October 30, 2020 | By Christine Hwang, 2020 Fall Intern; Xulei Wu, Senior Associate, Bridge Consulting
- Increasing e-commerce mental health service users, counselors, and involvement of major tech and internet players have created a promising digital mental health space in China
- A large demand for mental health services and rapid growth of VR/AI technology makes China fertile ground for innovative, potentially less stigmatized means of mental health care and education
- Chinese policy support has been conducive to the development of the mental health industry, though more needs to be done to ensure relevant industry standards in commercialized digital mental health offerings and wider access to mental health services
As a psychologist, Huang Jing found herself working different shifts this year. In the early morning of the day before New Year’s Eve, Wuhan announced the city’s lockdown due to COVID-19. The public expressed anxiety and fear on the Internet about this unknown disease. As a psychologist of an online mental health consultation platform, Huang Jing, like thousands of other psychologists in the country during this global crisis, immediately devoted herself to providing online psychological support to those in need.
More in China, such as those who lost a loved one, frontline workers, or the general public, are recognizing their own psychological needs during this unique time. Amidst the pandemic, many have utilized digital mental health services, especially medical staff at the frontline who did not have time nor resources to receive counseling services.
Huang Jing remembered vividly a session she had with one ICU doctor that told her his story: He had spoken to a critically ill patient only an hour ago and watched him drink porridge. The patient was getting better, but then things took an immediate turn and he died as they struggled to save him. The doctor felt weak and helpless for a long time. He doubted himself, wondering if he tried his best. In situations like these, online mental health services have proven to be essential.
The pandemic has brought remarkable growth to digital mental health care in China. It is important to note though, that China has seen a long history of change in the mental health industry through consistent, incremental changes. COVID-19 and other social events have just accelerated the process. Meanwhile, growing interest in mental health alongside a burgeoning tech industry has also led to the development of professional and diverse online mental health services, though some areas of development remain to be addressed.
Developments in Mental Health Care in China (1990 — 2020)
In China, policy support has been significantly promoting the development of an industry. There is no doubt that mental health has been mentioned as one of the most critical social development issues by the Chinese government in the past 20 years:
- In 2002, the first National Mental Health Plan was introduced, which presented a major turn to mental health care development in China. The goal was to establish an effective government-led mental health care system, improve services and workforce capacity, and boost the public’s understanding of mental health.
- In 2003, the SARS epidemic accelerated mental health care development in response to the increasing need of a population that was then much more ill-equipped to fight an infectious disease.
- In 2013, China’s first Mental Health Law came into effect, which had taken almost 27 years to draft.
- In 2016, the State Council released the “Healthy China 2030” blueprint and a new guideline was issued in 2019 that cited psychological health as one of the major health concerns. (See more on recent mental health policies here.
With increasing awareness of mental health from the whole society, we find that growing professional interest in pursuing a career in mental health care. Based on a report by MyTherapist (Jiandanxinli), one of the leading digital mental health startups in mainland China, the number of certified Level 2 and Level 3 mental health counselors in China increased from 160,000 in 2009 to 1.2 million in 2018.
In the report, a study conducted by MyTherapist and Peking University showed that more than half of psychologists surveyed provided online counseling services, and almost all psychologists who hadn’t offered online services indicated they would like to join the trend.
New Trends in Integration of Mental Health with the Technological Landscape
Worldwide, the digital mental healthcare market has seen rapidly growing investment in the past few years. According to MarketsandMarkets, the behavioral health software market will reach 2.31 billion USD by 2022, growing at a CAGR of 14.8%. While most of the market is concentrated in North America, digital mental health care in developing countries is promising with increasing internet coverage and smartphone ownership. Most digital mental health offerings in low- and middle-income countries target depression, severe mental illnesses, and substance misuse. China is a unique market given its large demand and the rapid rise of internet, AI, and VR technology that makes it fertile ground for innovative means of mental health care and education. We highlight the following characteristics:
A large number of Internet users and a growing online mental health market
According to a report by iimedia, one of the leading data mining and analysis companies in China, the scale of e-commerce users of online mental health services in China exceeded 20 million in 2018, and it is expected to triple in 2020. With over 900 million internet users in China, there is a large room for online mental health services to grow.
Involvement of tech and e-commerce giants in mental health
COVID-19 prompted large mobilization from e-commerce and tech giants to provide online mental health counseling services, which is a trend that will only increase in the future. Alibaba Health, JD Health, Baidu’s online doctor consultation platform, and Tencent’s WeDoctor all teamed up with experts to provide free counseling services during the pandemic. As of April 28, for instance, WeDoctor handled more than 1.7 million calls on their psychological counseling platform. With significant traffic across these digital health platforms and further inclusion of mental health services, accessibility to mental health care likely will continually improve.
A diverse and rapidly evolving Internet ecosystem
Popular social media platforms like WeChat, TikTok (Douyin), and Weibo were also instrumental for mental health education during COVID-19. Overall, the rapid development of social media (WeChat Official Account, Weibo, etc), short-video apps (Douyin, Kuaishou), and radio apps (Himalaya, Qingting FM) have also incubated diverse types of online mental health-related products. For example, KnowYourself’s WeChat Official Account provides mental health-related blogs and a directory to find offline psychologists or mental health support groups. If one needs a listener instead, Songguo Hearing connects users with an assigned listener to relieve them of stress or anxieties
Emerging applications of AI, VR in mental health
Since its introduction in 2016, the VR market has seen exponential growth in China, with estimates of a market valued at 90 billion RMB (around 13.4 Billion USD) in 2020. And, according to Yiou Intelligence, more than 130 AI companies are focused on health care applications. While specific mental health applications of these emerging technologies are still in development in the country, global research thus far has demonstrated VR therapy as a promising treatment especially for phobias, anxiety, and PTSD. Some companies working to address mental health needs in China with this cutting-edge technology are worth citing:
- Racking up considerable media coverage, Cognitive Leap is a US and China based tech company that seeks to address children’s mental health issues, such as ADHD, through VR and AI technology.
- Oxford VR, a UK-based VR startup, has also received attention for its unique partnership with AXA Hong Kong and the Chinese University of Hong Kong on a project piloting immersive VR-enabled therapy in Asia.
- Other companies to note are VTRT Solutions Beijing, which is reportedly the country’s first company dedicated to developing a local VR-enabled therapeutic program, and QingTech, a Shanghai-based company known for its patented eye-tracking technology and collaboration with the Shanghai Mental Health Center for VR substance abuse rehabilitation.
Of note, the advancement of AI technology has proven useful in crisis intervention capabilities. For instance, Alibaba, owner of China’s largest e-commerce platform Taobao, recently set up a “life protection plan” with the China Federation of Internet Societies and Ministry of Youth Rights Protection of the Central Committee of the Communist Youth League, in addition to its existing safety program established a year ago. According to a report by Philanthropy times, through connecting Taobao retailers, the police, and other related mental health organizations with AI-enabled technology, the safety program has since provided crisis support to at least 2000 people who expressed suicidal ideations while messaging on Taobao. The Tree Hole Rescue Team, on the other hand, has provided more than 600 volunteers across China with information to rescue nearly 700 people about to attempt suicide based on an AI program that detects risk messages on Weibo.
Mental Health Apps: Major Players and Global Comparisons
According to researchers at the George Institute for Global Health and the School of Public Health at Peking University, a review of 997 mental health apps from Android and iOS markets found that mental health education (67%), counseling services (65%), self-assessment of mental health status (44%), and Q&A module (40%) were the main functions offered by Chinese mental health apps. Many of these functions are available through a single app, as opposed to an app specific to each function, For example, Yixinli, a leading mental health app, provides professional education and training materials, an online community, and booking services for psychologists.
In contrast, mental health apps in the US tend to be specific to more in-depth mental health topics, such as meditation (ex. Calm and Headspace) or tools exclusively for depression or substance abuse (ex. Depression CBT Self-Help Guide), in addition to platforms that connect counselors to users (ex. TalkSpace, BetterHelp). Apps in China could benefit from more diversification in the future, though as a result a domestic mental health platform for now may act as both an app for promoting user wellbeing as well as a key shaper in China’s counseling and mental health field. MyTherapist, for instance, has been heavily involved in the professionalization of the counseling industry in China.
Areas for Further Development
Nonetheless, there remain issues that necessitate continual examination as the digital mental health space in China evolves. Supporting policies around mental health access and quality of services need to happen in tandem with fast-paced technological developments.
Quality and availability of mental health services and professionals
While we have seen increasing attention to the development of mental health care at the national level, we have also seen limitations of these plans and regulations. For example, these regulations highlighted medical treatments for mental illness patients, but more specific policies are needed to also encourage access to resources for the general public. With the spawning of various online counseling services, how to ensure therapist and counselor qualifications have also garnered more concerns and discussions.
The national certificate for counseling issued by the Ministry of Human Resources and Social Security, which allowed those not pursuing counseling psychology degrees to also enter the counseling field, was canceled in 2017 due to concerns of a gap between legal certification and preparedness for clinical practice. At present, official licensing can only occur through the Clinical and Counseling Psychology Registration System (CCPRS) or a program under the National Health Commission. Some counselors may also choose to obtain relevant degrees and start practice overseas first, under guidance. The leading mental health apps mentioned all have their own stringent criteria for counselors intending to sign up, but while the country awaits updated policies around licensing, there needs to be consistent, active, and intentional effort around standardization of existing regulations and support for professional counselor trainings. In addition, as with all digital products today, sufficient attention should be directed toward privacy protection.
Stigma around help-seeking
Mental health stigma has historically affected help-seeking behavior among the Chinese population. According to a 2016 article, an estimated 90% of patients with mental illness don’t seek professional help. Some reports have mentioned that compared to “Western” samples, Chinese people tend to report somatic symptoms more than psychological symptoms, which may lead to lower awareness around seeking help from therapists or psychiatrists as opposed to a physician. While recent developments during the pandemic have shown attention to mental health is increasing, most current users of digital mental health platforms tend to be female, in their 20s, and residents of wealthier cities, pointing to significant portions of the Chinese population that have yet to accept counseling and online mental health resources. However, more convenient access through technology will likely lower stigma around help-seeking, which is why the digital mental health space in China is especially promising compared to traditional face-to-face services.
The digital mental health space in China is indeed brimming with opportunities, riding on a wave of recent national attention toward mental health over the past 20 years and rapidly developing internet platforms, e-commerce usage, and VR/AI technology. The mental health app market carries much potential to expand and diversify. Simultaneously, though, industry standards for commercialized digital mental health services, further policy support, and improvement in public awareness for help-seeking are necessary ladder steps in the technological climb for more accessible mental health services. Only time will tell on whether mental health tech will truly revolutionize the country’s relationship with mental health — but we have our hopes up.
About The Authors
Christine (Yi Ting) Hwang
Christine Hwang is an aspiring global educator majoring in Human Development & Psychology at Northwestern University. She is passionate about social equity, and completed a Fall internship with Bridge Consulting in 2020. Check out her earlier pieces and follow her on Medium here.