海納百川 － all rivers run into a sea

Dr. William Lo is Chief Executive of Kwai Chung Hospital and Chairman of Mental Health Association of Hong Kong. I had a chance to interview him personally while being an editor at Harbour Lights, JCIHK Magazine. 

Dr Lo is a psychiatrist by background. He has been instrumental in the development of the Clinical Service Plan of KCH which helps facilitate the planned modernisation of HA psychiatric services. Dr Lo successfully implemented a series of corporate and local initiatives to enhance psychiatric support to cluster general hospitals, discharged mental patients and psychiatric outpatients. He is innovative in launching public mental health education activities such as the KCH Drama Group, Mental Health First Aid training and Open Art Competitions on Mental Health and Mental Wellness to combat the stigma of psychiatric patients. He currently also serves as Chairman of the Mental Health Association of Hong Kong, Associate Director of the Hong Kong Jockey Club Centre for Suicide Research and Prevention of the University of Hong Kong, and Board Director of the Haven of Hope Christian Services.

With Dr. Lo at his office.

How would you comment about current status of mental health among Hong Kong population? How can we define who is mentally healthy and who is not?

We can narrow down the concept of mental health into two main categories. One is mental illness, among which we have very precise definitions. Another one is mental well-being. Hong Kong, as a metropolitan city with developed economy, actually join the rank of mental health problems of developed economies in the world. First of all, we are facing a heavy burden of chronic mental illness (those who are mentally ill bring significant burden to the society). And secondly, we are talking about all sort of mental disorders, which are common these days. 

WHO predicts that by 2030 the number one disease burden would come from depression. According to recent epidemiological survey in Hong Kong, we are having similar percentage of population, who is experiencing common forms of mental disorders such as anxiety and depression as other developed countries. Those forms of mental disorders are mostly stress-related. Fast-paced high-pressure life and working style in Hong Kong make people more vulnerable to develop such forms of mental disorders. 

On the other hand, we are still struggling to provide optimal care for patients with severe mental illness. Because of improvement in technology, most of them can be discharged from hospital earlier than before and they are able to live independent life in the community. Yet I think because of misconceptions surrounding mental illness, patients are facing obstacles in having normal independent living. We call it stigma. It prevents patients from staying well. So we are also fighting uphill battle to remove or lessen stigma and to fight for equal opportunity as well as fighting against discrimination. 

What are main causes of becoming mentally ill?

Here we have factors of nature and factors of the environment. So it is kind of gene-environment interaction that brings out mental illness. Gene element means that number of severe mental illness actually are passed on in families. And the vulnerability won’t come up until person faces particular level of stress. That may trigger first episode and if not properly cared it may go on to second, third and fourth episodes. So in other words, it is interplay between genes and environment that brings on that sort of mental health problem. 

It is difficult to recognize mental illness because of such abstract presentation. Unlike physical illness, say you have a chest pain you can investigate whether there might be a heart problem, mental illness is basically disorder concerning about thinking, emotions and behaviours. Sometimes it may take a long time before individual will seek help and receive a proper care. That brings us to another challenge that we need to improve mental health literacy in the community. So people could get accessed to professional help more readily. 

How we can recognise those signs of becoming mentally ill early enough, before it is too late (like hearing voices or behaving strangely in response to them)?

When people hear voices - that’s already extreme and that stage people would be recognising easily. But before that we do have warning signs that can actually bring patient seek help on early stage. It can be done by patient himself or by professional. As we try to improve our service by early detection and early intervention, we would do more mental health promotion, increase community awareness about problems it may lead to. Another way is to bring awareness of problems, so the individual could seek help himself. So once people start experience problems with their emotions, they should be accessible to different level of care that is available in society. 

Mental Health Association would distribute questionnaire to the community and the scoring of the questionnaire would alert the patient who are on the verge of experiencing symptoms to seek health. Similarly for elderly person we start to have some community programs. For example, by using questionnaire we aim to identify people who start experiencing dementia. 

What about children and youth who have committed suicide? Can it be related to mental health issues?

For people, who were successful in committing suicide, I think it’s true to say that around 80-90% of them would have significant psychiatric conditions. So one aspect is we need to increase service access to patients who express suicidal wish. The another thing is overall trend. We have been experiencing decreasing trend of suicides since Asian Financial Crisis, because of improving general economic environment and service offering. The recent clustering of student suicides is very high profile and sensational case and for young suicides our perception is that one is too much. We have collaboration among Hospital Authority, school social workers, education department, school educational psychologists. We also have program called Student Mental Health Support Scheme, which aims to help students with mental health problems and have synergy of different professionals to provide comprehensive support. This also enhances awareness to detect vulnerable and students-at-risk. 

What would be top-three things to do in order to maintain good mental health and well-being? 

Mental Health Association just recently celebrated sixtieth anniversary and organised symposium with the theme ‘Depression is preventable’. We got evidence on how keep people well mentally. And there are few areas that worth considering. 

First of all, staying with relaxed mind. This needs to be acquired by person who is mindful about her mental health. Relaxation comes within different modalities. Some people would find satisfaction and joy in art activities, say calligraphy. So that kind of habits or hobbies that people can develop to keep their mind calm. 

Secondly, exercise. We have growing body of evidence that exercise is therapeutic to patients with depression. The exercise can be divided into two major groups - aerobic exercise and stretching or yoga-kind exercise, which are easy to do for patients of different physique level. 

Thirdly, live with grateful life. So to live with gratitude versus to live with competition, stress would be something quite difficult. It is rather a choice of individual that he would rather appreciate others more instead of measure oneself up to others. Competing mode versus mode of gratitude. This is a mindset change and matter of personal choice. 

What is the flagship project of Mental Health Association of Hong Kong and the results of it?

Association started as a study group of professionals related to mental health services. We do devote quite a big amount of efforts to public mental health education. So focus on keep general public up the date on knowledge related to mental health via symposiums, public talks, and recently we do fight-depression campaigns. So we do projects to arose community awareness of mental health. Our renewed vision is Mental Health for All. We also collaborate with businesses, such as Mindset, foundation set by Jardine, and do project to provide counseling service to disadvantaged groups. 

How other individuals and organizations could support and help you to achieve Association’s mission?

We would like to enhance community support to those who experience mental health problems. Community support has many domains, such as counselling opportunities, job opportunities for people who recovered from mental issues, focused support for age-groups. For example, for patients who suffer dementia, as kind of challenge they face is different from patients who experience severe mental illness. 

Another area is how do we embrace technology to do mental health promotion better and public education better. For example, collaborating with IT companies that can develop apps to deliver education and hopefully prevention of mental illness to people who would use it. We are open to collaboration with others. 

Why and how did you choose career path of psychiatry? 

When I was choosing specialization, something what attracts me in psychiatry field is to provide whole person care. This sort of comprehensiveness, when we look at the patient not only from the physical aspect, but also psychological and even social aspects. I don’t like a mechanistic view on the patient - when you see the patient as a heart, or as a bone or as a kidney. Get patients really recover and provide holistic care - that something I found appealing to what I like and think this area for me as the most suitable to acquire knowledge and skills.

Any personal motto or quote that inspire you in your daily life or challenging situations?

As calligraphy on my wall states 海納百川 － all rivers run into a sea. The sea can hold the water from thousands of rivers, it's big because of its capacity. A person is great when he can be tolerant and forgiving to many other people. It is only through acceptance you become great.