【明報專訊】LATE LAST YEAR the government launched the Three-Tier School-based Emergency Mechanism for secondary schools to identify and support students at high risk of suicide. The tentative plan was for the mechanism to be put in place until the end of next year. Lam Ching-choi, the chairman of the Advisory Committee on Mental Health, has recently stated that the issue of student suicides has improved, with four school suicide cases in September and October this year, fewer than the same period last year. Government data shows that there were 32 suspected fatal student suicides reported in primary and secondary schools last year and 22 cases reported up to October this year.
School life has fully resumed after the pandemic. Some students, however, found it difficult to adapt. The string of suicides after the start of school in September last year was presumably related to this. The introduction of the three-tier mechanism was undoubtedly a "contingency" in nature. However, the mitigation of the post-pandemic adaptation problem should not be equated with the disappearance of students' mental health problems. The highly competitive learning environment and parents' eagerness for their children to succeed invariably exert substantial mental pressure on schoolchildren.
Various local surveys and studies have shown that many schoolchildren have emotional anxiety and even symptoms of depression. From a sociological perspective, the phenomenon of suicide is imitative and contagious. The recent fall in student suicides does not mean the number will not rise again. Improving the mental health problems of schoolchildren is a long-term campaign, and there can be no let-up simply because the current wave of suicide has receded relatively.
No doubt, public policies must consider the issue of resource allocation. According to figures from the Hospital Authority (HA), the average waiting time for new stable psychiatric out-patient cases in various hospital clusters ranges from 21 to 77 weeks, and the longest waiting time can even be up to 104 weeks, equivalent to two years. Under the three-tier mechanism, when a school refers a student to a psychiatric clinic of the HA and if, after triage, the case is assessed as "urgent" or "semi-urgent", the median waiting time is no more than one week or four weeks respectively. If it is assessed as "stable", the waiting time is longer.
The authorities are concerned that if the three-tier emergency mechanism becomes regular, the use of mental health services by other members of society might be affected. However, reducing mental health support for schoolchildren due to staff shortages is not ideal. According to the HA, the cumulative number of Tier 3 cases received up to October was 330, with less than 3% being "urgent" and about 40% classified as "semi-urgent." It is unfair to overly criticise schools for mishandling cases, as school staff are not mental health professionals. Claims of excessive referrals are not necessarily just, but the authorities can assist schools in more accurately determining whether cases need a referral.
Some school principals and social workers pointed out that parents' consent is required for students to see off-campus social workers under the current mechanism. The problem is that some students' stress originates from their parents, whose written consent can be difficult to obtain. The authorities need to enhance educational efforts to help parents understand their children's mental health needs. They may also consider allowing off-campus support teams and social welfare agencies to work in schools more often.
Students may hide their suicidal thoughts, making it difficult for teachers to identify them. Apart from strengthening the training of school staff to better identify and support students with higher suicide risks, the government should also actively study and optimise the three-tier mechanism so that it can become a sustainable support system.
明報社評 2024.12.19：學童自殺個案雖減少 精神健康支援難鬆懈
政府去年底推出中學「三層應急機制」，識別及支援自殺高風險學生，暫定實施至明年底，精神健康諮詢委員會主席林正財近日表示，學童自殺問題已見改善，今年9及10月發生的校園自殺個案有4宗，少於去年同期。政府數據顯示，去年全港中小學匯報的學生懷疑自殺身亡個案共32宗，今年截至10月有22宗。
疫後校園生活全面復常，部分學生出現適應困難，去年9月開學後自殺事件頻生，估計與此有關，三層機制的出現，無疑帶有「應急」性質，惟疫後適應問題淡出，不代表學生精神健康問題消失。高度競爭的學習環境、家長望子成龍心切等，無不為學童帶來沉重精神壓力。
本地不同調查和研究都顯示，不少學童都有情緒焦慮甚至抑鬱症狀。從社會學角度，自殺現象具有模仿性和傳染性，學童自殺個案近期減少，不代表之後不會回升。改善學童精神健康問題是一場持久戰，不能因為當下自殺潮有所退卻，就鬆懈下來。
當然，公共政策必須考慮資源分配問題。根據醫管局數字，精神科門診新症輪候時間，各聯網的穩定新症平均需要排21至77星期，最長甚至可達104星期，相當於兩年。三層機制下，校方轉介學生到醫管局精神科門診，分流後若屬「緊急」或「半緊急」新症個案，輪候時間中位數分別不超過1星期及4星期；若屬「穩定」個案，則要輪候較長時間。
當局關注三層應急機制恆常化，或會影響其他社會人士使用精神健康服務，然而因為人手不足而減少對學童精神健康支援，亦非理想做法。根據醫管局數字，截至10月累計接獲330宗第3層個案，當中「緊急」個案少於3%，「半緊急」佔約四成。外界不應因此苛責校方處理不當，畢竟校方人員非精神科專業人士，「轉介過濫」一類說法未必公道，但當局確可以協助校方，更精準判斷個案是否需要轉介。
有校長及社工指出，現行機制下，安排學生見校外社工，需要取得家長同意，問題是個別學生壓力正源於父母，要向家長索取簽名同意，存在一定困難。當局有必要加強宣傳教育，讓家長明白子女精神健康需要，另外也可考慮讓校外支援隊伍及社福機構更常入校工作。
學生要隱藏自殺念頭，師長不易識別，政府除了加強培訓學校人員，提高識別及支援較高自殺風險學生的能力，亦應積極研究優化三層機制，令它可以成為一個具有可持續性的支援系統。
/ Glossary生字 /
tentative：not definite or certain because you may want to change it later
mitigation：a reduction in how unpleasant, harmful, or serious a situation is
equate：to think that sth is the same as sth else or is as important
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