Alvin Yau is exhausted. Like other residents in Hong Kong, he hasn’t had a break in nearly a year, ricocheting from one crisis to the next.
When Hong Kong was consumed by anti-government, pro-democracy protests last year, the 25-year-old banking analyst found himself constantly on edge, unable to sleep at night, and so overwhelmed he once burst into tears in the middle of the street.
The political chaos began calming somewhat in December – but only weeks later, the first reports emerged of a mysterious new virus across the border in mainland China.
The novel coronavirus has since exploded into a global pandemic, infecting more than 3.5 million people globally and killing more than 251,000. In Hong Kong, there have been more than 1,040 cases so far – relatively low due to months of stringent quarantine measures and closed borders.
But the pandemic dealt a second blow to a population already devastated by six months of violent unrest – and now, experts warn it could culminate in a mental health crisis.
Yau certainly feels the toll. “I feel fatigued, both physically and mentally,” he said. “After you go to the protests, you just feel tired. Right now, we don’t have protests so we don’t have that physical stress, but on the mental side, it’s still the same … I feel very hopeless.”
It’s a common sentiment: In a survey by Hong Kong University between March and April, more than 40% of respondents showed symptoms of anxiety, depression, post-traumatic stress disorder (PTSD), or any combination of the three.
These numbers may be even higher, in reality, due to under-reporting; many Hong Kongers are reluctant to talk openly about or disclose mental illness due to deep-rooted social stigma and insufficient mental health education.
Activists and educators have been working for years to break down this stigma, but they say the fight has taken on a new urgency, as people buckle under the weight of two back-to-back crises with no immediate relief in sight.
‘We’re not starting from zero’
The 2019 social unrest was violent in a way few Hong Kong residents had seen in the normally safe, orderly city.
Nearly every weekend, police and protesters faced off in heated clashes, leaving the streets littered with tear gas canisters, rubber bullets and smashed petrol bombs.
More than 2,600 people were hospitalized from June to December and protesters on the front lines said it felt like being in a war zone.
But the conflicts also left deep wounds in the city’s mental health. It was impossible to escape or ignore: the unrest shuttered businesses, disrupted daily life, and even turned family members against each other.
A study published in January found that almost 2 million people, about a third of Hong Kong’s adult population, experienced PTSD symptoms during this period, with another 590,000 suffering probable depression.
PTSD is an anxiety disorder that manifests after a traumatic experience and can cause sleeplessness, flashbacks, emotional withdrawal and traumatic nightmares.
If resilience and our ability to deal with difficult events was measured in buckets, Hong Kongers’ buckets were overflowing even before the pandemic began, said Hannah Reidy, a clinical psychologist and CEO of mental health organization Mind HK.
Millions worldwide are now struggling with the mental health effects of isolation, income loss, and more – but it’s taking a double toll on Hong Kongers because “their buckets were full anyway – we’re not starting from zero,” Reidy said.
The big stressors
One of the biggest and most common sources of stress has been the financial impact of these two crises.
The six months of unrest hit the entertainment, hospitality, and airline industries particularly hard, with travelers and international companies staying away and Hong Kong residents staying home. Now, the pandemic is causing further closures, pay cuts, hiring freezes and layoffs.
“It’s very, very hard to find opportunities, or they pay very little,” said Mark, a 23-year-old photographer and videographer who requested a pseudonym for privacy reasons. “I’m working full time but there have been pay cuts and no paid leave.”
Since the pandemic started, he’s lost about half his income, he said – and with bills and rent piling up, he’s worried. “How can anyone be expected to pay the same amount of bills when you’re not being paid the same salary?” he said.
Karman Leung hears the same anxieties on a daily basis. As the CEO of Samaritans, a Hong Kong-based 24-hour suicide prevention hotline, she’s noticed a shift in the issues people call about.
“There are a lot more people saying they will have to apply for social welfare and aid,” she said. “We have people who have lost their jobs, they mention that they’ve been struggling since last year – for example, they managed to keep their jobs last year but eventually still lost their jobs in the early months of this year.”
She’s also noticed other common stressors, such as the resurfacing trauma of the 2003 Severe Acute Respiratory Syndrome (SARS) epidemic. SARS killed more than 280 people in Hong Kong – the highest proportion of death per capita of any territory in the world.
“We have people who have been through SARS, and feel traumatized by the memories coming back,” said Leung. “Some of them have had family members who were sick during SARS, and they can’t help but worry what will happen this time.”