How to support Chinese students’ mental health
As part of Mental Health Awareness Week (10-16 May), Bernadette Cochonat has compiled a comprehensive explainer about the factors shaping Chinese students’ perceptions of, and attitudes towards, mental health; some of the key stresses they face and how to effectively support them through these.
A short history of mental health in China
Popular religions such as Buddhism and Taoism, and philosophical beliefs such as Confucianism, encourage people to live in harmony with nature and society. They encourage a strong sense of duty where each member of society must not bring shame to their family, but must display outstanding behaviour and work hard to make their family proud. Under these beliefs, people are not encouraged to bring attention to themselves or complain about their fate. Acknowledging a mental health issue can be considered a sign of weakness.
This stigma often leads many people in China to not talk about their mental health issues. Mental health discrimination is persistent. People with acute mental health issues prefer to ignore the symptoms - as do their relatives - while people with more complex mental health disorders tend to be inpatients of specialised institutions and live outside society. Change is starting to happen, with healthcare increasingly a national priority and ambitious plans in place to get treatment to at least 80% of patients suffering from depression, but there will be challenges to achieving this: training professionals, putting infrastructure in place to support treatments, and changing perceptions of mental health in society.
Pressure from family and society
With a population of almost 1.4 billion people, competition in schools, universities and the workplace is fierce in China, and the legacy of the one-child policy puts a huge burden on children’s shoulders. Each child grows up with the understanding that to support their family as an adult, they will have to secure a job with a good salary; they will also get married, buy a house and car, and have children before they reach the age of 30.
Family and societal pressure dictates this strict agenda and individuals are expected to fulfil these duties, leaving very little room for error, gap years, or exploring different paths to discover oneself. This also puts great financial and psychological pressure on the parents, who feel they have to push their children to be the best: parents follow their children’s progress and grades very closely, and often register their children for multiple extracurricular activities to optimise their chances of success.
The most pressured year is the year that students take the gaokao (China’s A-level equivalent). The gaokao is one of the most difficult and stressful exams in the world, with results that determine whether students are eligible to attend university, where demand for places is also competitive. The pressure on students and the impact on their mental health cannot be underestimated.
Supporting Chinese students in the UK
The first challenge for organisations working to support Chinese students’ mental health is communicating in a way that makes them feel comfortable engaging with the available support services.
1. Friends and influencers are trusted sources
The video Are you OK? is part of a campaign promoting mental health awareness. It’s designed not just for those who are struggling, but for everyone who knows someone who is struggling, encouraging them to reach out simply by starting a conversation with “Are you OK?” It highlights a very important point: being away from their family, Chinese students need to create a support network during their time in the UK, as they are more likely to share their thoughts and worries with their peers rather than seeking help through a more formal channel.
They are also more likely to trust recommendations via channels they know and trust. Red Scarf is a famous influencer on Chinese social media, posting content for students coming to the UK, and recently published an article  to advise students what to do if they experience mental health issues in the UK. It encourages students who feel anxious or stressed to acknowledge these symptoms and seek professional help before it gets worse, listing support services such as Nightline, Samaritans, Student Minds, university counselling services and the NHS.
2. Simple strategies can effectively demonstrate why students should seek help
A successful strategy can be to share with Chinese students ‘case studies’ of famous people who have experienced mental health difficulties, acknowledged the issue, and treated it so that it didn’t interfere with their life or success. For example, Winston Churchill suffered from depression, which he referred to as his ‘black dog’. He accepted that while his mental health fluctuated, it was a risk, and he had to seek help when that risk came closer.
Seeing mental health issues as a ‘black dog’ makes it easier to visualise the problem and formulate a plan with a set of actions to ‘tame’ the dog and learn to live with it. The World Health Organisation illustrated this with an animated video (available here in Chinese) for World Mental Health Day 2014.
3. Alternative routes to addressing and looking after wellbeing are worth exploring
Studies done  in Vancouver on Chinese residents found that their first point of contact for mental health issues was their family circle, then friends, and then traditional specialists or religious healers - specialist treatment and services came in fourth place. It was also found that Chinese patients with mental health issues report more physical symptoms than psychological symptoms in comparison to patients from other countries; for example, they will mention fatigue or muscle aches instead of describing how they feel.
Given that Chinese people are less likely to use professional support services or communicate about their emotions, and would rather look to alternative pathways, it may be easier to win the trust of Chinese students by directing them to practices they are more familiar with. These could include yoga, meditation or Chinese medicine such as acupuncture. Helping students to get into a positive daily routine with activities such as regular exercise can also be effective.
It’s important to acknowledge that most Chinese students coming to the UK have not lived away from their parents before. This means they have to deal with emotional separation, cultural differences and language barriers in addition to the usual challenges of the transition to university, which can be a lot to take on all at the same time. It's part of the reason why our Beijing team's expertise is so valuable in helping Chinese students to prepare for their move to the UK.
Chinese families tend to be overprotective of their children even when they are grown up, and often prepare their meals, clean their room and do their laundry so that they can fully focus on their studies. Once students have to deal with all these chores themselves in addition to their studies, they can find it overwhelming and start neglecting their health, eating fast food and getting stressed.
4. Knowledge is power: Use resources to increase understanding of mental health
Chinese students are keen learners, and so it is important to communicate accurate facts and debunk myths around mental health. UK universities and accommodation providers can inform and educate students to increase their awareness of mental health issues and learn to identify the signs of mental ill-health, not only for themselves, but for their friends as well.
Sharing and promoting resources can be a great way to destigmatise mental health issues and normalise the concept that everyone has mental health, and anyone can experience mental health issues. The World Health Organisation has created several posters called ‘Let’s talk about depression’ both in English and Chinese, the Chinese versions of which you can download here and here (English translations available respectively here and here).
Despite cultural differences which sometimes make it challenging to support Chinese students’ mental health issues, it’s important to keep communicating about it. It is not a topic that they are used to hearing about, and it is unlikely that their previous schools or universities in China proactively engaged with students about it. The most important thing is to educate, share facts and demystify mental health, making it a topic accessible to everyone.
As traditional support services are not necessarily the channel that Chinese students will go to for help, universities, accommodation providers and other organisations looking after Chinese students need to be creative and possibly rethink their approach. Consider how to increase awareness amongst students - with Chinese student ambassadors, for example - so that they can support each other better, and give them the tools they need to both identify if their peers are struggling, and guide them towards appropriate channels.
For Mental Health Awareness Week, we’re running a new blog every day this week from Monday to Friday, focusing on a different aspect of mental health and wellbeing in the Higher Education sector. Head here to see all of our Mental Health Awareness Week content.
If you need support, don't suffer in silence. The Mental Health Foundation has a list of resources and suggestions available here.