A series of brutal attacks in Hong Kong is shining a light on mental health in a city that has suffered from particularly acute strains while lacking sufficient resources to provide proper care for all who need it, mental health groups say.
Violent crime is rare in the financial hub but this month two women were stabbed to death in a busy shopping mall by an attacker who police reported had a history of mental illness.
Days later, another knife-wielding attacker severely injured the manager of a McDonald's restaurant.
Also this month, a 29-year-old mother was arrested on suspicion of suffocating her three young daughters and in February, police charged four people in connection with the killing of a 28-year-old model, Abby Choi.
The policy and advocacy group Our Hong Kong Foundation says the state of the mental health of Hong Kong's more than 7 million people has deteriorated while support from the public care sector is not adequate to meet the need for help.
"The mental health status of the Hong Kong population has been worsening over recent years," the foundation said in a report, citing a World Health Organization index that measures well-being and a 2022 survey that found that depressive symptoms were widespread.
A city government spokesman, asked about the state of mental health, referred Reuters to a meeting the administration organised this month aimed at exploring more ways to address mental health problems and support people who suffer from severe mental disorders.
Mental health experts point to the Covid-19 pandemic as a major factor in the increase in mental health issues, as it has been in many places.
But in the case of Hong Kong, its lockdown rules that were among the world's toughest came after unsettling pro-democracy demonstrations that began in 2014, bringing bouts of chaos and culminating in sometimes violent anti-government protests in 2019.
While at the root of the protests was concern over what many see as the erosion of civil liberties in the former British colony as the Beijing government tightens its control, a high cost of living, growing income gap and the perennial problem of a lack of housing exacerbate the frustrations.
Many people in densely populated Hong Kong wait years for public housing, most young people live with their parents and many thousands are packed into subdivided units, known as “coffin cubicles”.
'Exhaustion'
Judy Blaine, a researcher and consultant on mental wellbeing, says it is the compounding of stresses that takes a toll on Hong Kong's people.
"We're dealing with a triple whammy people have had. Hong Kong's experience is just emotional exhaustion," Blaine said.
"There is an underlying sense of uncertainty, an underlying sense of fear coupled with a lack of autonomy to do anything about it. That's when people become more defensive."
A severe shortage of care workers complicates efforts to address the problem, health charities say.
Carol Liang, deputy CEO of the group Mind Hong Kong, said waiting times for cases deemed non-urgent can be as long as 90 weeks in the Hospital Authority system.
"There are only 7.55 psychiatrists and 8.15 clinical psychologists per 100,000 people in Hong Kong compared with the OECD averages of 18 and 53, respectively," she said, referring to the Organisation for Economic Cooperation and Development global policy forum.