Subject: health services, youth development, mental health

Mental health services for young people in Hong Kong

  • According to statistics, some 10%-20% of adolescents worldwide suffer from mental disorders,4Legend symbol denoting The World Health Organization defines adolescents as those people between 10 and 19 years of age. See World Health Organization (2020). compared with that of 10.7% for adults.5Legend symbol denoting See Our World in Data (2018). It is therefore essential to address young people's need for mental health services, given the apparent higher prevalence of mental health issues and ramifications on their adult lives if the problems were left unresolved.
  • In Hong Kong, the Government seeks to protect the mental wellbeing of young people with the stepped care model and facilitates multi-disciplinary collaboration in the delivery of youth mental health services. The stepped care model comprises prevention, detection and intervention, with services which range from the least to most intensive that are delivered by the healthcare, education and social sectors:

    (a)Tier 1 refers to universal prevention, early intervention and mental health maintenance strategies that aim to prevent behavioural and emotional problems from developing in young people;

    (b)Tier 2 serves as a bridge between Tier 1 and Tier 3 to provide (i) more structured and targeted assessment and intervention for young people in need; and (ii) treatment in primary care settings for relatively complex cases identified by Tier 1; and

    (c)Tier 3 provides specialist intervention to moderate to severe mental health cases, usually in the form of crisis resolution, in-patient and day care services.

Service gaps in the stepped care model

Existing and new initiatives on youth mental health services

Issues of concern

Youth mental health services in Australia and England

Enhancing access to primary mental health care

Improving coordination of services across stepped care

  • The availability of appropriate care plans and clear referral pathways are crucial for young people, especially those with more severe mental health issues whose problems cannot be resolved with low-intensity care. This group of young people often encounter difficulties in gaining timely access to the right services. In this regard, both Australia and England have earmarked additional resources to better integrate and coordinate services along the stepped care model.
  • In Australia, PHNs mentioned in the previous sub-section are also required to observe nation-wide guidelines which focus on, among other things, operationalizing stepped care for mental health patients in primary care settings. For patients who require additional support or even specialist care, the guidelines stipulate the pathways for service referral, in addition to offering the best practices in providing initial assessment and progress monitoring. Moreover, a web-based portal has been developed by PHNs to exchange the latest information with other service providers as to the care options and referral pathways that are available for individual patients.
  • Meanwhile, England has leveraged a more school-oriented approach to provide extra capacity for early intervention and ongoing help for students with mental health needs. From 2018-2019 to 2020-2021, the UK government has committed some £215 million (HK$2.2 billion) to set up Mental Health Support Teams ("MHSTs") across England,29Legend symbol denoting The UK government's funding commitment for MHSTs is provided up to 2023-2024, but the funding figures after 2020-2021 are only indicative in nature. See NHS (2019a). which act as additional platforms in support of schools to improve their partnerships with NHS, NGOs and other service providers. More specifically, MHSTs can give timely advice to school staff and liaise with external specialist services to ensure clear referral pathways, especially where more severe cases are involved.
  • Each MHST comprises a multi-disciplinary workforce of nurses, therapists, and trained practitioners serving a cluster of 10 to 20 schools, with a view to helping young people in accessing the right mental health care support and staying in education. The UK government is currently on track to expand the number of MHSTs from 182 in 2020 to 400 by 2023 to cover one-third of schools in England.30Legend symbol denoting See NHS (2021).

Bolstering the multi-disciplinary mental health workforce

Concluding remarks

  • Young people are inevitably met with emotional and psychological challenges as they grow from adolescence into early adulthood. In Hong Kong, the Government delivers mental health services through a stepped care model for young people in need. Nevertheless, the public health system has seen a worsening backlog in the provision of specialist care. Apart from inadequate supply of specialist service, limited capacity and coordination in primary mental health services may have led to escalation of some cases which could have been addressed through low-intensity care.
  • Over the years, some overseas places have experimented with reforms to enhance the primary mental health services for young people and were able to ease the burden on specialist care. Such measures can range from (a) dedicated mental health centres catering to young people; (b) improved primary care platforms for identifying, treating and timely referral of cases with mental health needs; (c) incentivizing GPs to provide a wider scope of mental health services; and (d) equipping non-clinical practitioners to take up a bigger role in caring for mental health of young people. When properly implemented, such initiatives not only help contain the demand and waiting time for specialist care, they can also lead to better outcomes for service users including improved psychosocial function and easier access to psychological therapy.

Prepared by Charlie LAM
Research Office
Information Services Division
Legislative Council Secretariat
15 October 2021


1.See World Health Organization (2020).

2.The primary goal of stepped care is to organize services, given limited resources, such that the appropriate form and intensity of care are provided in response to an individual's needs.

3.Australia and England also adopt a tiered/stepped approach in mental health services, and it is noted that, similar to Hong Kong, specialist services would be placed at the highest tier/step as a last resort. More specifically, Australia follows a five-step approach of self-management (Level 1); low intensity services (Level 2); moderate intensity services (Level 3); high-intensity services (Level 4); and acute and specialist community mental health services (Level 5). For England, it adopts a four-step model which includes identification and assessment (Step 1); low intensity treatment (Step 2); moderate-to-high intensity treatment (Step 3); and highly specialist treatment (Step 4).

4.The World Health Organization defines adolescents as those people between 10 and 19 years of age. See World Health Organization (2020).

5.See Our World in Data (2018).

6.To ensure that Hong Kong's mental health regime can rise up to the challenges arising from various demographic changes, the Review Committee on Mental Health chaired by the Secretary for Food and Health was set up in May 2013 to review the existing policy on mental health with a view to mapping out the future direction for development of mental health services in Hong Kong. An Expert Group on Child and Adolescent Mental Health Services was set up under the Review Committee to develop more focused and in-depth studies on the subject concerned. The work of the Review Committee and Expert Group cumulated in the release of the Mental Health Review Report in April 2017. See Food and Health Bureau (2017).

7.In Tier 1, universal services have limited capacity in terms of professionals available to cater to the needs of the general population. Meanwhile, Tier 2 has been identified as the weakest link among the three tiers due to inadequate coordination of services.

8.The Advisory Committee comprises members from various sectors with a great wealth of expertise and experience, including professionals from the healthcare, social and education sectors, representatives from patient and carer advocacy groups, and lay persons with interest in mental health.

9.These channels include Maternal and Child Health Centres, HA, private practitioners and psychologists.

10.The Programme is a foundational psychological training course in the training curriculum for primary and secondary teachers. It includes three-day elementary training for teachers at large and five-day in-depth training for designated teachers, with a view to raising their awareness of mental health and enhancing their professional knowledge and skills to identify and support students with mental health needs.

11.EDB introduced the Learning Support Grant in 2003-2004 to enhance the support for students with special educational needs. The 2017 Policy Address delivered in January 2017 announced that the Learning Support Grant for public sector ordinary primary and secondary schools would also provide support for students with mental illness starting from the 2017-2018 school year.

12.The team may also work closely with the psychiatric team of HA and social workers from relevant social service units to provide support to students with mental health needs in the school setting.

13.According to the Food and Health Bureau, government, aided and caput primary/secondary schools, as well as primary/secondary schools under the Direct Subsidy Scheme are eligible for joining SMHSS.

14.ICCMWs provide one-stop district-based community support services for persons with mental health problems and their families/carers as well as local residents through a spectrum of services ranging from early prevention to risk management.

15.As at end-December 2020, the number of psychiatric doctors and psychiatric nurses at HA increased by a modest 14% and 20% versus 2013-2014 levels respectively. According to HA, it has also strengthened the multi-disciplinary manpower of child and adolescent psychiatric teams in the past few years.

16.The performance target was originally set at 90% but lowered to 70% in 2020 (see Estimates of Expenditure, various years). In order to cater for the increasing number of referrals, DH has begun the construction for a new Child Assessment Centre in Siu Sai Wan with target commencement date at 2024. A temporary centre was set up in Ngau Tau Kok in January 2018 to cope with the demand during the construction period.

17.HA received a total of 11 835 new cases in 2019-2020, of which 89% were triaged as routine cases and 11% triaged as urgent or semi-urgent cases.

18.According to the earliest data available, about one in four Australians aged 16 to 24 years had mental health issues in 2007. See Australian Bureau of Statistics (2008).

19.See Australian Institute of Health and Welfare (2021).

20."Parity of esteem" is defined as valuing mental health on equal policy grounds as physical health, meaning those with mental health problems will benefit from equal access to the most effective and safest treatment, equal efforts to improve the quality of care and equal status in the measurement of health outcomes.

21.See Education Policy Institute (2020).

22.See for example, Rickwood et al. (2015) and Hilferty et al. (2015).

23.There are currently 31 PHNs established across Australia.

24.NHS refers to the government-funded medical and healthcare services that everyone living in the UK can use without paying the full cost of the services.

25.In addition to psychiatric medication, some research suggests that evidence-based psychological therapies such as cognitive behavioural therapy and interpersonal psychotherapy are also effective forms of treatment for a range of mental health problems. As such, IAPT began in 2008 for the treatment of adult anxiety disorders and depression In England. In 2011, the UK government announced it was extending the IAPT project to encompass services for children and young people. See NHS (2019b).

26.The non-clinical practitioners under IAPT are known as "Psychological Wellbeing Practitioners" ("PWPs") who are trained to assess and support people with common mental health problems in the self-management of their recovery. The core IAPT courses for PWPs are accredited by the British Psychological Society.

27.These therapists need to have been trained in the particular therapy or therapies that they deliver in IAPT, with professional accreditation linked with the relevant professional body.

28.See NHS Digital (2020b).

29.The UK government's funding commitment for MHSTs is provided up to 2023-2024, but the funding figures after 2020-2021 are only indicative in nature. See NHS (2019a).

30.See NHS (2021).

31.GPMHSC is a professional body which accredits and sets the standards for mental health training and education for GPs. It includes representatives from general practices, psychology, psychiatry and the community.

32.HEE is an executive non-departmental body established in 2012 to oversee the planning, education and training of the health workforce in England.

33.Specifically, those recruited under MHST are known as "Education Mental Health Practitioners".


Hong Kong

1.Advisory Committee on Mental Health. (2020) Work Report of the Advisory Committee on Mental Health.

2.Bauhinia Foundation. (2017) Mental Health Care Services for Hong Kong Youth.

3.Education Bureau. (2016) Parent Guide on the Whole School Approach to Integrated Education.

4.GovHK. (2021) LCQ18: Mental Health of Students. 24 March.

5.GovHK. (various years) Estimates of Expenditure.

6.Food and Health Bureau. (2017) Mental Health Review Report.

7.Legislative Council Secretariat. (2017) Background Brief Prepared by the Legislative Council Secretariat for the Joint Meeting on 20 December 2017 – Mental health of adolescents. LC Paper No. CB(2)512/17-18(02).


9.《香港01》:【情緒疫症.下】教師忙救學生 誰救教師?,2020‍年1月20日。


10.Australian Bureau of Statistics. (2008) National Survey of Mental Health and Wellbeing: Summary of Results.

11.Australian Bureau of Statistics. (2018) National Health Survey: First Results.

12.Australian Institute of Health and Welfare. (2021) Mental Health Services in Australia.

13.Headspace. (2020) Annual Report 2019-2020.

14.Hilferty, F. et al. (2015) Is Headspace Making a Difference to Young People's Lives? Final Report of the Independent Evaluation of the Headspace Program.

15.Orygen. (2021) Federal Budget 2021-22 Summary.

16.PHN Advisory Panel on Mental Health. (2018) Reform and System Transformation: A Five Year Horizon for PHNs.

17.Rickwood, D.J. et al. (2015) Changes in Psychological Distress and Psychosocial Functioning in Young People Accessing Headspace Centres for Mental Health Problems.

England (the United Kingdom)

18.Child Outcomes Research Consortium. (2016) Child- and Parent-reported Outcomes and Experience from Child and Young People's Mental Health Services 2011-2015.

19.Department of Health. (2011) Talking Therapies: A Four-year Plan of Action.

20.Education Policy Institute. (2020) Access to Child and Adolescent Mental Health Services in 2019.

21.Ellins, J. et al. (2021) Early Evaluation of the Children and Young People's Mental Health Trailblazer Programme.

22.House of Commons Library. (2021) Support for Children and Young People's Mental Health.

23.Ludlow, C. et al. (2020) A Current Review of the Children and Young People's Improving Access to Psychological Therapies (CYP IAPT) Program: Perspectives on Developing an Accessible Workforce.

24.NHS. (2019a) NHS Mental Health Implementation Plan 2019/20 – 2023/24.

25.NHS. (2019b) Overview – Cognitive Behavioural Therapy (CBT).

26.NHS. (2019c) The NHS Long Term Plan.

27.NHS. (2021) Funding Boost for Young People's Mental Health Services.

28.NHS Digital. (2020a) Mental Health of Children and Young People in England, 2020: Wave 1 Follow Up to the 2017 Survey.

29.NHS Digital. (2020b) Psychological Therapies, Annual Reports on the Use of IAPT Services.

30.NHS England. (2019) 0-25 Children and Young People's Mental Health Services.

31.NHS England. (2021) NHS Mental Health Dashboard.


32.World Health Organization. (2020) Adolescent Mental Health.

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