In the next few months, Hong Kong researchers will begin the city's first survey on mental health.  This initiative comes after recent violent incidents linked to the mentally ill.

In July, a mentally ill woman decapitated her mother before committing suicide by jumping out of her apartment window. In June, a teenage boy stabbed his mother and sister to death.  A month before that, a man with history of mental illness stabbed his neighbors, killing two people.

These shocking incidents in low-crime Hong Kong have prompted urgent calls for greater help for people with mental illnesses.  Health-care experts stress that very few people with mental health problems are dangerous.  There are worries, however, that there may be more hidden cases of severe mental illness in the community that could lead to similar tragedies.

Rising demand for out-patient services

Hong Kong's public hospitals treated about 16,000 psychiatric patients between 2008 and 2009, slightly lower than the previous year.  But demand for out-patient services has risen since 2003, with 137,000 patients treated by 2007.  There are worries that these cases are just the tip of the iceberg.

Experts believe this is because mental illness carries a social stigma in Hong Kong - as it does in many parts of Asia.  Linda Lam, a psychiatry professor at the Chinese University of Hong Kong, says that while people's attitudes have changed over the past decade, there is still reluctance to acknowledge serious mental problems.

"People are more willing to talk about having mood disorders, panic disorders, anxiety," said Lam.  "But it is very difficult for family members to admit that they have more serious mental illness, such as psychosis or schizophrenia."

In November, Lam and colleagues will start Hong Kong's first mental health survey, interviewing at least one member of nearly 6,000 households to get a sense of the prevalence and causes of mental problems in this city of 7 million people.

Trying to determine causes, prevalence

The World Health Organization's latest global survey said Japan has an 8.8 percent prevalence rate, while Beijing has 9.1 percent and Shanghai, 4.3 percent.  In contrast, the United States has 26 percent, largely of because of wider diagnosis of depression and anxiety disorders.  The WHO estimates nearly 40 percent of suicides worldwide are committed in Asia.

Hong Kong's fast-paced lifestyle, cramped apartments and high cost of living create an often stressful existence.  Some of the recent violent cases and suicides happened in lower-income neighborhoods.

Some social workers and health-care experts say that although there are government-funded treatment programs, much more needs to be done to provide earlier diagnosis, especially among the young.

Providing community mental health centers

Next month, the government and private organizations will open psychiatric one-stop centers in all 18 districts in Hong Kong.  In some areas, though, they have yet to find places for the centers because of community resistance.

Sania Yau is the chief executive officer of the New Life Psychiatric Rehabilitation Association, which opened one such center last year.  "Basically they agreed to this approach of helping individuals by starting community mental health centers inside the district, but the concern is 'try not to be in my backyard'. Try to have it in another estate (housing complex), try not to be within my building," said Yau.

Yau says having the centers in communities is not only important in helping detect early signs of mental problems, but also in helping patients ease back into society.  New Life, for instance, runs halfway houses and training centers, and employs recovering patients in organic produce shops and other enterprises.

Thirty-four-year-old Odette says such services helped her learn how to cook and run a coffee shop.  "My mother, she doesn't have to worry about me so much because I'm in a stable progress in recovery.  I think the government has to give more working opportunities to us," said Odette.

Professor Lam at Chinese University says the survey's findings should help the government and private organizations come up with a more effective way to help the mentally ill, instead of the current piecemeal approach.

"We need an overarching mental health policy to help people in need," said Lam.  "Mental problems are slightly different from a physical illness, because people suffering from mental problems, they need medical care, they need social care, they need occupational rehabilitation, they need housing assistance.  And children need assistance at school."

The survey will take up to three years to complete, but experts say it is an important step in addressing mental health issues and preventing more deaths.