Is living in Hong Kong bad for your mental health? Benchmark survey – English speaking women in Hong Kong.


Whilst there is no significant difference between the number of men and women that experience a mental health problem, some mental health challenges are more common in women that in men. These typically include depression, anxiety,  self-harm, eating disorders, and some personality disorders.

RED DOOR, a psychology and counselling practice based in Hong Kong, recently ran a brief survey among English speaking women in Hong Kong exploring the experience of various mental health challenges and issues among that population. Over 120 women responded to this call for feedback. Whilst this is a small number compared to the size of the population, this research is not a measure of prevalence, rather than identifying those issues that are most commonly reported.

The 120 women were asked about their personal experience of mental health issues, their concerns for their children (if they have children) and their overall perception of Hong Kong in terms of being a positive or negative location in terms of supporting/compromising mental health.


Comparing good or bad (not including people who said it was neutral) more women rated the experience as BAD for their mental health than GOOD. Many reasons were cited as explanations of HK being challenging to your mental health.


Many of these should be concerning to local government, employers, educators and health professionals.  It seems that HK is seen as a place where people are under a lot of pressure, do not have all the sources of support they may require, but can find alternative self-medicating (drugs/ alcohol) options too easy to pursue. We will continue to explore this area.


What mental health issues do HK women experience?

The most common mental health challenges women experience in Hong Kong include feeling overwhelmed, experiencing bad stress, regular sleep disturbances and feeling anxiety. These concerns were experienced regularly or often according to the ratings.

women and stress

Other challenges experienced occasionally include feelings of poor self-esteem, experiencing sad mood and depression, perfectionism, marital discord, disordered eating, obsessive thought patterns, and consuming more alcohol than advised.

It is important that women get good advice how to deal with each of these challenges and we promise to communicate advice on each of these topics in our next series of blogs. Some brief advice for each includes

Feeling Overwhelmed.

Feeling overwhelmed is part of life, and will happen occasionally, but if you feel overwhelmed frequently you make like to follow some of the following advice, either on your own or in collaboration with a counsellor.

Thought patterns. We all hold some thinking patterns/ errors that exacerbate our experience of stress. If you are a catastrophic thinker, meaning you tend to think the worst things will happen, you plan 5-6 steps ahead in terms of awful things that might happen, you will experience more overwhelming experiences of anxiety.

What to remember: Repeat a few reminders to yourself. a) You’ve probably been here before, and survived, and maybe even managed such a situation with success. b) Some situations work out without you having to do (or decide) anything. Sitting for a moment is usually a good thing. c) You can’t control everything, but you can trust in your ability to respond to situations in a proactive and positive manner. And lastly, d) take each day one at a time, don’t worry to much about tomorrow, think about what you need to do today.

Add some perspective: Sometimes you ned to change your way of thinking. You might need to rewrite a situation using terms such as “at least” or “yet”. For example if you believe everything is going against you, you an use the phrase “at least” to put some hope or context into the situation. For example, “Everything is going wrong today. At least, I have my lovely dog to pat at the end of it. At least the day is over and I can relax now. At least I can tell my friends about it.” The “yet” phrase helps you look at your own capabilities with greater hope and humility. For example, “I can’t manage my finances, YET. ”

All of these elements in addition to slowing your thinking down, writing elements to be grateful for , and asking for support will help.

Bad Stress

Some stress can be motivating and galvanising. Prolonged stress (Chronic) or extreme levels of stress (Acute) is extremely detrimental to your health – mental health and physical health. Some thought elements that help you quickly include.

Thought patterns. We all hold some thinking patterns/ errors that exacerbate our experience of stress. In addition to catastrophic thinking, comparing, should-ing, blaming and overgeneralising all exacerbate our experience of stress in a situation.

Negotiation skills at work are essential. Do you have too much to do. How can you decrease your workload? Can you negotiate your workload?

Prioritising during the day, and in your career, is important so that you are spending time and effort on those activities which are of most benefit to you and your plans, and bringing you closer to your goals.

Lifestyle elements such as sleep, avoiding self medication and addictive practices, and eating and exercise all will improve your ability to deal with stress.

Sleep Disturbances

Women in HK mention that they often experience disturbances in their sleep. Even adults need about 8 hours of sleep a night. Try to get to bed before midnight, and create a positive bedtime routine which helps you get to sleep. This would include no screen time an hour ahead of bed time, take a relaxing bath or have a cup of cocoa, read in bed. In essence wind down, and tell your mind and body that you are preparing to power down.

If necessary you can consider sleep aids, homeopathic or medical. Be sure to take sleeping medications under the care of a physician.


Anxiety is one of the most common mental health issues for both men and women, adults and children. Learning to deal with anxiety may include medication, but often involves therapy, especially cognitive behavioural therapy techniques. Consider to see a counsellor if you are experiencing anxiety on a regular basis. A treatment plan often includes monitoring, thinking pattern assessment, thought log and training in relaxation and meditation techniques. For some quick advice check out our previous blog on anxiety.

Women in Hong Kong require support for these challenges. Whilst support groups and counselling services exist, there seems to be a need for much more, available services.

#mental health #internationalwomensday #HongKongmentalhealth #anxiety #stress #women

If you need therapy and find the cost a barrier  consider finding a therapeutic support group as an alternative. These groups are usually much cheaper, and also have the benefit of the group dynamic to help members.

RED DOOR runs a divorce therapeutic support group, and is interested to provide therapy groups to those experiencing anxiety or low self-esteem. If you are interested to join such a group contact us at






Self-Harm risk higher for those who are emotionally oversensitive.


It is natural to be concerned that your teen may self-harm, usually through cutting or burning themselves. Self-harming as a behavioural trait usually starts in the mid teen years, and can continue for years, if therapy or treatment is not successful.  People who have a history of self-harm sometimes may also develop suicidal ideation (contemplating suicide) although this is not always the case. Regardless self-harm is considered serious in itself, and as an possible component of other psychological issues such as clinical depression, dissociative disorders, eating disorders and obsessive-compulsive disorder.

The root cause of self-harming behaviours can be traumatic events including child abuse, but other stressors such as bullying, family tension and extreme pressure have been suggested as potential causes. The teen that considers self-harm may feel lonely, out of control, invisible, and a deep sense of self-loathing. They are quite likely to have oversensitive emotions, to the extent that their reactions can sometimes seem extreme, or such that they seem numb, from previously feeling worries too strongly.

The teenage years can typically be a period of emotional sensitivity which is why self-harming behaviours may emerge at this time. Children who are extremely sensitive, prone to lashing out, have poor impulse control or hold catastrophic perspectives are more prone to pursue behaviours such as self-harm.

The desire to cut is often in response to emotional situations or the thoughts attached to those situations. The world seems too much, too painful, too difficult. Cutting can be an act of to externalise the experience of internal pain, remind them that they are alive, or even a punishment for behaviours they judged as shameful. When we treat such teens in therapy, we try to help teens deal with their situation and their emotions, and gain back a sense of emotional regulation, essentially an ability to manage their oversensitive emotions.  

Understanding and regulating emotion can be taught. Therapists aim to teach their client to observe and correctly label emotions as well as create and utilise a non-judgemental internal dialogue to learn to respond to emotionally charged situations in a different manner than they have in the past.

Typical reassurances that parents may engage such as telling kids to stop, calm down, model themselves after another person, exercise more, or “try to get over it/forget about it”, typically do not work well with emotionally oversensitive people. This is because these teens need to first learn how to understand their personal relationships with the world, before assurances and suggestions may make any impact.

Therapy techniques such as DBT (Dialectic Behaviour Therapy) and CBT (Cognitive Behavioural Therapy) can be effective treatment options. These therapies are often data based, and help teens learn to read their own patterns of thoughts and behaviours through emotional monitoring, thought logs, and response adjustments. A simplified version of this process is described below.

Emotional monitoring can be taught to both children and adults. There are many tools to help people correctly identify and label emotions. Physical experiences such as tension, butterflies in the stomach, headache, clenched jaw are also detailed. Correctly helping identify the expression and experience of an emotion helps the client associate particular thoughts patterns associated with those emotions, or simply help them notice that they feel emotions they thought they had “lost”. Many teens confuse feeling anxious with feeling angry and hence respond by lashing out, rather than behaviours that may help them calm down.

Thought patterns are essential to associate with certain emotions. These thought patterns may have been learnt over many years and may include catastrophising (this is the worst thing ever!) , negative comparisons (She is so cool, I am such a loser) , mind reading ee my blog on common thinking errors). By catching these thoughts in action. Essentially people are taught to catch these thinking patterns and reflect upon them from alternative perspectives. They may be asked to keep a log of negative events and how they felt about those events so that they can be discussed in terms of creating a more rational perspective on the situation being reviewed.

For example, a bad event will be compared with other events to help the client understand its relative importance. A particular teen may consider getting a “C” grade on a test a major tragedy. That teen could be asked to asked to rate it out of ten, and gives it a seven, the therapist might ask what would be a 10. Typically, a score of 10 may be allocated to a severely traumatic event such as death of a loved one. The therapist then asks, what would be a 9? A nine might be chronic illness or injury. The process continues, and the therapist will ask, “Does getting a C still represent a seven out of ten?” Usually using such perspective tools helps client’s better rate the bad event into a more realistic context.

Once thought patterns and perspectives have been regularly assessed cognitive reframing and discourse can be utilised to create a new set of responses. For example in the case given previously, a teen who performs badly on a test, and may have self-harmed as a punishment of perceived poor performance, can learn to talk themselves about the realistic importance of each grade, the steps that they can take to explain or overcome poor grades, ways to study better. Different behaviours, not cutting or self-harming.

During this whole process (which is greatly simplified here), very little judgement is given regarding the actual self-harming behaviour. That behaviour is attached to a range of emotions and thoughts. Instead of challenging the self-harm behaviour directly, and potentially driving the behaviour underground or increasing feelings of shame around that behaviour, we recommend to address the root of the problem, and learn better emotional regulation. Emotional regulation, hopefully, leads to a better long- term solution, less shame, and more resilience.

If you have a teen who is self-harming please consider counselling for them immediately. The earlier you start to challenge the underlying emotions, the better.