Mental Health Support in Hong Kong: A 2021 Report
September 15, 2021
It was only until recent years when the importance of mental health came into the public spotlight, especially after more than a year under the COVID-19 pandemic. We have seen rising cases of mental health issues in Hong Kong and all over the world, as evidenced by an increased prevalence of anxiety, stress overload, loneliness or social isolation, burnout and symptoms of depression.
Around one-fourth of the employees in Hong Kong reported having experienced mental health issues from September 2019 to September 2020, as a survey by the City Mental Health Alliance Hong Kong found out. What is even more alarming, about 60% of Hong Kong adults fail to acknowledge where they may seek help for their mental wellbeing.
Amidst the public health crisis, different businesses and insurance providers in Hong Kong have been making a conscious effort to look after employees’ wellbeing in the new normal.
We at Alea have conducted in-depth investigations to provide you with an extensive report on mental health, professional services and above all, insurance initiatives for mental health in Hong Kong.
Mental health challenges in the workplace
The pandemic has swept across the world reshaping the way we work and operate. The World Health Organization reported that deteriorating mental health conditions give rise to absenteeism (employees being habitually absent from work) and approximately US$1 trillion worth of productivity loss a year globally. A “returning to work” dilemma arises from struggles of the traditional in-office versus alternative remote (or work-from-home) arrangements.
According to the survey result in Microsoft’s Work 2021 Trend Index report, 66% of employees wish to retain the option of remote work, while 65% of business leaders plan to redesign the office to accommodate hybrid work as an evolution for positive change. The transformation has doubtlessly posed a challenge to both employees and employers adapting to a different mode of work. People across the world are mentally preparing for the long haul, with the possibility that the global virus may remain permanent and most virulent seasonally.
Employee mental health
Abrupt lifestyle changes under various prevention measures and social distancing regulations have challenged employees both personally and professionally, with far-reaching implications on their mental health.
COVID-19: from a fresh reset to a stressor
As reflected in the ongoing Cigna COVID-19 Global Impact Study, though in the beginning of the pandemic, the majority of employees felt productive and content with work-from-home practices with reduced commuting time and more flexible working arrangements; the year-long pandemic has been a dual crisis of physical and mental health for many. Stress and uncertainties across physical, family, social, work and financial levels easily builds up to an intolerable amount that becomes detrimental to productivity. If left unattended, chronic stress may even backlash as mental illnesses.
Shrinking in-person networking
Despite the relaxation of safety restrictions overall, social distancing measures are still in place — in and out of restaurants, cinemas and bars. Not everyone can perfectly adapt to the shrunken networking and social interactions, coupled with overwork and digital exhaustion as a result of intense virtual collaboration. Humans are “by nature a social animal”, after all.
Exacerbating overall wellbeing
According to a 2020 report by Mind HK, inadequate management of employee mental health issues in the workplace may perpetuate poor mental wellbeing. Stigmatization and misunderstandings of mental health problems are likely to aggravate the hardship for workers, who could use proper guidance from the management level to overcome their difficult times.
Unaligned expectations and inadequate support While some companies may focus largely on minimizing disruptions in order to survive the tough business environment, they often overlook employees’ growing mental needs. Deteriorated mental state, in turn, may affect an employee’s performance at work, leaving business leaders with unfulfilled expectations.
In particular, a 2020 research by AXA found that almost half of the remote employees who expect to receive face-to-face counseling/therapy sessions did not receive corresponding support during their international assignments; the same happened to half of those who expect support from an expatriate support group and a mentoring or buddy system.
What to know about mental health insurance in Hong Kong
In the past few years, starting with Mind HK, the city has been making progress towards a more open discussion about mental health to address the issue on a wider scale. According to the organization’s statistics, an estimated 1 in 7 people in Hong Kong experiences a common mental disorder at a point in their life. Of those, three-fourths do not seek professional help, and thereby suffer in isolation due to stigma, sense of shame, insufficient awareness about their own condition and a shortage of accessible professional support.
It is therefore no surprise that the pandemic has heightened the risk factors generally associated with whole‑of-society mental health.
In the past year, Alea has seen more employers and corporate members wanting to provide mental health cover to their staff. As explained by our Co-founder Amelie Dionne-Charest: “our members and prospects are now increasingly upfront about their need for mental health coverage. We are now having conversations we never used to have in the past.”
Insurance coverage: exclusion, sub-limits, surcharge, etc.
General exclusions of mental health consultations Mainstream health insurance plans in Hong Kong seldom provide full coverage for mental health care, but only the most severe aspects of it, i.e. psychiatry. Not to mention such protections often come with caps, sub-limits or special conditions imposed on the beneficiary. Many plans strictly limit the benefit to inpatient care, only accepting hospitalized cases.
For instance, the Voluntary Health Insurance Scheme launched by the Food and Health Bureau in April 2019 only requires relevant insurance products to fully cover medical expenses for hospitalization in psychiatric treatment (a minimum of HK$30,000 per year). Insurance providers are under no legal obligation to cover other psychiatric-related treatment expenses, let alone daytime outpatient clinics and psychological counseling.
Moving on to extend coverage for services beyond psychiatry
In order to meet the surging needs for mental health treatments, we are witnessing a new trend in the insurance industry. Insurers are extending coverage beyond psychiatry, to more common conditions with additional coverage for psychological consultations and counseling.
Although insurance coverage for mental health is generally capped, it usually includes:
Physical illness or conditions caused by or linked to mental health, except for cases associated with self-inflicted harm (e.g. suicide, attempted suicide, self-harm) and addiction. Consultations or therapies conducted by clinical professionals registered under either the Hong Kong College of Psychiatrists (medical doctors); or the Hong Kong Psychological Society’s Division of Clinical Psychology (DCP) or the Hong Kong Association of Doctors in Clinical Psychology (for psychologists which are not medical doctors).
Note that most insurance providers do not cover alternative therapies (e.g. art therapy, play therapy, etc.). Plus, since psychologists and mental health practitioners are not medical doctors, their services may not be covered by some insurance providers.
Mental health coverage by different insurance providers
|Insurance Provider||Psychiatry||Psychology||Extra Benefits or Notes||General Exclusion|
|A+||Psychiatric inpatient hospital care: |
Fully Cover up to US$ 13,500 / € 10,000 / GBP 9,000 / CHF 15,000 per year.
|Outpatient psychiatric care: 50% up to $ 2,700 / € 2,000 / GBP 1,800 / CHF 3,000 per year.||Last updated brochure effective date: 1/1/2020|
Full cover up to 30 days inpatient psychiatric treatment and psychotherapy in the plan year.
Up to US$10,000 per year for psychiatric treatment and psychotherapy.
|We will only consider claims for psychiatric treatment provided by psychiatrists or qualified and registered psychotherapists.|
|Allianz||Inpatient Psychiatry and psychotherapy: |
|Psychiatry and psychotherapy: |
Full refund up to 20 visits/year.
|Drug and alcohol addiction treatment (for dependant children): |
£830/€1,000/ $1,350/ CHF 1,300 Child speech and language therapy (for the treatment of dyslexia and dyspraxia) (for members aged 16 or younger)
|Drug addiction or alcoholism care and/or treatment of drug addiction or alcoholism (including detoxification programmes and treatments to stop smoking), death associated with drug addiction or alcoholism, or the treatment of any condition that in our reasonable opinion is related to, or a direct consequence of, alcoholism or addiction (e.g. organ failure or dementia).|
|ALC||Psychiatric Illness: Full refund limited to 30 days each year.||Psychiatric Illness: A treatment plan from your psychiatrist or psychologist will be required for review and is limited to £10,000: €12,000: US$15,000 each year. |
|April HK||Hospital treatment of mental and nervous conditions: |
Fully covered for up to 60 days.
|OUTPATIENT MENTAL AND NERVOUS CONDITIONS: |
Physician or psychologist consultation fees, diagnostic scans and tests, medicines and drugs prescribed by a physician for mental and nervous conditions: US$5,000 per period of insurance.
OUTPATIENT BEHAVIOURAL AND DEVELOPMENTAL DISORDERS: Physician, psychologist and psychotherapist fees, diagnostic scans and tests, medicines and drugs prescribed by a physician for a behavioural or developmental disorder: $1,500 per period of insurance.
|April France||Hospitalization for the treatment of mental or nervous disorders: Up to 30 days/year.||Psychiatrists and psychologists consultations/year and a maximum of €/$200 per consultation: Up to 20 Visits.||The consequences of any neuropsychic, psychological or psychosomatic disorder, any manifestation justifying neuropsychiatric treatment, and in particular nervous depression or anxiety.|
|AXA Global||Psychiatric treatment: |
**Full refund up to 100 days over membership lifetime. **
|Psychiatric illness: |
Full refund up to 30 sessions.
|Bupa IHHP||Psychiatric treatment: Full refund.|
per consultation (EUR 190 / GBP 120 / USD 195), A combined max. of 15 consultations within a 30-day period for GP/Specialists and Psychologist.
|Bupa Global Elite||Psychiatric treatment, where it is medically necessary for you to be treated as a daypatient or inpatient to include room & board and all treatment costs related to the psychiatric condition: Full refund for a total of 90 days per lifetime. |
Any psychiatric treatment overnight in hospital and as a day-patient for 5 days or more will need pre-authorization. Benefit will not be paid unless pre-authorization has been provided. (Paid in full 90 days lifetime limit)"
|Consultation fees with psychiatrists, psychologists and psychotherapists : Such consultations must take place in the psychiatrist’s, psychologist’s or psychotherapist’s office. |
(Paid in full * Up to 30 consultations each policy year)
|Cigna Elite||Psychiatric Inpatient Treatment |
Covers psychiatric treatment (mental illness or nervous disorders) in a Standard Private room of a hospital for the primary purpose of receiving psychiatric treatment): HK$60,000 per policy year up to 30 days per policy year.
Extended benefits: Psychologist registered in Hong Kong: HK$800 per visit up to 5 visits per policy year.
|Psychiatric Outpatient Treatment or Psychological Outpatient Treatment: HK$800 per visit up to 5 visits per policy year.|
|Cigna Global Platinum||Mental and Behavioural Health Care |
As part of inpatient, daypatient or outpatient treatment.
Fully covered up to 90 days.
|Mental and Behavioural Health Care |
As part of inpatient, daypatient or outpatient treatment.
Fully covered up to 90 days.
|Passport Card||Inpatient treatment of mental or nervous disorders: |
Full refund up to 30 days per year and 90 days lifetime benefit.
|Outpatient care – Psychiatry: |
$10,000 Per Insurance Year US$30,000 Max Lifetime
|Morgan Price||Inpatient psychiatric treatment up to the number of nights shown in each period of insurance: |
Full refund - Maximum 30 nights.
|Outpatient psychiatric treatment, when referred by a physician: |
Full refund - Maximum 30 visits.
|Now Health||Full refund for up to 30 days.||Up to USD 7,500/ EUR 6,000/GBP 4,600 |
For the first 5 sessions members may choose to visit a Registered Psychologist directly without the need for referral. Maximum of 20 sessions per Period of Cover.
Note for individual insurance
Applying for individual health insurance involves underwriting, a process by which the insurer assesses risk and determines the appropriate cost and extent of cover. Applicants must complete a detailed health questionnaire and the underwriting team may decide to counter offer exclusions or loadings on declared medical conditions.
Alea’s health insurance advisors have witnessed strict underwriting in regards to mental which most often leads to wide exclusions. Where someone declaring hypertension in their health questionnaire may be offered a 30% loading by the insurer, most often the mildest mental health declaration leads to an exclusion with little scope to negotiate cover or a loading. Anyone who has had a mental health consultation or counseling session — even if no diagnosis has been made — before signing a plan, would be automatically considered as “having a pre-existing condition”.
Discrimination against pre-existing conditions, especially mental health, is another reason why it is recommended to get solid individual health insurance as early as possible in life and most importantly before any symptoms or diagnosis of any condition.
Note for group insurance
For most companies, there is no discrimination against pre-existing conditions — all employees are covered regardless of their health conditions. Large corporations with a larger group size may enjoy more advantages leveraging for better rates and supporting services.
In particular, a tailor-made indemnity plan is available to employers with more than 50 employees. Some health insurance providers take a further step to offer flexibility and creativity in supporting services. For example, in the insurance provider Aetna recently launched an e-health app that provides 24-hour mental wellbeing support.
Despite recent progressive improvements within the insurance industry, mental health care remains under-discussed with a gap in the Hong Kong market, as it is still subject to:
1 - Intolerance for pre-existing mental health conditions:
While insurance providers are looking to increase mental health cover, pre-existing mental health conditions constitute a material obstacle. When applicants declare past mental care, this usually leads to exclusion on such future care.
We at Alea have witnessed the strong disconnect that exists between the insurer’s marketing of its mental health benefits with its accessibility to consumers that need it most, the ones that have sought care.
2 - Exclusion of self-inflicted harm:
The most extreme cases of mental conditions, which are associated with addiction, self-inflicted harm and suicides, are often under general exclusions listed in the contract.
3 - Caps and sub-limits:
There are caps in mental health items, unlike in most physical conditions, e.g. cancer, diabetes, chronic conditions, etc.
4 - Inadequate coverage:
Most of the time, mental health care for milder cases takes place in an outpatient setting. Even though outpatient services such as psychologist consultations may be included in the plan, its coverage usually comes with a sub-limit which will be exceeded easily.
The amount allocated might be inadequate to cover a complete series of psychological treatments, which often require multiple sessions — you may need to pay out-of-pocket for the extra costs. The costs per session in English in Hong Kong vary between HK$1,500 to 2,500.
Trends in mental health protection: initiatives by insurance providers
Leading insurance providers in Hong Kong are taking a proactive approach to combat pandemic fatigue by introducing mental health protection to acknowledge the public’s mental wellbeing needs. Here are a few examples.
1) Aetna: Game-changing 24/7 healthline
Aetna International partnered with healthtech company Wysa to explore e-health intervention and make mental health services accessible at fingertips for their clients and prospects, with the launch of a mental health mobile app in July 2020.
These dynamic functions of the [Wysa](https://www.wysa.io/) app enable global employees to keep track of their mental wellbeing, delivering both immediate and continuous virtual support:
- Anonymous, safe outlet: Wysa, a text-based AI agent serves as a chatbot buddy to provide users with an anonymous safe space to vent anytime, anywhere
- A library of 150+ digital self-help tools: to assist users in developing mental strength and resilience
- Immediate help: easy access to a professionally trained human coach
- Follow-up care: Aetna members are signposted to additional services offered by Aetna, if ongoing support is needed
- Complete confidentiality: Aetna and Wysa promise to protect user’s private information
2) Allianz: mental awareness series
Adopting a similar approach to virtual support, Allianz organized a Mental Awareness Month in October 2020. The month kicked off with 3 short videos (Happy at home, Happy at work, Happy abroad providing tips and reminders, as well as a webinar themed “How the Science of Happiness can help you make the most of your expat assignment” to educate members about mental health.
3) AXA: targeted findings on international working
AXA places mental health at the forefront in their research about the international working environment amid COVID-19. Its in-depth report “World of Work 2020” looks into the needs of mental health support for remote workers overseas and provides insights on the pandemic’s impacts on international workers. Below are a few takeaways from the report on caring for and supporting staff in the pandemic:
Design a health and wellbeing strategy addressing the needs of your staff: 24/7 hotline, second medical opinion service, care manager support or employees wellness programs.
Facilitate immediate on-site support: Consultations and immediate preventive support should be made available to anyone in need. Peer support and open communication are also fundamental.
Workshops or seminars for employees: Provide education and training to prepare employees for forthcoming adversities and challenges, inclusive for all members of the company.
Promote mental health support available, regularly: Make sure every employee and their families are aware of what support they have at their disposal, along with its benefits.
4) Cigna: Extensive coverage on mental health challenges in the pandemic
Cigna’s global survey was used to track the impacts of COVID-19 on 5 dimensions of employee wellbeing (physical, family, social, work and financial). Results of the report with additional insights on monitoring employees’ well-being were presented in an online webinar (on October 1, 2020) in collaboration with The Economist.
The insurance provider promotes a comprehensive stress care digital hub in the workplace, offering expert advice, interactive webinars and more to educate workers on stress management. The Cigna Check-in series, publications and personalized questionnaire on stress are cases in point demonstrating its dedicated efforts.
Pronounced uptake in telemedicine & telehealth services
Overall, there has been a pronounced uptake — a 4,347% growth in the US alone as cited by American Hospital Association — in the provision of telemedicine or telehealth services among insurance companies, mostly for free to clients. Certain insurance providers even include referrals and access to professionals’ mental health services.
Employee Assistance Programme
More and more employers are willing to provide an outsourced Employee Assistance Programme(EAP) to empower employees and/or dependents with a choice to get support from a hotline in case they prefer to keep their struggles confidential from their management.
Mental health services in Hong Kong
Outside the workplace, various mental health services are available across the territories, from psychiatrists, clinical psychologists to counselors.
Mental health services in the public sector
To access public healthcare, you can visit a general outpatient clinic (GOPC), A&E or family doctor to request a referral (valid for 3 months), with which you can be referred to psychiatric services in the public sector. Here is a list of available public psychiatric day hospitals and public psychiatric outpatient clinics under psychiatry.
Hospital Authority’s Mental Health Direct Hotline (24-hour)
Tel: 2466 7350
Clinical psychological services can also be sought from the Social Welfare Department (SWD) with referral from any service unit under the SWD.
Social Welfare Department Hotline (24-hour)
Tel: 2343 2255
Mental health services In the private sector
Some private hospitals provide inpatient treatment for patients upon referral by a private psychiatrist, such as:
- Gleneagles Hospital Hong Kong — Behavioral Health Clinic: it serves as a psychiatric specialist ward in particular for psychological evaluation, counseling, psychological behavior treatment and medication
- Evangel Hospital
- Hong Kong Baptist Hospital
- Saint Teresa's Hospital
In the usual admission span between 5 and 7 days, the inpatient charge per day is below HK$2,200, and the total charge with the inclusion of meals, doctor’s rounds and medications is estimated at below HK$30,000.
You can also find a list of registered clinical psychologists here. Note that currently there is no official regulation for counseling and psychological professions in Hong Kong. Psychologists are under no obligation to be licensed or registered with a professional board or government agency in order to practice.
However, private organizations including the Hong Kong Psychological Society’s Division of Clinical Psychology (DCP), and The Hong Kong Association of Doctors in Clinical Psychology (HKADCP) have been set up to create a framework and regulatory standards. You may refer to their registers for more information.
The pandemic has ushered in the opportunity to rethink and redefine how we work, as a wake-up call for the importance of dedicating tailored mental health support in an inclusive work environment.
An advisor will be in touch to answer all your questions!
This article was independently written by Alea and is not sponsored. It is informative only and not intended to be a substitute for professional advice and should never be relied upon for specific advice.