Help Is at Hand

The COVID-19 pandemic was a stressful time for everyone. The World Health Organization estimates depression and anxiety increased 25 per cent globally during its first year alone. In Hong Kong, as hospitals became overwhelmed, people were asked to stay home unless their symptoms were severe. And therein, Dr Christian Shaunlyn Chan of the Department of Psychology saw a lesson.

Dr Chan had worked previously on disaster relief in the Philippines following destructive typhoons. He saw parallels with the COVID-19 situation – insufficient resources and people overwhelmed. Both situations forced people to get on with looking after themselves and each other.

“One thing that became very clear to me during the pandemic is that you can’t always rely on having access to professional support. If we use that perspective to understand the mental health crisis, there’s a lot to be learned,” he said.

One takeaway is that professional mental health resources are essential but will never be sufficient to meet all needs. Another is that awareness can lead to hypersensitivity about one’s condition.

“During the pandemic, if you started coughing or had a fever, the first thing you would think is, do I have COVID? This is also true in mental health. When people feel down or anxious, very quickly they wonder if they are mentally unwell. This reflects on one hand a destigmatisation of mental health, which is a good thing. But it can also lead to over self-diagnosis or worse, with increasing demand flooding the existing medical system,” he said. “The question is, how do we educate people to have a certain level of awareness without overwhelming the system?”

Lifestyle medicine

That inspired Dr Chan to think about how mental health has been handled in other societies and other times, especially during hardships and calamities. “Before the advent of psychiatry and psychology, there were tools and resources in the community that people used, knowingly or inadvertently, to support themselves through hardship,” he said.

Many of these tools are well known to researchers – diet, exercise, relationships, sleep, exposure to nature and finding meaning in life. Dr Chan has compiled them into a six-facet framework, the Health Hexagon Model, to guide his own research and hopefully guide others in their daily lives.

“For some reason, the idea of lifestyle medicine has not gained much traction. Maybe in part because these things by and large cannot be commodified. But they have sustained civilisations and we should not neglect them to the point that we get sick and need professional help,” he said.

The benefits of exercise, sleep and constructive relationships to mental health have been extensively researched and reported. Dr Chan has also been exploring the role of diet, not so much in terms of intake but when and how people eat and with whom. In an outreach exercise, he organised a film screening and discussions for Kerry Group staff during the 2019 social movement that focussed on the role family meals can play in bridging differences and mending divisions.

He has also done work on the mental health benefits of exposure to nature. One published study looked at the effects of mandatory hotel quarantine during COVID-19 and found perceived stress was somewhat mitigated by having a view of nature out the window versus a city view. Another published study used virtual reality to increase enjoyment of nature among people who did not like to spend time outdoors.

Creating a safety net

Dr Chan is also interested in the idea of ‘sacredness’ in people’s lives, such as having special days or events that are protected from everyday concerns. There is less and less of this in Hong Kong, he notes, as people deem it acceptable to miss important days, such as a grandparent’s 90th birthday banquet, due to work. “What are the consequences when we chip away at the sense of sacredness so nothing remains sacred? This is an important question to be explored,” he said.

His goal is not to eliminate stress or mental disorders but, as a community clinical psychologist, to find ways of helping people try to work through them before they think of turning to therapies or medicines.

The approach is also more aligned with different cultural approaches where the mind and body are regarded as unified, rather than separate entities.

“It’s quite unproductive to tell people that what they’re dealing with is psychological, it’s not physical. We need to take care of the person holistically and help them build routines and habits that weave a safety net for when hardship comes and they are stressed out,” he said.