Virtual Mental Health Services During COVID-19 Epidemic in China
Author: Shaohua Wang
Translated into Spanish by Silvana Gordillo González
The Coronavirus Disease 2019 (COVID-19) epidemic emerged in Wuhan, China, spread nationwide last December and then swept the globe in early 2020. After being declared as a Public Health Emergency of International Concern (PHEIC) on January, COVID-19 was later announced by the World Health Organization (WHO) as pandemic in March (WHO,2020). Apart from the serious threats to people’s physical health, the COVID-19 epidemic also has significant psychological consequences, such as panic disorder, anxiety and depression that affect people more than the disease itself and possess the possibility of transforming collective trauma to generational trauma. The essay focuses on the mental health services provided in China and its virtual nature as the salient characteristic, summarizes the progression of virtual psychological interventions, analyzes the challenges of the online mental health services during COVID-19 epidemic in China.
Virtual Mental Health Services During COVID-19 Epidemic in China
The Coronavirus Disease 2019 (COVID-19) epidemic emerged in Wuhan, China, spread nationwide last December and then swept the globe in early 2020. After being declared as a Public Health Emergency of International Concern (PHEIC) on January, COVID-19 was later announced by the World Health Organization (WHO) as pandemic in March (WHO,2020). According to the latest situation report on Coronavirus disease 2019, there were 3,090,445 confirmed COVID-19 cases and 217,769 deaths worldwide by April, 30, 2020 (WHO, 2020). The world is facing the most challenging global crisis since World War II (Guterres, 2020). Based on the data from National Health Commission of the People’s Republic of China (NHC), as of Friday, May 1, 2020, 82,875 confirmed COVID-19 cases had been reported on the mainland China, 4,633 people had died of the disease, and the number of recovered cases was 77,685 (NHC, 2020). Apart from the serious threats to people’s physical health, the COVID-19 epidemic also has significant psychological consequences, such as panic disorder, anxiety and depression (Bao, et al., 2020; Gao, et al., 2020; Jacobson, 2020; Liu, et al., 2020; Lu & Bouey, 2020; Qiu rt al., 2020; Yao, et al, 2020), that affect people more than the disease itself and possess the possibility of transforming collective trauma to generational trauma. The Chinese government has taken proactive measures not only to contain the spread of the novel coronavirus (Yao, et al, 2020) but also provided mental health services with its own traits, which is the main focus of the essay.
Virtual Services as A Salient Characteristic
Since the unexpectedly quick transmission of the coronavirus and the necessity of social distancing, traffic limits and quarantine measures to “flatten the curve”, traditional face-to-face psychological interventions gave way to virtual forms. Various channels including hotline, online consultation, online course and outpatient consultation were also used for providing mental health services (NHC, 2020). The popularization of internet services and smartphones in China has grown since the Severe Acute Respiratory Syndrome (SARS) epidemic in 2003. Along with the emergence of fifth generation (5G) mobile networks, mental health professionals and health authorities were able to provide online mental health services during the COVID-19 outbreak (Liu, et al, 2020). The widely used and easily accessed social media platforms in China, such as WeChat, Weibo, and TikTok, served as information-sharing, data-collecting, research-analyzing, counseling-providing, evaluation-conducting tools and will continue their functions.
Progression of Virtual Psychological Interventions
Despite the urgency and limited time, the collective efforts of China from the government, the academia and civil society to address psychological problems during COVID-19 epidemic and provide virtual mental health services reflected the specific situations and showed a high level of solidarity.
The issue of the “Principles for Emergency Psychological Crisis Intervention for COVID-19 Pneumonia Epidemic” by the central health authority in China on January, 26, showed that the NHC “has integrated psychological crisis intervention into the general deployment of disease prevention” (Li, et al., 2020) and marked the starting point of mental health services provided on national level. The notice on establishing psychological assistance hotlines for the epidemic and guidelines for psychological assistance hotlines during the COVID-19 epidemic were released on February, 2 and 7, respectively (NHC, 2020). All of these measures primarily relied on virtual forms and with the severity of the situations increased, for instance, the extreme case of the 11-week lockdown in Wuhan, Hubei, the epicenter of the country, has made online psychological interventions more crucial.
A study shows that mental health associations and academic societies organized expert teams, published guidelines and instructions for mental health services following the aforementioned guidelines(Ibid.). Within one month, the drafts, guidelines and online educational articles, videos were placed on WeChat and other internet platforms at the early stage of the outbreak for the general public (Ibid.). A number of studies and researches have been conducted on the mental health of Chinese people under the influence of COVID-19, some drew inspirations from the previous studies (See Bao et al., 2020; Hong et al., 2017; Kauer et al.,2014; Liu et al., 2020; Shi et al., 2019). According to Qiu Jianyin and her colleagues, they conducted a nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic by sending out a self-report questionnaire; 72 online mental health surveys targeting different populations associated with the COVID-19 outbreak were distributed by February, 2 in a survey program called, “Questionnaire Star” through WeChat, one of the world’s largest mobile applications with over 1 billion monthly active users (Jacobson, 2020).
The general public received information and status updates, conducted self-evaluations, took online surveys, communicated with others, searched and asked for professional help mainly through virtual services during the epidemic. The role of social media played, except from providing usual services, as the sharing (even venting) platforms of creativity and solidarity. During the Wuhan lockdown, people documented the scenes where everyone living in the buildings lightening up the flashlights in their phones and singing the national anthems to cheer each other up during a blackout. It went viral and encouraged so many people in other provinces, even the Chinese people who were abroad at the time. The hashtag “#jiayouwuhan”, which means “Stay Strong, Wuhan” were on trend in Weibo and this was considered a way of showing mental support. People sharing their improved cooking skills during quarantine by posting delicious dishes on Weibo and TikTok also helped with the anxiety and distress in general. Installed in smartphones or other digital devices, people can easily access applications that take temperatures, provide psychological coping tips, and other professional channels like call-based, web-based and phone-based counselling. Several artificial intelligence (AI) programs have been put in use as interventions for psychological crises during the epidemic by monitoring and analyzing messages posted on Weibo, and alerting designated volunteers to act accordingly (Liu et al. 2020).
Challenges of Online Mental Health Services in China
The progression of virtual mental health services need to be acknowledged, it does not mean the challenges of online mental health services during COVID-19 epidemic in China should be neglected. A series of national and provincial policies, guidelines, principles and notices demonstrated the recognition for public mental health needs from China. However, there were a few concerns and challenges.
First of all, the source of data collected and analyzed should be accurate and representative enough as it is the basis for later policies and guidelines. How to choose a proper sample to provide the tendency most relates to reality is not easy, and even harder due to the uncertainty of the coronavirus and pressing time and goal to help and save more. A first nationwide large-scale survey of psychological distress in the general population of China was conducted during the tumultuous time of the COVID-19 epidemic, which based on “a total of 52 730 valid responses from 36 provinces, autonomous regions and municipalities” (Qiu et al., 2020); Another study which involved 4872 participants (valid and complete, with consent) from 31 provinces and autonomous regions about mental health problems and social media exposure during COVID-19 outbreak. The randomness on people who took online surveys and disproportionately demographic range made the outcome less convincing at national level.
Second, the detailed classification of different groups affected need to be identified and stated, especially the lack of gender-sensitive approaches needs to be addressed. If we look at the percentage of men and women participating in online surveys, it was usually the rates of women participating that was higher than that of men, and among them were relatively young women (Li, et al, 2020; Qiu, et al., 2020; etc.), who were reported have higher distress level. What about the women who did unpaid care work at house more than ever and could not either have time or access to virtual mental health services? Mothers, instead of other family members, are more easily to be infected as they are the ones who always take care of the sick (Zhang, 2020). There were few questions asked, designed about the low rates of men participating and reported lower stress than women. Was it because they really felt comfortable or suppressed themselves from expressing their true feelings and seeking for professional help, as they were supposed to be “tough” and “masculine”? The importance of a more gender-sensitive approach cannot be overlooked.
The key intervention targets for 6 groups: confirmed patients, persons under investigation for COVID-19, healthcare workers, persons in immediate contact with patients, ill persons who refuse to seek care, and susceptible persons/the general public(Lu &Boouey, 2020).All the online surveys retrieved from the sample of active social media users. What about senior citizens or children who are more vulnerable to the coronavirus and normally have less access to online services? It was not until February that the NHC released the ‘Psychological Adjustment Guidelines for Coping with the New Coronavirus Pneumonia’ for specific populations, including older adults, children and adolescents, pregnant women and health professionals (Li, et al., 2020). Chinese people who were abroad living and studying were not the priority of the initial key target groups. For example, overseas Chinese students were also affected as the pandemic spread to the world and even worse, they would suffer double as they had to endure what happened to their loved ones in China and later what happened to them, be it confirmed illness, helplessness or discrimination based on their race and nationality.
Third, the low rates of utilization were inconsistent with the goals of the Guidelines/ Principles. China has long been faced with an extremely low rate of mental health service utilization (Shi, et al, 2019). Owning to lack of medical professional, a well-established mental healthcare system and has no existing national-level emergency response system and designated workforce to provide the psychological crisis interventions during a national emergency or disaster (Chen & Fu, 2020). Scholars concerned that the well-meaning efforts could be “uncoordinated and inadequately supervised and thus are likely to cause confusion to service consumers and inefficient use of resources” (Lu &Boouey, 2020).
Last, a significant digital disparity led to less satisfying effectiveness, which is always a problem in low and middle-income countries. The accreditation, registration and licensure requirements for counselling psychologists in China have not been fully established, “which imposes more threats to the overall quality of online mental health services” (Yao, et al., 2020).
As an UK Government health adviser stated, “To be clear we have one strategic aim: save lives” (Horton,2020). Richard Horton, editor-in-chief of The Lancet, warned us that the world is “dangerously unprepared” and this crisis “has barely begun”. China has been making efforts for the progression of the virtual mental health setvices, however, there are also challenges. The reverse effect of too much social media exposure may lead to a certain amount of anxiety and distress is mentioned (Li, et al., 2020). The United Nations Educational, Scientific and Cultural Organization (UNESCO) declared that “Nurses, doctors and facts are life savers” (UNESCO, 2020). Conducting fact-based researches and providing tailored policy and guidelines while taking the opportunity to enhance medical emergency prevention mechanism in China are reasonable strategies. Evaluating and accessing the implementation and monitoring the mental status of the Chinese people in a long run could help with the understanding of the COVID-19 pandemic and its effects on human beings. Hopefully, enough attention would be paid continuously in order not to turn the current collective trauma towards transgenerational trauma which hinders the well-being of Chinese people. This is a lesson that the whole world need to think, reflect and learn.
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 Dr. Qiu is now working as a Director of the Department of Psychological Counseling & Psychotherapy and the Department of Psychotherapy Research at the Shanghai Mental Health Center, and the Deputy Director of the Department of Medical Psychology, Division of Mental Health at the Shanghai Jiao Tong University School of Medicine. In addition, JQ is also the deputy director of the Psychosomatic Medicine & Clinical Psychology Committee, Chinese Women’s Medical Association, director of the Shanghai Mental Health Association, vice-director of the Psychoanalytic Committee and Psychological Counseling & Psychotherapy Committee of the Chinese Mental Health Association, and vice director of the Women’s Mental Health Group in the Chinese Society of Psychiatry.
Shaohua Wang, currently works as Digital Content Creator Assistant at Ideas for Peace, graduated in 2020 from the United Nations Mandated University for Peace with a special focus on Gender and Peacebuilding. Shaohua holds a Bachelor’s Degree in Diplomacy and a Master’s Degree in International Relations from Guangdong University of Foreign Studies, China. Having been educated in China, the United States, Russia, and Costa Rica, she is fluent in Chinese, English, Korean, and Spanish. After serving as Project Assistant at Fumei Charity Fund and Personal Assistant to the Chairwoman at a pharmaceutical company that preserves and produces Chinese medicine of ethnic minorities, Shaohua received training from the World Federation of United Nations Associations(WFUNA) in China and the U.S., especially on SDGs. Besides interning at Provincial Office of Foreign Affairs and Fortune 500 Global company, Shaohua expanded her horizon by moderating and volunteering at the University Team at Museum of the Original Site of Whampoa Military Academy and later becoming the media producer and project manager for a UNV-UNHCR program，which aimed at preparing working skills for field workers with people with disabilities. As a trained non-binary gender specialist who possesses exceptional skills for interpersonal communication and effective negotiations, Shaohua researches for Women Empowerment organizations and participates in Self-Defense courses in the hopes of achieving Gender Equality.
She can be contacted at email@example.com and in through LinkedIn
*Please note that all opinions expressed in this article are those of the author only and do not represent the official position of the University for Peace