Authors (including presenting author) :
Lam MML(1), Xu MJQ(1,2), Ko FSL(1), Chan GHK(1)
Affiliation :
(1) Hong Kong Mental Wellness Association
(2) Department of Psychology, The University of Hong Kong
Introduction :
Suicide is a major health problem and most suicides are related to psychiatric illness. In September 2023 in Hong Kong, at the time after the resumption of regular academic year and normal school life after the COVID pandemic, the rate of suicide among students had been rising alarmingly. Among the 30 completed youth suicides at the time, approximately only one-third were known to psychiatric service. With reference to psychological autopsies which revealed that up to 90% of the young people who committed suicide have mental issues, in which two-thirds have mood problems such as anxiety and depression (1, 2), the situation of Hong Kong indicated that preventive measures could not address the mental issues of the majority (about 60%) of the students who were prone to suicidal risks. They were left undetected in schools or in community. Upon the situation, two NGOs joined hands to drive an imminent response by launching the WeCare SOS program, an emergency community mental health support program for youths at risk of suicide. It was a school-based program operated on a staged model in partnership between the public and private sectors to provide evidence-based service through professionals and with funding solicited through donation.
(1) Robins E., Murphy G.E., Wilkinson R.H., Jr., Gassner S., Kayes J. Some Clinical Considerations in the Prevention of Suicide Based on a Study of 134 Successful Suicides. Am. J. Public Health Nations Health. 1959;49:888–899. doi: 10.2105/AJPH.49.7.888.
(2) Brådvik, L. (2018). Suicide Risk and Mental Disorders. Int J Environ Res Public Health, 15(9). doi: 10.3390/ijerph15092028
Objectives :
Through public-private partnership, the main objectives of the Program are to increase accessibility to psychiatric service for youths at risk and enhance knowledge of teachers and community service workers in early suicidal identification and risk detection.
Methodology :
Students with medium to high risk for suicide and in emotional distress were identified by teachers and screened by school social workers for consultation within 48 working hours by a psychiatrist in private practice in the community. The student would then be referred by the psychiatrist for psychiatric service in the public healthcare system. Four free psychiatric consultations with prescription of drugs would be provided while the student was waiting for public service. Emotional support was also provided by the social worker along the course. Pre and post students self-rated subjective assessments were conducted, using the Generalised Anxiety Disorder-7 (GAD-7z) scale, Patient Health Questionnaire-9 (PHQ-9), Depression Anxiety Stress Scales (DASS-21), General Health Questionnaire-12 (GHQ-12), World Health Organization-Five Well-Being Index (WHO-5) and Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS). Clinical Global Impression (CGI) rating scale was used by the psychiatrists to track the symptom changes of the students. Four professional training workshops were also conducted for school social workers, teachers and community workers to enhance their knowledge of early suicidal identification and risk detection.
Result & Outcome :
A total of 220 students were engaged in the Program, with 120 (54.54%) at moderate to high risk of suicide. 154 (70.00%) of them had experience of self-harm or attempted suicide. There were more female (144; 65.45%) than male students. Most of them are secondary students with an average age of 14.32. A majority of the students resided in districts of lower income, which correspond to those of the median monthly household income statistics of the Census and Statistics Department, including Yuen Long, Tuen Mun, North District, Kwun Tong, Shamshuipo and Yau-Tsim-Mong.
143 students (65.00%) were diagnosed with emotional disorders, including 81 depression (36.82%), 27 anxiety disorder (12.27%), 7 mood disorder (3.18%), 16 manic depressive disorder (7.27%) and 13 post-traumatic stress disorder (5.91%). There were also 22 students with psychosis (10.00%). 43 students were with special educational needs, including 18 autistic spectrum disorder (8.18%) and 25 attention deficit hyperactivity disorder (11.36%). There were also 11 students (8.00%) attending the program with other problems. Among all the students, 175 (79.55%) needed to take medications after attending psychiatric consultations.
Preliminary findings from the pre and post students self-rated subjective assessments all indicated obvious improvement in their mood state. Objective improvement was also shown in symptom relief, as reflected in the 0.92 level of increase in the CGI category. Further, with a total of 273 school social workers, teachers and community workers attending the four training workshops, improvement in program efficiency in addressing the mental health needs of the target groups was evident along the course of the Program.
Through the WeCare SOS program, accessibility and acceptability for students in risk of suicide are increased. Prevention of suicide is enhanced through the timely evidence-based, early detection, early interventions and a multisectoral suicide prevention strategy.
