It is almost a clich in medicine that health is not just an absence of disease; it must encompass a sense of well-being. This applies particularly well to mental health which is conceivably entwined with psychological well-being. However, again another hackneyed phrase, the definition of the term "psychological well-being" is notoriously elusive. Although everyone admits that this is an extremely important topic to consider, it does seem to be less palpable than one might have desired.

Psychological well-being embraces more than a pleasant feeling, a sense of comfort, a connotation of feeling good or an implication of high spirits. While the psychological well-being of the community is multi-faceted, being the outcome of interactions between many variables, the attainment of mental health often entails the presence of stability, not necessarily immutability, of inner and outer environments.

Hong Kong has always been a vibrant city known for its rapid tempo in life. However, like any modern city, there is a price to pay. There are indeed too many changes over the years. Among them are increased fragmentation of family, with the traditional extended structure giving place to a nuclear one, dwindling of social support system, deterioration of social institutions such as religion, and brushing aside of the traditional values. People have all along since young been inculcated with concern for self-ownership or possession and social comparison rather than common asset, focus on personal success or wealth or honour rather than altruism, emphasis on performance or surface gloss rather than virtues or plainness, and regard to high technology rather than natural talents or craftsmanship. At any rate, they had had their days for many years, which inadvertently led to an over optimism.

During the Asian economic bust, Hong Kong began to face the music and in its wake was handed out its share of problems which have since cast a long shadow on its future. The tides have somehow turned. It is not simply another rough ride in life, twist of fate, confidence in crisis, or slip into pessimism. With this unprecedented turn, they now find themselves stranded in an uncharted territory.

Instead of following a well trodden path as before, they now have to fumble in unmapped space-time for a lifeline. They lose direction, and are desperate for support and guidance. At their wits' end, they simply feel demoralised, helpless, forlorn, hopeless and dejected, imagining they are doomed. Some of them do not see, or they believe they cannot see, a light at the end of the tunnel. These debt-stricken people might choose to surrender their lives out of erroneous belief that this is the only way out of the straits. This sad affair is not an incidental assemblage of personal problems. Because of the scale, it has by now grown into a social problem, part of which has even manifested itself in public health dimension.

Obviously, the task of making a big difference on this issue bordering on life or death of a significant proportion of the population cannot be relied entirely on increased sophistication, however enhanced, of tertiary care, that is, specialist mental health services. Rather, with the expected responsibility of providing comprehensive and holistic care, the family physician is well placed to help his patients to handle or cope with the inevitable vicissitudes that have come along not only with developmental stages or transitions of life but sometimes with socioeconomic upheavals.

There is ample evidence from Hong Kong, China and elsewhere that those who are going to take their lives have many a time consulted their family doctor within weeks before. The task of suicide prevention can therefore be shared partly by a family physician who with appropriate training for sensitivity should do an initial risk assessment and, if possible, stratification before management or referral. One ounce of prevention is always worth a pound of treatment and even better than a ton of cleaning up the mess. Understandably early intervention is the key of success in salvaging lives.

Many of the help-seekers come from the marginalised sector of the population and they are badly in need of assistance. Those distraught might ask from their doctor for a quick fix to their problem or expect him to wave the magic wand. To them the doctor has to lend a patient ear while explaining that he is already trying his very best, thereby reassuring them that they are not alone. These patients will benefit from some form of grief counselling for their multiple losses of wealth, esteem, pride and perhaps their jobs as well.

Problem-solving therapy is certainly more definitive and specific than crisis intervention but the latter has the benefit of

saving lives earlier. The former will be useful in helping the person to confront the situation head-on without dodging it or using negative coping tactics.

On the presumption that the wretched might well be a victim of the circumstance themselves, it makes good clinical sense never to distance or induce shame or guilt in those distressed, or else, in their abyss of helplessness, they will feel being rejected so much so that they would no longer seek help anywhere before their ultimate act of "self-management". It is reasonable to instil a ray, or better still a bunch, of hope, as long as it is realistic, in the heart of the shattered. Not infrequently, after discourse with the doctor, the despaired might be able to appreciate realistically how many cards he or she still has on the table and once again what the future has in store for him or her.

For those who are psychologically too fragile or vulnerable, the soft option would be to help him or her to come to terms with what has happened, which implies an attitude of resignation. They might feel reassured by the proposition that there is always a rise in boom years and a fall in slack years. Maybe boom years are just round the corner, so the counselling goes.

One of the antidotes to pessimism is humour and its use has been shown to ameliorate the negative emotions associated with the stressful experience. It is also correlated with positive reframing or restructuring of mind, a component of cognitive therapy, in such a way that the agony will be felt less intensely, by, for example, 'distancing'.

When a patient visits a family physician, there is value in administering periodic doses of stress inoculation which will hopefully build up and boost the resilience to stress such as adversity appearing later in life. Anticipatory guidance equally applies here.

Hence, there are more than a handful of tools a family physician can utilize in calming the distressed patients down, comforting and bringing them back from the brink of self-destruction. Surely the physician is far less helpless than the patients themselves. After all, he has a duty of care to his patients coming to his door for help explicitly or otherwise. Shall we then accept this as a goal, a call and a mission for us?