As more elderly people in Hong Kong resort to taking their own lives, suicide prevention teams have swung into action. Experts have called for greater attention and resources to be devoted to senior citizens to ease their plight and prevent the problem from getting out of hand. Gaby Lin reports from Hong Kong.

Sitting in her flat's dimly lit living room, 86-year-old Wong (full name withheld on request) talks slowly, yet enthusiastically, with Leung Wing-tong - a social worker with Suicide Prevention Services. The inconvenience caused by Wong's hearing loss couldn't dampen her spirits when sharing her recent life.

"I'm sorry to have you listening to me rambling. If nobody visits me, I would be immersed in negative thoughts, and this is pretty upsetting," Wong said apologetically with a bitter smile.

The octogenarian has lived alone since her husband died last year. His decadelong poor health required her constant care. She is among thousands of elderly people in Hong Kong getting support and counseling from SPS - a charity group set up nearly three decades ago to help emotionally distressed individuals with suicidal tendencies, and instill in them the will to live on.

Leung says his organization has been following Wong's case since her 70s, and has been paying her regular home visits to provide stronger support amid her failing health and, sometimes, emotional instability. "We would rather take precautionary measures right now before it's too late," he tells China Daily.

Suicides among the elderly have been a long-standing problem in Hong Kong. The situation seems to have worsened in recent years with cases of people aged 60 or above taking their own lives showing an upward trend since 2020, according to the University of Hong Kong's Centre for Suicide Research and Prevention.

The city recorded 1,092 confirmed suicides last year, with seniors accounting for 473 cases, or over 43 percent of the total, says the Samaritan Befrienders Hong Kong, quoting Coroner's Court statistics. The organization says that although suicides among the elderly have dipped slightly by four cases from a peak of 477 in 2022, they do not indicate an improvement, warning that the issue remains "very serious".

A combination of causes

What's compelling the elderly to taking their own lives? The reasons are multifaceted and often involve a combination of factors, including physical and mental illnesses, loss of family members, relationship problems, and financial difficulties.

Experts and social workers believe that an exodus of residents from the special administrative region stemming from the 2019 social unrest, as well as the COVID-19 pandemic and its effects on the community, have exacerbated the problem.

Hong Kong enforced stringent curbs during the pandemic, including social distancing curbs and a mask mandate. All the restrictions were dropped early last year.

Leung says these measures and the pandemic itself have taken a heavy mental toll on the elderly, with many of them having experienced "a heightened feeling of isolation".

"Some of them are feeling helpless with health problems. During the COVID-19 outbreak, their lives and daily routines were disrupted," he says.

"They couldn't even meet regular hospital appointments or have family visits when they were hospitalized. All these made them feel increasingly fearful and anxious."

The pandemic also forced residents to embrace the digital age in their daily routine, such as the mandatory use of the LeaveHomeSafe app, with many elderly people struggling to keep pace with the trend, Leung says. "Not having to rely on technology didn't matter much to them before the pandemic. But, in recent years, many elderly found they couldn't even go about their daily lives without relying on technology. This leaves them frustrated and makes them feel they are no longer a part of society."

Wong Yan-lung, former chairman of the Advisory Committee on Mental Health, says that the SAR government's pandemic response may have weakened support in some critical areas, like measures to address the mental well-being of the elderly.

The broader economic downturn following the pandemic has also exacerbated the suicide crisis among the elderly, Wong says. "Feeling financially insecure and living an unstable life can make senior citizens feel they have nothing to live for," he adds. "Even if their overall situation isn't dire, many of them fear they might become a financial burden on their children as they age."

Wong calls on the government to improve the quality of respite services and tackle the stigma surrounding care homes. "The environment in some care homes is poor, making many elderly unwilling to live there," he says. By improving care homes' condition, it can "let them know it's a real option they can choose from, and they don't have to worry about the remaining years of their lives".

Making the work of caregivers easier is also crucial, Wong says, suggesting that employers be encouraged to provide more flexibility for employees who need to take care of the elderly in their families. "This will help caregivers to better support elders and make them (the elderly) feel they are not dragging the family down."

In his 2023 Policy Address, Hong Kong Chief Executive John Lee Ka-chiu unveiled plans to bolster residential care for the elderly, such as lifting the quality and capacity standards of care homes, as well as scaling up the Residential Care Services Scheme in Guangdong province to provide more choices in cross-border elderly care. There are four residential care homes in Guangdong that are now registered under the program.

Loneliness is another key factor driving the elderly to suicide. Since the 2019 social unrest, many young people have left Hong Kong, leaving some seniors without the companionship of their children.

However, Leung, who has been involved in suicide prevention work for 17 years, does not see emigration as a "new issue", but one that has "aggravated the old problem" - deepening emotional estrangement among generations. "No matter how strong they were when they were young, the elderly will still want to have someone around them, and care for them when they become old and weak."

During an SPS visit to her home, Wong told China Daily the pain she is experiencing has knocked the wind out of her. "My legs are in pain, so I can't work out. I can't eat," she says, rubbing her swollen legs. "I can't stop ruminating, thinking about the 'bad things'."

Wong says she seldom leaves her home, except when her daughter comes over to take her to the hospital for regular appointments. "There is a lot of grievance and sorrow in my heart. I have no one to talk to, and no one can help me. I'm sobbing every night and can't get a good sleep because all of these make me feel terribly heartbroken."

Mental health lifelines

Some elderly people, struggling with suicidal thoughts, are reluctant to confide their sorrow to their families or relatives. Such reticence could stem from elderly depression, which is frequently underdiagnosed. "Studies have shown that depression without (showing) sadness may be more common among older adults," says clinical psychologist Angie Shum Kwan-yu. "Instead of openly discussing their feelings or emotional distress, they often tend to express their depression through somatic symptoms and complaining about other physical conditions."

A survey by the Chinese University of Hong Kong, covering around 4,870 community-dwelling adults and residents of residential care homes aged 60 and above, from 2019 to 2023, found that 8.6 percent of those living at home were experiencing anxiety or depression.

According to Hong Kong's Census and Statistics Department, the city had about 2.32 million people aged 60 and above as of last year. It estimates the elderly population aged over 65 will reach 2.76 million by 2046, accounting for 36 percent of the total population.

Shum believes that helping the elderly to find new hobbies and feel more in control of their lives can alleviate their struggles. Being a patient listener is also crucial. "Sometimes, it takes time for older adults to open up," she says. "We can do that by expressing genuine interest in their stories and experiences."

The Hong Kong Jockey Club Charities Trust initiated the JC JoyAge: Jockey Club Holistic Support Project for Elderly Mental Wellness in 2016. The project has trained a group of "gray-haired volunteers" to support elderly people grappling with or at risk of depression.

Shum, who is project manager of JC JoyAge, explains that the elderly often respond better to supporters of a similar age. "Our trained peer supporters themselves have gone through situations similar to those they support," she says. "This is more effective in building rapport and trust, as well as cultivating a sense of understanding and connection among them."

The SAR government has rolled out a suite of initiatives over the past decades to address growing mental health needs, including primary-healthcare-based treatment, health assessment, training, outreach, and a "18111" support hotline established in 2023. It has also implemented the Elderly Suicide Prevention Program since 2002, providing psychiatric care for those with suicidal tendencies. In the 2023-24 financial year, the program provisionally recorded 954 active cases.

In addition, authorities set up care teams across all of Hong Kong's 18 districts in 2023 to bolster all-around community-level support, with elderly care as one of the key priorities.

Terry Lum Yat-sang, a professor at HKU's Department of Social Work and Social Administration, stresses that it's important to train all front-line social service workers, including members of care teams. "Care teams can be a valuable resource. They can be quite helpful by visiting the elderly and caring for their basic needs," he says. "But providing mental health care is a different story that requires a certain amount of training."

The expert in elderly care also sees Hong Kong's existing mental health social services as "fragmented" and mostly "passive", requiring those in need to proactively seek help themselves.

Wong Yan-lung suggests the administration step up outreach efforts to address the issue, while continuing to improve services. "I think elderly people who are depressed are less likely to proactively call the government hotline. Therefore, I think the authorities should increase outreach, provide more resources, and take the initiative to reach out to them."

Lum suggests that family doctors be included in the mental health support network, and that more related services be offered at places frequented by the elderly, such as district elderly centers, private medical institutions, and district health centers. This would raise their exposure and access to these much-needed services.

"While the government promotes primary healthcare, we should also advocate primary mental healthcare," he says. "Elderly people in need should not have to travel all the way to public hospitals to receive care. Instead, they should be able to obtain services in the area where they live and visit."

Lum also says raising mental health awareness among all age groups is important, allowing campaigns like Shall We Talk to reach people from diverse backgrounds. "If young people know more about it, they can pay closer attention to their grandparents' well-being at home. In turn, grandparents can also keep an eye on the younger generation. This would benefit the entire population."

In the long run, investing time in the elderly is paramount, says Leung, urging the community to show more care and better engage with older generations.

"You need to spend time and thought with them. There's no shortcut."

Contact the writer at gabylin@chinadailyhk.com