Fearful 'madness': halfway houses, psychiatry and Hong Kong in the 1980s

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"Douglas" Cheung Wai Chung | The University of Hong Kong

In Hong Kong, the 1980s saw rapid progress in urbanisation and development. Many public housing estates were built, and the community care principle of psychiatry aroused more attention from the community. At the same time, urbanisation also strengthened public stigma towards psychiatric patients. The closer contacts between different people lightened debates about psychiatric services and patients. In this article, I try to show how public fear motivated the development of psychiatry in Hong Kong during the 1980s. Fear triggered by the Anne Anne Kindergarten Incident in 1982 and the proposals of halfway houses for psychiatric patients once hindered the developments of modern psychiatry. Nevertheless, it turned out to be a motivational force promoting modern psychiatry in Hong Kong.

Psychiatry in Hong Kong

Psychiatric services in Hong Kong did not develop very rapidly until the latter half of the twentieth century. The first modern psychiatric hospital in Hong Kong, the Castle Peak Hospital (CPH), was not opened until 1961. It marked the beginning of modern psychiatry in Hong Kong. Community care programs were not widely promoted at that time. Later in July 1977, the Community Work and After Care Unit was established. Members of the unit were professionals at the CPH. This unit lent a helping hand to schizophrenia patients who were short of family support. In 1981, the Kwai Chung Hospital was opened, in which the first psychosurgery using bi-plane radiological apparatus in Asia was performed. In the early 1980s, Professor John Wing, a professor of psychiatry at the London Institute of Social Psychiatry, suggested that keeping patients unoccupied with leisure activities might be hazardous to their health. These examples reveal how various programs, advanced therapies and ideas about psychiatry were becoming more visible in the public sector.

he entrance to a hospital building. Beige pillars hold up a large rectangular structure over an entrance that leads to an open courtyard. — The Castle Peak Hospital (Courtesy of Mr. Mok Tsun Pat).

Fear and the 1982 Anne Anne Kindergarten Incident

Despite gradual improvements in psychiatric services, the Anne Anne Kindergarten Incident, a stabbing incident in 1982, bolstered public fears towards mental health patients. The Anne Anne Kindergarten was located at the Un Chau Estate, a crowded public housing estate in Sham Shui Po. In June 1982, a former schizophrenia patient in the CPH killed his mother and sister in a flat of the Un Chau Estate. He then stabbed many people in the Anne Anne Kindergarten nearby, causing six deaths and many injuries.

The incident was described as a massacre in the press and fear triggered by the stabbing prompted debates and investigations into psychiatric services. The Hong Kong government had to respond to public fear immediately. As early as 1982, a working party was set up after the kindergarten stabbing. The working group gave many recommendations regarding the future of psychiatry services in Hong Kong. For example, only patients who were medically stable enough could be discharged from the hospital. The discharged patients had to also comply with several conditions, such as taking follow-up treatment in outpatient facilities. As a result of the working group’s suggestions, a confidential central registration system was established in 1982 to keep track of former psychiatric patients who committed violence. A trial twenty-four-hour hotline service was also launched to allow psychiatric patients and their friends or family members to seek advice.

One important recommendation of the working group was to establish halfway houses for discharged psychiatric patients. Hence, the Social Welfare Department sped up the establishment of halfway houses, especially in public housing estates, after the Anne Anne Kindergarten Incident. It was proposed that halfway houses should be built in public housing estates for two main reasons. Firstly, it was argued that this would allow recovered patients to reintegrate with the community, as recovered patients would live in a community environment and could integrate with the rest of the community with support from trained professionals. Next, the unwillingness of private property owners made it more challenging for the government to open halfway houses in private premises. The Department planned to build twenty more halfway houses by the 1990s, with 15 of these to be established in housing estates.

Fear and halfway houses

Halfway houses were not new in Hong Kong. By the 1980s, halfway houses for psychiatric patients had been established in Wong Tai Sin and other districts for many years, but nearby residents were not highly aware of them. The first halfway house in public housing estate, the Irene House, was established in Wong Tai Sin in 1967, while a halfway house in Tuen Mun was opened in 1975. It was not until the 1980s that halfway houses began to attract widespread public attention.

Due to common misconceptions towards psychiatric patients, plans for halfway houses strengthened fears among estate residents. Preoccupied with the memory of the stabbing incident, residents in housing estates shared a common resentment and fear towards the opening of halfway houses. They perceived former psychiatric patients threatening their personal safety. In the 1980s, 明愛/Ming Oi, a charitable organization in Hong Kong, surveyed opinions from estate residents about halfway houses in Tai Po and Wong Tai Sin in Hong Kong. For the case in Tai Po, over half of the interviewees did not know future residents in the halfway houses in the Kwong Fuk Estate were recovered psychiatric patients among 1073 interviewees. 78% of the interviewees declined to support the establishment of halfway houses in Kwong Fuk Estate. Whilst 45% of the opponents regarded the project as threatening to their personal security, and 11% thought that the halfway houses would cause mental troubles to the nearby residents.

In Wong Tai Sin, a halfway house in Lower Wong Tai Sin Estate received no widespread objection when it was established in 1967. By the time of Ming Oi’s interview, the halfway house had been established for 18 years. But nearly 90% of the 1000 or so respondents did not know the halfway house was established there. Only 3% of the interviewees claimed that halfway houses affected their daily life. Ironically, over 40% of the Wong Tai Sin respondents declined to support the establishment of halfway houses. Another example is the Sun Chui Estate in Shatin which was a hotspot of debates about psychiatric halfway houses. In August 1984, some residents of Sun Chui Estate even protested proposals for halfway houses and marched to the District Office in Shatin.

A large sign for the ‘Sun Chui Estate’ sits in front of a grey high rise residential-style building.

Fear and modern psychiatry

Public fear might impose negative effects on the development of psychiatry. Katherine Shin, an officer from the Social Welfare Department, argued that the greatest hinderance to the proposals for halfway houses was the resentment of residents. Dr. Mak Ki Yan, the chairperson of the halfway houses management committee of The Mental Health Association of Hong Kong, argued in a booklet that society concerns over halfway houses in Hong Kong was not because of rising awareness of psychiatry in the community. Instead, public fear resulted in growing concerns towards halfway houses for recovered psychiatric patients. Deborah Chan, the general secretary of the New Life Psychiatric Rehabilitation Association, claimed that the Sun Chui Estate issue would delay the planning of other similar social welfare services.

But continued public fear enhanced public consciousness over psychiatry. After the government announced its plan to build halfway houses in housing estates in August 1984, people in Hong Kong became increasingly concerned with psychiatry in Hong Kong. More and more newspaper articles about halfway houses also triggered widespread attention towards psychiatry and the patients. People were becoming more conscious of the issues of psychiatry.

For the well-being of psychiatric patients, the government did not stop building halfway houses. Facing intensive opposition from estate residents, the government tried to relieve their fear by initiating public education campaigns. The Social Welfare Department implemented public education programs to change common biases towards psychiatric patients, responding to the fear among Sun Chui Estate residents. The Committee on Public Education in Rehabilitation implemented several education programs starting from late 1984. For instance, the government produced two documentaries and some seminars to promote the importance of halfway houses to people in Hong Kong. In the mid-1980s, the District Board of Shatin established a working party to design and implement public education programs. The group cooperated with the Chinese University of Hong Kong to launch an adult education program about psychiatry. Some volunteers were trained to work for volunteering services for psychiatric patients. Meanwhile, educational material regarding mental health was distributed in schools.

Non-government organizations and healthcare professionals tried to clarify general biases about the halfway houses for psychiatric patients through public channels. Dr. Mak Ki yan clarified that halfway houses are transitional in nature, and established to help recovered patients rebuild their confidence in everyday life. The patients would learn how to socialise and live with other people in the community after living in the halfway houses for a period. Mak affirmed that halfway houses were particularly important for patients whose families could not provide adequate support to them. Also, Mak reassured the public that halfway houses were safe for everyone in the community by showing that violence committed by psychiatric patients was not higher than the so-called mentally healthy individuals, not to mention the recovered patients.

Mak reassured that halfway houses were designed for recovered patients who were medically fit to live in the community. In other words, the functions of hospitals and halfway houses were totally different. Frances Chen, the chairperson of the Coordinating Committee on the Mentally Ill from the Hong Kong Council of Social Service, endorsed the government’s plans as well. He affirmed that residents in the halfway houses would pose no security risk to the community because they underwent professional and detailed assessments before their admission.

The government continued to construct halfway houses in different districts despite public fear and resentment. Mui Man kit, the Social Welfare Department’s regional officer for the New Territories, expressed in August 1984 that the government would not give up the directives of establishing 11 more halfway houses by the late 1980s. With the assistance of non-governmental organizations, many halfway houses provided important rehabilitation services to former psychiatric patients. Some of them are still in use, such as the homes in Kwong Fuk Estate

As this suggests, the determination of the government and non-governmental organisations helped to relieve public resentment and promote modern psychiatry in Hong Kong. The story of halfway houses in Hong Kong shows how fearful feelings among the public might be transformed into a driving force for the implantation of modern psychiatry. As the Hong Kong Social Welfare Council highlighted in 1986, ‘if we know more about psychiatric patients, we would no longer be afraid of them’.