When Emily (not her real name) found herself swamped with thoughts of harming herself or even committing suicide, she turned to Mandy Ma - a friend from the virtual world - to kill her negative emotions.

Emily had never met Ma in person, yet she trusted her and poured her heart out, hoping to find solace as she struggled to overcome a cluttered mind.

The secondary-school teenager had found herself worn out by academic strain, the torment of childhood psychological trauma, insomnia and lack of appetite until she reached out to strangers for consolation on Open Up - a round-the-clock online platform to help Hong Kong people aged 11 to 35 with emotional problems and address the city's mounting suicide rate among young people.

Initially, Emily was hesitant about exposing her feelings. However, after multiple conversations with social workers and volunteers on the platform, their patience, care in listening and nonjudgmental attitudes gradually warmed the cockles of Emily's heart and made her feel safe. It helped her build up a trusting relationship with them.

Before turning to Open Up, Emily had been trying to seek aid from psychiatrists and had received support from community nurses and social workers. But treating mental health is a long and repetitive process. While experiencing emotional ups and downs, she often blamed herself for failing to recover fully after years of treatment and medication, aggravating her pain.

Since psychologists and social workers require appointments or payment, they are not always accessible. Open Up is thus able to fill the gap, offering Emily a safe channel for her to express her feelings, says Ma, a senior social worker who has been with Open Up for four years.

People with emotional distress who wish to seek help can chat with volunteers at Open Up via popular instant messaging platforms like WhatsApp Messenger and Facebook Messenger, and Open Up's official web portal at any time to deal with family or work problems, interpersonal relationships or academic strain.

It's a big step forward for thousands of Hong Kong teenagers like Emily who are mired in emotional, psychological and mental health challenges.

According to the Samaritan Befrienders Hong Kong, the city recorded an 8-year high suicide rate among residents aged 10 to 29 last year, with 159 taking their own lives.

A survey conducted by the Chinese University of Hong Kong from January to March involving 791 secondary school students showed that 16.1 percent of boys and 26.1 percent of girls interviewed had shown medium or severe depression symptoms. A separate poll by the CUHK team in 2017, which surveyed 4,884 pupils and secondary school students, found that bad sleep, poor academic performance and parents' high expectations of their children had greatly contributed to mental stress among young people.

Despite these problems, many did not receive professional aid, according to the Hong Kong Youth Epidemiological Study of Mental Health (HK-YES) - the first large-scale household-based epidemiological study focused on the mental health of Hong Kong's young population and conducted from 2019 to 2022.

After interviewing 3,340 respondents aged 15 to 24, the survey found that nearly one in six young people experienced some form of probable mental disorder. Yet, among those affected, only 17.7 percent were receiving psychiatric or psychological services, with 8.2 percent receiving other forms of mental service, such as from social workers or occupational therapists. More than 74 percent were found not to have received any form of service.

Comparative edge

Paul Yip Siu-fai, director of the Hong Kong Jockey Club Centre for Suicide Research and Prevention at the University of Hong Kong, says young people prefer text messaging over phone calls or face-to-face conversations to communicate.

His team found that youngsters hold more positive views on online platforms like Open Up that provide a high degree of privacy, maximum textual expression, and flexibility in reaching out to them without venue or time constraints. As a result, such channels can actively support more people who are at risk of mental breakdowns.

Since its inception in October 2018, Open Up had helped 61,662 users as of June, with more than 220,000 hours of online text counseling provided.

Open Up, which is supported and funded by the Hong Kong Jockey Club Charities Trust, adopts a collaborative model among social workers and volunteers. It had trained 970 volunteers from October 2018 to June to ensure round-the-clock services. The team of volunteers, led by dozens of experienced social workers, ensures that both novices and seasoned volunteers are supervised, guided and received timely assistance while providing services.

If volunteers believe that a case requires special attention, they will inform social workers, who will then make a judgment based on the circumstances. For users exhibiting strong suicidal tendencies, social workers and platform administrators might contact the police, depending on the severity of the case.

Apart from Open Up, many similar programs offer real-time counseling services to youth facing emotional crises or in high-risk situations. For instance, Nite Cat Online, established in 2011, provides online counseling services to children as young as 6. The Caritas Infinity Teens-Cyber Youth Support Team helps to strengthen interpersonal networks, life satisfaction and emotional health online and offline. Moreover, the 6PM Cyber Youth Support Team offers comprehensive support for teenagers and their families through diverse online media.

Sources of pressure

Pauline Luk, a volunteer who has been with Open Up for six years, reveals that interpersonal relationships are among the most common causes of emotional stress. Teenagers often worry about not being liked by their friends and go to great lengths to try to be popular. They may even force themselves to socialize in order to meet the expectations of others, or avoid exclusion or bullying, even if some introverted teenagers prefer solitude, she says.

"Bullying among adolescents extends beyond verbal insults and includes physical violence," says Luk, who often encourages victims to approach their parents or teachers for help. But, for those who are bullied, taking such a step can be incredibly difficult.

Chang Wing-chung, co-investigator of the HK-YES project and chairperson and clinical associate professor of the Department of Psychiatry at HKU's School of Clinical Medicine, notes that in their adolescence, young people are undergoing transition from childhood to adulthood, so they need to gradually establish an independent identity within the family, and develop their personality through interaction with their peers.

Therefore, teenagers' relationships with their peers become very important since they often need a sense of recognition from the latter, and this is crucial in forming their self-identity. If teenagers cannot develop a sense of identity, they may become socially isolated, with serious negative effects on their emotional health, says Chang. Yet, the family serves as the foundation for the emotional development of adolescents and plays a central role in their mental health.

When families function well, parents can offer appropriate care and support, which is essential to enable children to build up confidence and cope with external pressures. When adolescents face challenges in their peer relationships at school, a strong family bond can offer support in resolving such matters.

Teri Chan, who is also a volunteer at Open Up, blames poor academic performance as another source of pressure for troubled teenagers, and this often stems from their parents' excessively high expectations of them.

The first step

Chang believes Open Up's biggest advantage is that it provides a new way for young people, who are usually hard to reach and resistant to mental health counseling services, to take the first step in seeking help through relatively convenient online communication.

Ma thinks the platform's advantage is its way of communication online and in text, as well as anonymity that offers a safe space for those seeking help, alleviating concerns about their identities being exposed, reducing psychological defenses, and allowing them to express their thoughts and worries more freely.

For many young people who are experiencing psychological trauma, or are shy and unaccustomed to verbal expression, Ma says using text messages to communicate can avoid privacy breaches and interruptions caused by phone conversations, especially in confined spaces. Texting also allows those requiring help to preserve all chat records, enabling them to review past conversations for reflection, or seek assistance again in similar situations.

Nevertheless, Ma notes that anonymous online and text communication does have unavoidable limitations. The lack of expression beyond texting can sometimes make it difficult to accurately capture teenagers' true emotional state, and the service itself cannot fully replace the comprehensive interaction experience provided by face-to-face communication.

Furthermore, when dealing with more complex psychological issues, Open Up's anonymity requires users' consent to obtain personal information, which may pose challenges in referring them to more professional offline psychological services.

According to Ma, the platform has been collaborating with various sectors of society and multiple online and offline psychological support organizations to make its assistance for teenagers more comprehensive.

With the consent of those seeking help, Open Up will contact school social workers who can directly interact with them. Through social workers, it's also possible to consider whether or not to collaborate with families, teachers, hospital doctors, community nurses, and others to find the best way to support troubled teenagers.

Chang emphasizes that only a multilayered social psychological support network can help adolescents better cope with mental health challenges, which should better coordinate with the online platforms like Open Up. This would ensure that platform users, after taking the brave first step to seek help, have more avenues to find offline assistance beyond the platform.

A social worker's busy schedule at Open Up has left Ma sometimes unable to keep up with time. She recalls not having heard from Emily for a while. But her worries quickly evaporated when a message from Emily suddenly came through. She learned that Emily had decided to undergo stable psychiatric treatment at a hospital, saying her condition had significantly improved.

Despite the ups and downs, Ma, the volunteers and social workers are there to help Emily and others in whatever way they can. The nature of their job, which mostly involves dealing with and solving adverse emotions and negative thoughts, has sometimes brought frustration and sadness.

However, moments like reading Emily's messages always motivated Ma and her colleagues to carry on and to help young people like Emily find the path to recovery.