Suicide Prevention Services provided by Caritas received more than 11,000 requests for help in 2022, reflecting the need for greater focus on the mental health of Macao residents. On the other hand, some citizens say they have not received adequate help when seeking public psychological counseling services, indicating that the current mechanism of health authorities does not work effectively. Professionals in the area point to a structural problem
According to data released by the Health Services, in 2022 there were a total of 80 suicides, of which 15 were registered in the fourth quarter, that is, an average of at least one suicide per week from October to December last year.
Caritas Suicide Prevention Services also received 11,000 requests for help in 2022, of which 401 were for suicide, against 300 in 2021, with some of the calls being made by family members and friends of people in emotional distress.
Ng Lai-ying, director of Suicide Prevention Services at Caritas, tells PLATFORMA that it is important to observe whether there is a significant difference in the behavior of people in our circle and whether they are planning to commit suicide.
At the same time, she notes that the community can also play an important role in promoting mental health.. Caritas is also currently planning to improve its community programmes.
An attitude problem
When it comes to emotional suffering and suicide, David, a professional in psychological counseling, tells PLATAFORMA that during the pandemic many people felt that “everyone else is going through the same thing, but they are happy, only I am unhappy because I am not resilient”, something that he considers to demonstrate a society that is “unhealthy” mentally.
“The causes of suicide are varied, but there is often a stigma attached to people who are mentally and psychologically ill,” points out David.
Alice, a local resident, was faced with these difficulties when she started looking for help from different agencies when she was in secondary school. The resident comments that the provision of psychological counseling services in public institutions has been insufficient “for a long time now” and that the quality of counselors varies greatly. For example, when she went to Health Services to seek psychological counseling services, the counseling lasted only about five minutes.
“I initially went to the consultation thinking that I might have depression. I was asked about my emotions and why others didn’t feel the same.” she indicated.
Alice was later referred to a specialist at a private hospital, where she received regular medication and follow-up appointments until her condition improved.
Man Yee, a high school student, received treatment at Kiang Wu Private Hospital and Conde de São Januário through the Directorate of Education and Youth Development Services.
The student recalls that she switched from one service to another many times as she wanted to know exactly what she needed before seeking help.
Failures in the support network
David, who has worked as a social worker in the Government for many years, believes that the public sector needs a better division of labour.
The counselor points out that part of the pressure on frontline professionals is due to the fact that they have to do a job that is not what they expected when they entered the profession.
“The reason many counselors and social workers resign is that some organizations don’t divide their roles and pool them, asking them to do many different tasks. But social workers and psychological counseling are different in nature, because social workers focus more on serving the public with social resources, while psychological counseling focuses on psychological growth.”
As a result, David points out, early career social workers and counselors tend to prefer other professions.
Ah Yee, a social worker who specializes in youth services, says that if a case requires psychiatric and psychological assistance, she usually cooperates with a psychological counselor from the same department to conduct an assessment.
Yee also notes that many counselors, especially in the field of youth work, leave midway through the process.
“Sometimes the client would call the counseling service directly and it takes two months to get an appointment. [In my organization] there are only one or two advisors, which means there are even fewer advisory options available. Sometimes the same case is referred several times to different units, ”she points out.
This social worker considers that the ‘four-level joint prevention mechanism’ currently established by the Health Services for mental health are just guidelines that have not yet been implemented at all levels.
“The paradox is that the roles of the social worker and the psychological counselor are duplicated in different organizations and the evaluation criteria are different for each organization, so the procedures can be duplicated”, she warns.
“If the hierarchy were based on professional areas: social worker, counseling, then therapist and psychiatry, the hierarchy would be more straightforward and many cases could be handled more accurately at the initial stage.”
Shortage of psychiatric staff in the public sector
In 2022, the acting director of Psychiatry of the Conde de São Januário, Kwok Wai Tak, stated in the Legislative Assembly that there would be a shortage of psychiatrists and psychotherapists.
According to the Macao Daily newspaper, that same year, the Secretary for Social Affairs and Culture, Elsie Ao Ieong, indicated that the number of psychiatrists and psychotherapists in Macau in 2022 was around 100, with the number of medical personnel in this specialty in Health Services to increase from 32 to 41 between 2019 and 2022.
In comments to PLATAFORMA, the President of the Macau Psychology Association, Lee Seng Hang, points out that social workers, psychological counselors, psychotherapists and psychiatrists are all “guardians of mental health” and that therefore they should work together, but that residents often confuse these functions.
“Due to Macao’s history, not everyone can distinguish between the roles of psychological counselors and psychotherapists […] psychological counseling deals more with the general public or students suffering from mild to moderate psychological growth, career development and emotional distress. “, describe.
“Psychotherapy involves clinical work, including assessment, treatment, rehabilitation planning and post-cure follow-up, and provides assessment and treatment services for people with mental illness or mental impairment. It should be possible to broaden the scope of the psychologist profession to attract more people. With the completion of the new hospital complex in Cotai, the recruitment of more psychology professionals should also be expanded”.
According to the sector representative, there are currently more than 300 psychological counselors in Macau, spread across government departments, schools and social solidarity organizations.
For Lee, the lack of psychologists is felt only in the public sector, as there is only one public hospital with a psychiatric clinic, and the recruitment period for the public service is long.
However, he admits that the resources of each organization are limited and the qualification of supervisors needs to be improved. “A well-developed professional environment can enhance the professional capacity of assistants and provide better service to service users. But the reality is that resources are limited and it is difficult to assign them to all positions.”
PLATAFORMA questioned the Directorate-General for Health about the recruitment of psychiatrists and psychotherapists for the CHCSJ, with this entity responding that “in the future, the recruitment and training of relevant medical personnel will be started in an orderly manner, according to the needs of the situation and in accordance with the statutory procedures and mechanisms”.
