Kuen during his teenage years, and this interest was blended into his clinical research, for the welfare of others.

His research has demonstrated the vast health benefits of Chinese martial arts. “Regular practice can improve mental health, not only for the elderly but also for other populations such as teachers. From my research, regular practice of Chinese martial arts enhances physical fitness, cognitive stimulation, and social engagement of elders, all of which are beneficial for maintaining mental well-being and preventing or managing depression. This practice reduces stress, improves focus and concentration, and enhances self-care among teachers, and these are particularly important for educators working in demanding and stressful environments,” Prof. Tsang explained.

In the long run, Prof. Tsang looks forward to further interdisciplinary mental health research that will bring novel healing methods to clinical trials and eventually clinical application. “We have to partner with community organisations in sharing these novel methods. The curricula of physiotherapy and occupational therapy programmes at the bachelor and postgraduate levels can cover these methods so that future health professionals will learn, practise and apply the approaches in their clinical practice,” he said. After all, a collaborative effort in mental health promotion—be it cross-interdisciplinary or cross-sectoral, in research or in clinical application—should be what “Happy Hong Kong” is really built on.