Yet To Be Heard, Need To Be Heard– Case Studies on Mental Health Services in the Field of Public Welfare in China

Author: Kristine(Xuanwen Tan)

In 2019, the Covid-19 epidemic broke out, the virus was raging, and the cities were shut down. Panic mood nurtured in the crisis of virus, lockdown, and shortage of masks. People suffered from losing families, jobs, and financial resources. Medical workers not only struggled physically with the stressful 24/7 service, but also suffered psychologically from facing unknown emergencies. Anxiety and despair spread in the crowd. At this particular moment when people’s mental health is in danger, professional counseling agencies and nonprofit organizations positively launched online projects for psychological therapy. Video lessons and live broadcast salons helped some people find inner comfort in fear and isolation.

Although Mental Health Services in China have contributed to conciliating people during

the pandemic, their force is still weak. The sad and anxious netizens’ messages are gloomy and pervasive; the helplessness between lines telling their tragedies is depressing and tearful. There is still a considerable gap between the needs of public’s mental health and the service which we have provided. From the limited resources in the pandemic, it is evident that the China’s psychology industry hasn’t met people’s demands especilly the psychological needs of socially marginalized groups such as elders living alone, left-behind children, and disabled people. [i]

In May 2020, the National Health Commission established the initiative of “Mental health services should focus on socially disadvantaged groups,” calling on all walks of life to pay attention to vulnerable groups such as the elderly, children, pregnant women, the disabled, and patients with severe chronic diseases. For those people, we need to improve their health condition and well-being by providing timely care and assistance, security services, and, most importantly, mental health services.[ii]

Decent psychological therapy is expensive, so people who can afford this service are a limited group with fortune and resources. As for the disadvantaged groups, they are relatively vulnerable in social life, are weak in safeguarding their legitimate rights and interests, and have a weak ability to resist risks.[iii] No wonder that it is difficult for them to obtain such essential but expensive resources.

Therefore, in order to meet the needs of disadvantaged groups for mental health services, it is imperative to develop a solid psychological service system that can provide low-cost or even free services for the underprivileged groups. 

What is the current operation of the public organizations and projects that focus on the mental health of disadvantaged groups? Do they encounter any difficulties in the process? How to direct their future development? According to the charaters of these organizations, this paper divides the organizations that carry out public welfare psychological consulting projects into three categories for case studies:

1- Private Non-enterprise organizations(民非组织)that cooperate with the government

2- Grassroots charitable organizations that rely solely on social donation and volunteers 3-Traditional paid psychological consulting companies which provide some free or low-cost psychological consulting services because of enterprise social responsibility (CSR). Currently, these organizations are playing their respective roles in this field, but they also face severe problems and challenges

1. “Government + Charity”: Private non-enterprise organizations that undertake government-purchased services

Private non-enterprise organizations, as social organizations closely related to the government, have shown unique resource advantages in the help of disadvantaged groups, but they have also encountered potential challenges. Different non-governmental organizations that provide mental health services in various regions. The most representative one is Guizhou Dexin Care and Service Center for Women and Children (starting now referred to as Dexin).

Dexin was approved and established by the Guizhou Provincial Department of Civil Affairs. The center’s purpose is to provide legal promotion, psychological counseling, and social services to urban and rural women, children and families.” The processes of bringing out a psychological project are discovering regional problems, carry out inspections and evaluations, initiate projects, and undertake relevant competent non-governmental organizations (such as Guizhou Dexin Care and Service Center for Women and Children). The steps mentioned above are all conducted by government officials who don’t work in the psychology industry. Besides, observation and examination take a long time to finish. Therefore, there is a considerable distance between who needs help and who offers support.

“China Women’s Federation and UNICEF Community Child Protection Project”[1] (2017-2020) is a typical case to study this issue. [iv] Ms. Zhang is the project site’s general manager as well as especially-appointed consultant of Dexin to undertake this project. She promoted the psychological assistance work for left-behind children at Qixingguan in Bijie for three years. Ms. Zhang introduced the work of the project site to the author: At first, check relevant reports and documents to understand the information of left-behind children in the area; the second, go to the community school to do group counseling, deal with individual cases after investigating the case, and tailor solutions for the children; Finally, pay a return visit to project sites and evaluate project effects.

Ms. Zhang had group counseling

Ms. Zhang mentioned Xiaoyu (a pseudonym), a seven-year-old boy who was autistic due to improper parenting methods. Initially, the Qixingguan preschool class’s principal and teachers found that Xiaoyu’s expression and understanding skills were so poor that he could barely speak complete sentences. He also had an attention deficit. Therefore, they hoped that Ms. Zhang would give Xiaoyu individual counseling in this project. “I conducted behavioral guidance and asked the systems around him (including the community, school principals, headteachers, and classmates) to help me implement behavioral training programs.” Ms. Zhang recalled. “When the chairperson of the Women’s Federation and I evaluated the effect of the implementation of the project, the fluent dialogue between Xiaoyu and the chairperson moved me. I think all the hard work is worth!” When she talked about him, her brows were filled with pride.

Ms Zhang, Xiao Yu and Xiao Yu’s grandmother took a group photo, Xiaoyu and his teacher

In addition, in response to the high rate of migrant workers in Qixingguan, Ms. Zhang and other psychologists set up Warm Heart Home(心晴家园) with the purpose of finding “child companion mothers” (童伴妈妈)for left-behind children. They trained suitable and local middle-aged women to provide children necessary reminders and care. According to Ms. Zhang, left-behind children were left unattended at home and wandered the streets all day. Warm Heart Home was set up to allow these children to be with someone when they feel lonely and to have a safe and friendly harbor after school.

Faced with the existing results, Ms. Zhang felt joyful but worried: due to the limited scope of the project, it is impossible to continue to help more children who need mental health services. She said. “Without the leadership of community leaders, we cannot continue to work at the project site. Therefore, we cannot finish long-term cases and contain long-term companionship. What’s more, although the women’s federation, civil affairs, and the community have worked hard, workers in the Warm Heart Home are volunteers without any pay. As a result, the project is likely to be unsustainable. This phenomenon is foreseen by all functional departments in the project. However, it has not been resolved so far.”

In general, as a benchmark organization in the field of psychology in Guizhou, Dexin has undertaken a large number of psychological assistance projects in schools and communities. The remarkable results achieved in psychological education work are admirable, but there are still two problems that need to be solved: one is the sustainability of the project. Ms. Zhang explained, “The average duration of the project in schools and communities is few weeks, so it is difficult to guarantee the long-term effectiveness.” Second, because the front-line staff does not have the decision-making power of the project, many problems found in the implementation process cannot be resolved in time because they are out of the project scope. For example, the field workers like Ms. Zhang cannot extend the time of assistance according to the actual situation.

[1] Due to several cases of serious deaths of left-behind children caused by parents’ inability to bear guardianship responsibilities across the country from 2012 to 2015, the National Women’s Federation established a community child protection project in nine project sites. Among them, the 2019 All-China Women’s Federation and UNICEF Community Child Protection Project Qixingguan project site is the name of the project undertaken by the Guizhou Psychological Counseling Association.

2. “The Public+ Public Welfare”: Grassroots charitable organization for mental health

Grassroots charitable organizations mainly refer to charitable organizations that do not have any government or official background endorsements and develop purely from the masses This article selects “Mind China”(心声) to study.

Mind China is a youth charitable organization focusing on the development of mental health in China. It is committed to using social innovation and youth power to raise public mental health awareness, improve people’s mental health, and promote the social integration of mental patients. Mind Chind is also aimed to strengthen related institutional exchanges and cooperation to promote the development of mental health in China.[v]

At present, Mind China adopts a project-based operating model. It has different individuals in charge of five areas: advocacy, education, development, research, and service.

Advocacy: Raise public awareness, leverage more resources through public advocacy.

Education: Release popular science articles about mental health through its public account; launch online lecture about psychology knowledge-based sharing and knowledge.

Development: Build a online community for medical students who want to be psychologists or psychiatrists, and build a project platform to provide corresponding resources for them.

Research: Conduct research in related fields and evaluate its project results.

Service: Create a safe online community for the families of patients with mental illness to communicate.

The founder of Mind China, Dr. Yao, recalled that the project which impressed him the most was the “Wings Project.”[vii] This project makes the voice family members and caregivers of patients with mental illness to be heard. To implement this project, Dr. Yao and his coworkers conducted a “Survey on the Needs of Caregivers of Patient with mental illness in China” to better understand the dilemmas and needs of the mental illnesses’ caregivers. In the second step, Mind China established an online community for these families, hoping to provide some support and help to caregivers. Dr. Yao told the author that in the process of operating the community, he encountered many incidents. “It is impossible to fully empathize with the caregivers, but I expect to give them power and warmth by being with them.” Dr. Yao recalled. The care and love showed by these patients’ families became one of his motivations for insisting on promoting mental health education and services.

Regarding the future development of Mind China, Dr. Yao mentioned two key points: First, he wishes to use more participatory evaluation methods to assess the effect of Mind China’s project. Secondly, continuously cultivate talents who master both the management method of charitable projects and the knowledge of mental health as Dr. Yao believes that mental health consultation for disadvantaged groups is a cross-professional field. There are multiple combinations of “gender + psychology,” “education + psychology,” “sexual minorities + psychology,” and such professional cross-field talents are very scarce. Therefore, Mind China established the Choose Psychiatry (CP) project community, which aims to improve medical students’ understanding of psychiatry and encourage more medical students to choose this major.

As for the weakness of Mind China, Dr. Yao admitted that the lack of sufficient funds to support the operation of the volunteer mechanism is a major issue. Thus, the organization cannot attract more volunteers. Lack of incentive mechanisms to encourage volunteers to participate also bothers. Furthermore, subject to the size and characteristics of the organization, there are limitations in project type and content. For example, Mind China chose to form a community rather than directly conduct individual counseling. It is because that Dr. Yao considered the difficulty of the implementation of psychological counseling: “Now our Wing Project has three groups of patient communities, which are only used as safe space (safe space) for chatting because if it involves specific psychological counseling services, we are currently short of professional volunteer resources. If we encounter some extreme situations, it will be difficult and risky for us to solve.”

3. “Business + Public Welfare”: public welfare projects of traditional paid psychological consulting companies

The free or low price service provided by traditional paid psychological consultation companies (including physical and mental health service platforms) are an important part of public welfare psychological consultation. Xinlin001company is the case this paper will discuss.

“Xinlin001(壹心理), launched in July 2011, has attracted a wide range of audiences through the Internet. Adhering to the core concept of “The World and I Love You,” Xinlin001 has 22 million registered users. It provides five hero products and services: consultation, psychology courses, mental quizzes, FM, and e-commerce. By the end of July 2019, the platform has more than 500 psychological counselors and nearly 200 paid courses. More than 200 psychological institutions and more than 200 psychological authors have established close cooperation with this platform. “[viii]

Xinlin001 disseminates mental health knowledge through WeChat articles, FM, and online free consultation, which has promoted the popularization of mental health knowledge. The most charitable project launched by Xinlin001 is the Life Q&A, which creates a “psychological mutual assistance & growth community.” This online community has replied to people’s questions for more than 64 Ten thousand times for free. Unitil now, psychological help related questions have been searched for 2 million times per month, and suicide questions have been searched for more than 200,000 times per year.[ix]

【 Life Question Hall 】 Home page               “Suicide” entry page

Such an anonymous psychological assistance platform gives people the opportunity to express their inner confusion and distress. All users, including registered psychological counselors and general psychology enthusiasts, can ask and answer questions in this community. The answers of professional psychological counselors will be screened into the “30-day essence” area, allowing questioners and potential talkers to see accurate and effective responses at the first glance.

Screenshot of some answers

Adhering to the original intention of “The world and I love you,” Xinlin001 has made an outstanding performance in the field of psychological counseling, but there are still barriers to disadvantaged groups. After interviewing Mr. Zou, who works on this type of online psychological consultation platform, we learned that there are currently three main problems with online psychological consulting commercial institutions such as Xinin001: First, although the number of users is considerable, these users mostly live in cities. Thses users know that they need psychological guidance and help or they are interested in psychology. However, vulnerable groups in need of help are empty-nest elderly, left-behind children, and the disabled. They may find it difficult to get help through online platforms because mobile phones and electronic information technology are a barrier for them. Second, there are many online public welfare consulting projects of Xinlin001but almost none offline. Therefore, it is difficult to establish face to face communication between the consultant and the visitor. “Due to the lack of physical communication like observing facial expressions, the consulting effect could not be ideal.” said by Mr. Zou. Third, as Xinlin001 is a commercial organization public, welfare projects are only used as a publicity method to promote paid psychological services. In-depth treatment or intensive psychological consultation still requires high-paid consultation, which means it still difficult for disadvantaged groups with insufficient financial resources to afford long-term therapy with these professional counselors.

Conclusion and Development Advice

The advantages and weakness of these three institutions are summarized as follows:

Guizhou Dexin Care and Service Center for Women and ChildrenThe government specifies goals and work plans; the goals are clear and targeted;Stable funds and sufficient human resources during the project implement.Government departments participate in project cooperation1. Not very flexible for frontline counsellors to adjust project design in time; 2. Although the funds are stable, they are still unable to support follow-up service sometimes.  
Mind China  Be able to set up projects which target real problemsAdjust flexibly1. Lack of resource and funds to ensure the operation of the project 2. Lack of sufficient incentive mechanism to encourage volunteers to continue to participate 3. Less people they can help due to lack of the reputation and popularity
Xinlin001  Be rich in information, extensive participation, and strong interaction (similar to Zhihu in the field of psychology)Make people to obtain low-cost and free consulting experience service easily1. Information is messy and difficult to filter for the mass 2. Long term services require payment, and it is difficult for disadvantaged groups to benefit in the long term 3. Online platforms is a barrier for disadvantaged groups

There are a few suggestions as follows.

First, for private non-enterprise organizations that undertake government-purchased services, the government should increase funding and resource input in the field of mental health. Simultaneously, the government is supposed to delegate power to the organizations themselves. What’s more, to improve the supervision system of social organizations, third parties such as the public and social media can be introduced to conduct independent evaluation and supervision of these products. [x]

Second, grassroots charitable organizations need to continue using small fulcrums to leverage enormous resources. It is suggested to seek cooperation with private non-enterprise, and grassroots charitable organizations like Mind China can provide professional volunteers. They can also participate in the third-party evaluation of the projects.[xi]

For paid psychological consulting companies, they can expand the user group through public advertisements and try to promote this platform to low-tier cities and marginalized people.[xii]

In summary, domestic mental health public welfare organizations are still in initial stage. The respective functions are shown, but resources are scarce. There are still huge gaps between organizations and disadvantaged groups. We expect more people to pay attention to mental health public welfare field, and improve the mental poverty of the disadvantaged.


[i] Looking at the development of Chinese psychology from the fight against the new crown pneumonia epidemic Zhou Xiaolin School of Psychology and Cognitive Sciences, Peking University, Beijing

[ii] 2020-05-15 National Health Commission: Mental health services should focus on socially disadvantaged groups 

[iii]  2020-02-07 Peng Siqing: Pay attention to the “new vulnerable groups” emerging under the impact of the epidemic

[iv] 2020-06-30 China Women’s Network: Guizhou Dexin Care Women and Children Service Center

[v]   2019-07-28Xinsheng Mind Public Account

[vi] 2020-12-01 Xinsheng Public Account-Project-Screenshot

[vii]  2020-06-17 Xinsheng Public Account Tweet: From “you” to “us”, care is not lonely | Community Recruitment of Caregivers of Mental Illnesses

[viii]   2011-2019 One Psychology official website Guangzhou Renxin Network Technology Co., Ltd.

[ix]  2011-2019 One Psychology official website Guangzhou Renxin Network Technology Co., Ltd.

[x] Stricker G.Psychotherapy in cyber—space【J】.Ethics Behav,1996, 6:175—177.

[xi]   Innovative fulfillment of corporate social responsibility and social enterprise development Lin Zeyan (The author is the Minister of the Economic Department of the All-China Federation of Industry and Commerce. This article is the author’s preface to the book “Looking for Humpback Whales: How Do Chinese Enterprises Carry out Social Innovation?”)

[xii] Qualitative Research on the Ethical Issues of Online Psychological Counseling An Qin, Jia Xiaoming, Hao Yan Chinese Mental Health Journal, 2012, 26(11): 826-830.

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