Utilization and Stakeholders’ Perceptions of Mental Health Service in Middle Schools in China: Evidence From a Middle School in Beijing

Abstract

Background: Worldwide, children and adolescents' mental health problems are becoming increasingly serious, and the topics related to these issues are receiving more and more attention. Many countries and organizations are committed to promoting and protecting children’s mental health, with the provision of school-based mental health services as an essential part of the process. Since the 1980s, China has also been concerned about students' mental health, and subsequently has issued many relevant policy and guidance documents. Many schools have also provided mental health services. However, currently, there is no national standard or operational model for school psychology and counseling, and no survey of the demand for school mental health services from various stakeholders. Therefore, this study has three aims: 1) to understand current mental health services that the school provides to their students; 2) to explore middle school students’ demand for school-based mental health services from different stakeholders; and 3) to investigate the challenges or difficulties that the school face to provide the services.Methods: This study was conducted in a middle school in Beijing. Two questionnaires were collected from 199 students and 145 parents, respectively, and three teachers were interviewed, which included their attitudes toward mental health, knowledge and satisfaction with current in-school mental health services, and expectations and suggestions for such services in the future. Referring to the questionnaires and interview outlines used by previous researchers, the research team created separate student and parent questionnaires. After analyzing the data, the interview outline was modified. For the student questionnaires, we focused more on the types of problems the students thought they needed counseling for. For the parent questionnaire, a logistics regression was done to see if parents' demographic characteristics had an impact on their attitudes toward school-based mental health services. For the qualitative analysis, we used thematic analysis to check, code, and identify themes in the interview scripts. Results: Currently, this school has dedicated mental health facilities. The school-based mental health services include mandatory mental health classes for Grades 6 and 7, annual psychological assessment since Grade 5 to record in student psychological profile, counseling, and a crisis intervention system. Students can make appointments with counselors through their course selection platform, but only 31 students had taken or were taking the counseling. However, 80.40% of the students believed that people should take counseling when facing mental health problems. All parents and teachers have a positive attitude toward mental health and the services. 64.83% of the parents knew that the school provided counseling for students. 81.91% of students believed that counseling services should provide understanding and support, as well as professional guidance and advice for students, and 53.10% of parents hoped that it could provide professional suggestions and guidance for their children. For the type of counseling problems, more than 50% of the students want to counsel about study-related issues. Only 1/4 of the students expressed the need for referral services to be provided, but all teachers agreed on the need. Challenges to school-based mental health services, teachers said that more and more students would have mental problems due to high social pressure and competition; there is not enough public education on mental health; and there is a lack of professional mental health teachers and a lack of follow-up training. Conclusion: The school currently provides a relatively comprehensive package of mental health services, but the suggestions and challenges raised by students, parents and teachers should be studied and resolved promptly by the school and relevant departments. Future research should dig deeper into the reasons for the changes in students' mindsets and discussions on the establishing a referral system.