“Three-Tier School-based Emergency Mechanism – What’s Next?” 「三層應急機制」之後 ……

“Three-Tier School-based Emergency – What’s Next?”

Executive Committee

The Hong Kong Association of the Heads of Secondary Schools (HKAHSS)

5 February 2024

 

As a professional body, the Hong Kong Association of the Heads of Secondary Schools (HKAHSS) always has grave concern on students’ mental health and student suicide.  As an issue which has been emerged for quite a long time, student suicide is alarming.  In the academic year 2015-2016, the cases of student suicide kept increasing in number.  To handle the severe situation, the Government set up the “Task Force on Prevention of Youth Suicides” which was a multi-disciplinary platform in 2016.  The Task Force had conducted a comprehensive study and submitted a report with recommendations.  Sadly, the situation did not improve much.  In 2023, the suicidal rate of youth between 15 years old and 24 years old had hit a record high.  Though many organisations tried to study and understand this phenomenon and published the data and reports of youth suicide[i], the issue of student suicide persists.  The situation is alarming again.

 

From December 2023 to January 2024, the Government has implemented the “Three-Tier School-based Emergency Mechanism” (“Mechanism”) in all secondary schools in Hong Kong for two months.  On 29 January 2024, the Government announced to extend the implementation of the “Mechanism” to 31 December 2024 and launch new measures to enhance the support for schools to early identify students with higher suicidal risk.  The new measures include organising training courses for schools and arranging mental health activities to be held in schools to promote students’ mental health.  Nevertheless, the problems students face in their growth have different causes.  The cases of youth suicide accumulated in these three years because of the pandemic.  Both the experts and the academics pointed out that some of the notes left by the students who had committed suicide and the relevant studies showed that some of the youth suicidal cases were related to the social incident in 2019 and the pandemic which lasted for nearly 3 years. [ii]  The number of cases of youth suicide currently keeps increasing and the youth who committed suicide are getting younger and younger.  Some youth committed suicide because of hidden impulse and they had never sought help from others.  The ways they used are also comparatively fatal[iii] and they ended their lives without any early warning.  Facing the large amount of accumulated cases of mental health, how should the counselling and rehabilitation services be followed up well in an orderly manner?  Will the Government be more determined to have long-term plans to solve the root of the problem of youth suicide and students’ mental health, and the problem relating to the system?

 

With reference to the “Special Action Plan to Comprehensively Strengthen and Improve Student Mental Health in the New Era (2023-2025)” issued by the Ministry of Education, our Association would like to make the following recommendations for the medium-term and long-term strategies in four areas: (1) Emergency Monitoring, (2) Mental Health Education and Training, (3) Professional Consultation Services, and (4) System and Support.

 

1. Strengthen the Mechanism for Monitoring and Handling Emergency
   1. Our Association thinks that the Government has timely extended the implementation of the “Three-Tier School-based Emergency Mechanism” which can meet the urgency of handling students’ mental health. It is essential for the Government to examine the Mechanism and collect the views from schools and other relevant stakeholders as soon as possible to understand the implementation and effectiveness of the Mechanism, which enables the establishment of a sustainable emergency mechanism.
   2. Make good use of and integrate with the Student Health Service of the Department of Health to develop some tools which can effectively assess the development of youth’s mental health. By having a better understanding of students’ mental health, early intervention and support can be provided.
2. Examine and Straighten out the Mental Health Education and Training with the Right Focus
   1. Examining the existing school curriculum and implementing all-round mental health education to meet the different learning and development stages of youth are essential to help students master the knowledge and skills of mental health, and build up the awareness of self-help and seeking help from others. Students will learn to face difficulties and failures rationally, strengthen the quality of their mental health, and develop “Growth Mindset”.
   2. The Government should provide Education Manuals for parents, teachers and counsellors on the usual mental problems faced by students to help the “gatekeepers”, in particular parents and the public, to have a deeper understanding of mental health. This enables parents to discover the needs of their children at an early stage and seek help as soon as possible.
   3. The current pre-service teacher training programmes should be examined to include mental health education in order to equip the newly-joined teachers with the relevant knowledge and strengthen their capacity in counselling.
   4. The holistic review of the various in-service teaching training programmes is necessary. The Education Bureau (EDB) should adjust the priority in development and the focus in professional training to give teachers space to take the training for the areas which are of urgent needs, and strengthen the capacity of teachers in counselling the students who are in need so as to build up a strong and powerful protective shield for students.
3. Plan as a Whole and Coordinate the Professional Consultation Services
   1. Based on the experience of the present “Student Mental Health Support Scheme”, the issue of youth’s mental health can be effectively handled through the support from and collaboration of the different professional bodies. The Government should continue to have this Scheme in place; and set up the position of “Mental Health Coordinator” to strengthen the work on overall planning and coordination, which can help to effectively handle the existing huge amount of accumulated cases on students’ mental health.
   2. The district-based services including the District Health Centres should be used more effectively to strengthen the rehabilitation work on secondary school students, and to raise the awareness towards healthy lifestyle.
   3. In the long run, the Government should assist schools in developing professional mental health counselling services as a safety net. Besides, professional manpower and support should be provided to give consultation service on mental health to students who are in need, to give professional service on emotional support and psychotherapy, and to give support as soon as possible.
4. Improve the System and Support
   1. It is crucial to give teachers space and create more time for teacher-student interaction to allow teachers and students to build up close relationship and trust. This enables teachers to give timely counselling and support the students who are in need and face difficulties.
   2. The society and the Government should examine and evaluate the existing school curriculum, examination system and the requirements for university admission. The society and the Government should work hard on changing the atmosphere of having too much emphasis on academic results to reduce the overwhelmingly high stress and burden on study.
   3. It is important to make good use of the strength of the education of all-round development in ethics, intellect, physique, social skills and aesthetics in schools. The learning needs of students with different background and abilities should be addressed. By providing personalised learning programmes, students can develop their potential and interests.  The environment for all-round development can thus be created in schools.

 

Our Association will continue to pay close attention to and follow up with the development, and give our views in good time.  We sincerely hope that the HKSAR Government can take the initiative to collaborate with the education sector and other professional bodies.  The Government should take more focused action with greater intensity and give greater support as soon as possible through the collaboration of different bureaus and different professional bodies to help our students to be physically and psychologically healthy, and to build up the environment and atmosphere for our youth to grow healthily with positivity and resilience.

 

We strongly believe that through the collaboration of “the whole society, cross-sectors and cross-professions”, our students’ mental health and welfare can then really be improved in the long run.

[i] (1)       As stated in the report on the results about the study of the mental health of juvenile and youth in 2019 published by the Advisory Committee on Mental Health in December 2023, 16.6% of the youth had mental illness; 74.1% of them had not received any form of treatment; 19.4% of the youth had thought about committing suicide in the past one year.  The risks and protective factors could be divided into four types, which were related to family, source of stress, the living style and psychological factors.

(Source of information: https://www.healthbureau.gov.hk/download/committees/acmh/work_report_of_ACMH_2022_2023_c.pdf)

 

(2) In December 2023, the Department of Psychology of the Chinese University of Hong Kong and the New Life Psychiatric Rehabilitation Association jointly published the report on the study on “Hong Kong Youth’s Mental Health”, to understand the condition of the mental health of the juvenile and youth between 6 years old and 17 years old.  The survey results showed that among the juvenile and youth interviewed, 24.4% of them were disturbed by at least one type of mental illnesses in the last one year; but around half of their carers did not want to seek professional help.

(Source of information: https://cuhk.edu.hk/cpr/pressrelease/100413_survey.pdf)

 

(3) In January 2024, the Department of Health announced the key findings of the annual health assessment service of the annual Student Health Service in the 2022/23 school year.   The health assessment revealed that the percentage of students requiring a referral to the Special Assessment Centre, specialist clinics or other organisations for psychosocial and behavioural problems had increased from 1.1 per cent in the 2018/19 school year to 1.8 per cent in 2022/23.

(Source of information: https://www.info.gov.hk/gia/general/202401/03/P2024010300237.htm)

 

(4)  In November 2023, The Hong Kong College of Psychiatrists pointed out that as shown from the data of The Hong Kong Jockey Club Centre for Suicide Research and Prevention, among every 100,000 people, 12 to 14 people committed suicide in the last 10 years in Hong Kong; and suicide was the main cause of the death of youth. The Hong Kong College of Psychiatrists  found it disturbing that the cases of student suicide appeared one after another in the recent month; and emphasised that there were many factors which affected students’ mental health and caused self-harm and led to suicide.  Some of the factors included stress in study, family problem, social conflicts and the negative influence of the social media.  It was hoped that educators, parents, medical staff and social workers can collaborate in different aspects to ease the problem through reducing the stress and other factors leading to distress for youth and students.

(Source of information: https://skypost.ulifestyle.com.hk/article/3655667/)

 

[ii] In 3 months, there were 12 cases of student suicide.  Is the reason related to the two significant social incidents? Authoritative parenting harms parent-child relationship.

(Source of information: https://shorturl.at/altGR)

 

[iii] The Samaritan Befrienders Hong Kong – Suicide Crisis Intervention Centre followed up with 164 cases involving juvenile or youth of 19 years old or below. 35% of them were under 13 years old; and the youngest one was 6 years old.  The Centre believed that the cases reflected that there was the tendency that students who committed suicide were getting younger and younger.  The Suicide Crisis Intervention Centre analysed the cases of student suicide of this year and found that 79% of them used more fatal methods, which was 29% higher compared with the methods generally used. The Centre believed that this situation was worrying and worth close attention.

(Source of information: https://hk.on.cc/hk/bkn/cnt/news/20231220/bkn-20231220112851967-1220_00822_001.html)

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「三層應急機制」之後 ……

香港中學校長會秉持專業，一直關注青少年精神健康及自殺問題。學童自殺問題令人擔憂，已經不是第一天出現的議題。2015/16學年，香港學生的自殺個案曾持上升趨勢，政府因應情況嚴峻，於2016年成立跨專業的「防止學生自殺委員會」，就學生自殺事件進行全面分析，並提交報告，作出建議。可惜的是，情況未見顯著改善，及至2023年，15至24歲的青少年自殺率更創歷史新高。雖然不少機構均就此現象作出調查、研究，並發表青少年輕生個案數據和報告^[1]，惟學童自殺個案至今仍未見有遏止跡象，情況再次令人擔憂。

政府當局於2023年12月至2024年1月，在全港中學推出了為期兩個月的「三層應急機制」，並於1月29日公布延長有關措施至2024年12月31日，同時推出加強支援學校及早識別有較高自殺風險學生的新措施，包括為學校舉辦培訓課程、安排在中學舉辦精神健康活動，以支援改善學生的精神健康。然而，學生面對的成長問題涉及不同因素，加上近三年的疫情，導致青少年精神健康問題和個案出現累積效應。專家及學者均指出，一些輕生學童的遺書及相關研究顯示，部分個案的成因與2019年社會運動及歷時約三年的新冠肺炎疫情有關^[2]。新一輪青少年輕生的個案數字持續上升，並呈現年輕化趨勢，部分個案屬隱蔽衝動，並從未向人求助，這些年輕人的自殺方式亦較致命性^[3]，可在毫無預警下便結束生命。面對這樣的情況，政府提出了短期應急措施，但對於積存的大量精神健康個案，又如何妥善有序地跟進輔導和復康服務？針對青少年自殺及學童精神健康的根本性或系統性問題，政府會否有更大決心作長遠規劃？

參考2023年4月國家教育部發出《全面加強和改進新時代學生心理健康工作專項行動計畫（2023—2025年）》，本會希望從(1)監測應急、(2)心理健康教育和培訓、(3)專業諮詢服務、(4)制度和配套，提出以下中長期策略的建議：

(1) 強化監測和應急的機制

(a) 對於「三層應急機制」適時延後，本會認為政府能應學童精神健康所急。政府當局宜儘快檢視、收集學校和相關持分者意見，了解機制的效能和運作，以助建立可持續的應急機制。

(b) 善用和結合現有衞生署的學童健康服務，研製符合青少年發展的心理健康測評工具，加強心理健康監測，了解學生心理健康狀況，儘早介入和支援。

(2) 檢視、梳理和對焦的心理健康教育和培訓

(a) 檢視現有的學校課程，推行全方位的心理健康教育，配合青少年不同學習和發展階段，幫助學生掌握心理健康知識和技能，建立自助、求助意識，學會理性面對困難和挫折，增強心理健康的質素，發展成長型思維(Growth Mindset)。

(b) 政府當局向家長、教師和輔導員等持分者提供學生常見心理問題教育指南，提高「守門人」特別是家長和公眾對精神健康的了解，裝備家長及早發現子女的需要，並儘早尋求協助。

(c) 檢視現有職前教師培訓課程，加入心理健康教育，裝備新入職教師相關知識和提升輔導的能量。

(d)梳理現職教師各類專業培訓，教育局調整發展優次和培訓重點，讓教師釋出空間進行應急的培訓，提升教師於輔導有需要學生的能量，為學生築起強而有力的保護屏障。

(3) 統籌和協調專業諮詢服務

(a) 從現有「醫教社同心協作計劃」的經驗所得，透過跨專業支援，能有效應對青少年精神健康問題。政府當局應繼續有關計劃，並增設精神健康統籌主任職位，加強統籌和聯繫有關工作，以便有效應付現時海量的學童情緒健康個案。

(b) 善用和聯結地區康健中心等區本服務，強化中學生的復康工作，並建立健康生活的意識。

(c) 長遠來說，政府當局協助學校發展專業心理輔導服務的保護網，提供專業人員和支援，為有需要的學生提供心理健康諮詢、情感支援及心理治療等專業服務，及早支援。

(4) 改善制度和配套

(a) 釋放教師空間，創造更多師生相處時間，讓教師與學生建立緊密和信任的關係，使教師能適時輔導和扶助有需要和困難的學生。

(b) 社會和教育當局應檢視現有課程、考試制度，以及大學收生要求，致力改變過分側重學業成績的風氣，減低過高的學習壓力和負擔。

(c) 善用學校五育並重優勢，關注不同背景及能力學生的學習需要，提供個性化的學習，讓學生發揮潛能和發展志趣，創建全人發展的校園環境。

本會將繼續關注和跟進發展，適時提出意見。盼望特區政府能主動與學界及其他專業攜手合作，透過跨部門、跨專業協作，儘早採取更大力度和針對性的行動和支援，促進學生生理及心理健康，共同建立能讓青少年正向、健康和具生命韌力成長的環境和氛圍。

我們深信，透過「全社會、跨界別、跨專業」的共同努力，學童的精神健康及福祉才能有長遠的改善。

香港中學校長會 執行委員會

2024年2月5日

 

^[1](1)2023年12月精神健康諮詢委員會公佈有關於2019年開展的少年及青年精神健康調查結果所示，16.6%青年過去曾出現精神疾病；74.1%沒有接受任何形式的服務；有 19.4%青年在過去一年曾出現自殺念頭。其風險及保護因素可分為四大類，分別為家庭相關、壓力源、生活模式和心理因素等。(資料來源: https://www.healthbureau.gov.hk/download/committees/acmh/work_report_of_ACMH_2022_2023_c.pdf)

[2]2023年12月中文大學心理學系與新生精神康復會公布「香港青少年精神健康」研究，了解本港6至17歲在學兒童及青少年的精神健康狀況。調查結果顯示，24.4%的兒童及青少年在接受訪問時的過去一年，受到至少一種精神疾病困擾，但近半數照顧者不願意尋求專業協助。(資料來源: https://cuhk.edu.hk/cpr/pressrelease/100413_survey.pdf)

(3)衞生署於2024年1月公布轄下學生健康服務於2022至23學年提供周年健康檢查服務的主要檢查結果，因心理及行為問題而需要轉介到健康評估中心、專科診所或其他機構的學生比率，由2018至19學年的1.1%上升至2022至23學年的1.8%。(資料來源: https://www.info.gov.hk/gia/general/202401/03/P2024010300237.htm)

(4)2023年11月香港精神科醫學院指出，根據賽馬會防止自殺研究中心數據，香港在過去10年，每10萬人裡面就有12至14人自殺，同時「自殺」是青少年死亡主要原因之一。醫學院認為近月接連出現的學童自殺個案令人不安，並強調導致學生精神健康問題以及自殘與自殺的因素眾多，其中包括學業壓力、家庭問題、人際衝突及社交媒體的負面影響等，期望教育工作者、家長、醫療人員以至社工能夠多方合作，透過減輕困擾青少年和學生的相關因素和壓力，以紓緩問題。(資料來源: https://skypost.ulifestyle.com.hk/article/3655667/)

^[2] 學童自殺3個月內12宗！輕生原因與2件社會大事有關？家長高壓管教反損害親子關係. (資料來源: https://shorturl.at/altGR )

^[3] 撒瑪利亞防止自殺會自殺危機處理中心今年跟進164宗19歲或以下個案，13歲或以下佔35%，最年輕的求助個案僅6歲。機構認為，反映學童自殺問題有年輕化趨勢。自殺危機處理中心分析今年學童自殺個案，79%採用較致命的方式，比一般自殺者高逾20個百分點，機構認為情況值得關注，令人擔心。

(資料來源: https://hk.on.cc/hk/bkn/cnt/news/20231220/bkn-20231220112851967-1220_00822_001.html )