Financial Secretary Paul Chan (left) and Secretary for Culture, Sports and Tourism Kevin Yeung (right) meeting the press on April 24, 2023 for the Happy Hong Kong campaign. Photo: Kyle Lam/HKFP. Used with permission. The original version of this report was written by Lea Mok and published in Hong Kong Free Press (HKFP) on June 25, 2023. The following edited version has been published on Global Voices under a content partnership agreement with HKFP. An indiscriminate assault where a man diagnosed with schizophrenia killed two women in a shopping mall in early June has shocked the public and prompted discussion about mental health disorders in Hong Kong and how they might be connected to violent behaviour. More knife assaults and murders have been reported in the past few weeks amid the government's post-Covid “Happy Hong Kong” campaign. Some Hongkongers have begun satirically calling the city an “International Knife-tropolis” or a “Brave New Hong Kong” (a reference to the dystopian novel, “A Brave New World“), mocking the police for allegedly allocating resources to national security instead of public safety. Amid rising crime rates, police have denied that this is the case. At the same time, government officials’ reiterations that “there was no sign of inadequacy in the city’s mental health services” have also been increasingly questioned. HKFP spoke to a front-line psychiatrist and a psychiatry scholar to delve into the possible root causes of the attacks — and whether they are a symptom of worsening mental health in the city. While the city's health authority described the shopping mall attack as “an isolated event without any [warning] sign,” claiming that the tragedy was unrelated to a shortage of manpower in mental health services, Eric Chen, a psychiatry professor at the University of Hong Kong, has a different view: Let’s say a tsunami hit us tomorrow — the strongest in the past decade — and there were casualties. While one may call such a natural disaster ‘an isolated event,’ we should also ask: What happened to the Observatory? Why didn’t it give a warning? Was our equipment up to standard or up to date? If the equipment was not performing as it should, it was not an isolated event. The observatory in the metaphor — public counseling services and other treatments offered to people suffering from mental disorders — have always been understaffed, the scholar added. According to the HA, a psychiatrist in the public hospital system would, on average, have 761 patients on their books. The total number of psychiatrists has fallen about 300 short of the World Health Organization’s standard, which in Hong Kong’s case, recommends 700 psychiatrists. Chen said: It would be a joke to say the incident has no direct connection to a manpower shortage, we were just too used to the lack of manpower sometimes… But now, two people have died — is it really not preventable? Willy Wong, a veteran psychiatrist, was worried that the government would address the problem in terms of quantity rather than quality, Every time such incidents happen, everyone would be tense and rushing to react, and every time they urge an increase in manpower to shorten the waiting time for mental health service… But after allocating more resources, [the authority] would expect you to meet certain quantifiable targets. Shorter waiting times and more pations recieiving treatment are often achieved at the expense of quality of service. Both psychiatrists stressed that the quality of the consultation is directly related to the time invested in each patient. Currently, public hospitals only give an average of five minutes to talk to a patient — including the time spent writing reports and arranging a follow-up consultation. Wong asked, How would anyone be ready to open their heart to a psychiatrist in just five minutes? Although the Health Bureau denied the mall attacker lacked medical support and follow-up, it proposed 10 “enhanced measures” to support people with mental health needs. Yet, most of the goals had been set in the past but failed to achieve. Chen pointed out, They never address the root of the problem — lack of manpower. Image via HKFP. Used with permission. Both Chen and Wong suggested extending the public-private partnership in psychiatric services — newly introduced last year — to lighten the burden of psychiatrists in public hospitals. The crime rate for people with mental illness is lower than that of the general population, as pointed out by psychiatrists’ groups and health authorities. Yet, social stigma is prevailing in the city, especially after the shopping mall attack incident. Wong said that his patients were troubled by the news and that mocking and misconceptions might keep people from getting the help they need.