Hong Kong mental health three-tier stepped care system for children and youths
Tackling mental health issues can be an overwhelming experience. There’s often confusion about which services might be the most helpful, whether you’re trying to understand your child’s behavior, applying for support for your academic journey, or managing a diagnosed mental health condition. In Hong Kong, aside from working directly with counsellors, psychologists, or psychiatrists, a structured three-tier stepped care model has been established to address varying levels of mental health needs among children and youths. This model is designed to bridge the gap in care, especially in the face of rising mental health challenges across the city.
Understanding Hong Kong’s Three-Tier Mental Health System
The three-tier stepped-care model in Hong Kong categorizes interventions into three levels:
Tier 1: Universal Prevention & Early Intervention
Focuses on mental health education and early detection, with external support for school-based programs.
Aims to prevent emotional and behavioral issues before they escalate.
Tier 2: Targeted Assessment & Intervention
Provides structured assessments and intervention services for at-risk youth with services in school.
Helps bridge the gap between early detection and specialized care.
Tier 3: Specialist Intervention
Offers intensive psychiatric care for severe cases.
May involve hospital-based treatment and crisis management.
| Mental health services for children, adolescents and young adults | |||
|---|---|---|---|
| Target | Primary (6 to 11 years old) | Secondary (12 to 17 years old) | Adults (18 years old or above) |
| First Layer Comprehensive prevention, early detection and early intervention |
Mental health promotion and public education programmes, such as the Mental Health Support Hotline (Tel:18111) and Shall We Talk mental health promotional program | ||
| Student Health Service Center | |||
| Child Assessment Service (under 12 years old) | |||
| Second Layer Targeted assessment and intervention services and case referral |
Integrated Children & Youth Services Centre (6 to 24 years old) | ||
| School-based assessments and intervention Student Mental Health Support Scheme (the SMHS Scheme), and One School Social Worker for Each School Policy |
Integrated Community Centre for Mental Wellness (15 years old or above) | ||
| Early Assessment Service for Young People with Psychosis Programme (Aged 15 to 64) | |||
| School-based assessments and intervention Student Mental Health Support Scheme (the SMHS Scheme), and Two School Social Worker for Each School Policy |
University Counseling Services | ||
| Clinical Psychological Service of the Social Welfare Department | |||
| Third Layer Specialist Intervention |
Child and Adolescent Psychiatric Specialist Clinic from the Hospital Authority | Adult Psychiatry Clinic from the Hospital Authority | |
Table was extracted and translated from here.
How the Stepped Care Model Works in Practice
To illustrate how this model operates, consider the following scenarios:
Scenario 1: Universal Prevention (Tier 1 – Early Detection and Intervention)
Case: Sarah, a 14-year-old secondary school student, notices that her friend Kate has been showing signs of depression. However, during their growingly long phone conversations, Sarah begins to feel increasingly down herself, leading to feelings of guilt about burdening her friend.
Intervention: Sarah’s school organizes mental health workshops and mood-management sessions conducted by professionals, which she began attending. These sessions not only raise awareness about depression but also introduce resources (like the online platform "Shall We Talk") that help students learn how to support one another and manage their own emotions.
Outcome: Sarah learns to better manage her moods and is empowered to have open, honest conversations with Kate, and reminding herself that she is not solely responsible for solving her friend’s problems, and that she’s allowed to take a break from talking with Kate about difficult topics.
Scenario 2: Moderate Distress (Tier 2 – Targeted Assessment & Intervention)
Case: Kate, a 15-year-old secondary student, has been experiencing persistent low moods and a loss of motivation in class. Teachers have noticed her inattentiveness and have referred her to the school nurse. Kate talks about reduced ambition in school and disinterest in her future, a stark contrast to her past eagerness to excel academically. Despite these concerns, Kate minimizes her situation, partly due to comparisons to her older brother who was experiencing panic attacks from challenges in school.
Response: The nurse refers Kate to the school social worker, who begins providing structured one-on-one sessions. Employing Cognitive Behavioral Therapy (CBT), the social worker guides Kate in recognizing and challenging her negative thought patterns. Through these sessions, Kate starts understanding her emotions and gains the confidence to discuss her struggles with her parents.
Outcome: Kate progresses by challenging negative self-talk and gradually becomes comfortable sharing her feelings with not only her family but also her friends. She continues with periodic sessions to monitor her progress and further develop her emotional resilience.
Scenario 3: Severe Mental Health Issues (Tier 3 – Specialist Intervention)
Case: Caleb, a 17-year-old student, initially experienced mild panic attacks during the college application process. However, as academic and school-related stress increased, his panic attacks became more frequent and severe, eventually affecting his willingness to attend classes following an unexpected attack in class.
Response: Following the social worker’s suggestions, Caleb’s parents sought help from a psychiatrist in the public hospital, who administered medication and therapy for Caleb following a formal diagnosis of panic disorder. As Caleb’s panic attacks gradually subsided over the course of three months, he began to worry about the possibility of their recurrence if he stopped taking his medication. Caleb transitioned to seeing a private counselor for long-term support focused on relaxation techniques, identifying triggers, and reinforcing coping strategies.
Outcome: Caleb successfully reduces his medication dosage under the psychiatrist’s supervision while continuing his counseling sessions, until he moves out of Hong Kong for his university studies.
Conclusion
These scenarios demonstrate how the three-tier stepped care model aligns the level of intervention with the specific mental health needs of young people in Hong Kong. By addressing concerns early through education and targeted support, the system helps prevent the escalation of mental health issues for youths stepping into adulthood, thereby reducing dependency on overburdened specialist services. As Hong Kong continues to develop and refine its mental health support structures, efforts to strengthen Tiers 1 and 2 may further alleviate long waiting times in the public healthcare system and ensure that children and youths receive the appropriate care at the right time.
