Mental health assessments will be added to compulsory health examinations for high school students and college-bound graduates, China’s top health authority said Friday. The new policy has incited wide discussion in the days since it was announced, much of it centering around privacy concerns and potential discrimination.

In the guideline on “preventing and treating the country’s depression issue” — in teenagers, the elderly, people working in high-stress environments, and women who were pregnant or recently gave birth in particular — the National Health Commission said a “depression assessment” will be added to health exams administered annually at domestic high schools. The notice added that schools should “establish student mental health files” and “pay special attention to students with abnormal evaluation results.”

While the guideline calls for similar measures at universities, it is unclear how they would be implemented since tertiary institutions don’t have the same standardized annual health exams as high schools.

The guideline is aiming to alleviate depression nationwide. According to the Chinese Center for Disease Control and Prevention, the country had over 173 million people with some form of mental health issue in 2015 — the last year for which official data could be found — and 2% and 5% of the overall population had depression and anxiety, respectively.

According to research from 2016 that analyzed 39 studies conducted between 1997 and 2015, the prevalence of depression in over 32,000 Chinese university students surveyed was nearly 24%. Last year, a domestic media outlet’s poll on microblogging platform Weibo showed similar results, with 27.6% of over 312,000 respondents reporting “serious depression.” Meanwhile, under COVID-19, the situation only seems to have gotten worse.

Although the new guideline brings much-needed recognition to mental illness in China, as well as the government’s heightened attention to a long-neglected issue, some experts are questioning whether the plan may have concerning applications, potentially leading to young people with mental health issues being “outed” and discriminated against.

“What does ‘special attention’ mean?” wrote Zhang Jin, director of mental health platform Duguo, or Getting Through It. “I’m very worried that some schools might put labels on students who test ‘abnormal’; bar them from group activities and exams; omit their test scores from official averages; or even ask them to leave the school.”

It’s this fear of discrimination that causes so many students to hide their mental health issues, Zhang told Sixth Tone. “They’re afraid people will look at them differently,” he said.

Zhang isn’t the only prominent figure in the mental health field to raise concerns about the NHC’s initiative. Sciencecat, a blogger who posts about mental health to her more than 10,000 followers on Douban, another Chinese social network, doesn’t trust education institutions to protect students’ privacy, given the many complaints she has received from students after meeting with their school counselors.

“The counselor often tells the student’s parents and teacher about the issue even when it’s a non-emergency. This contravenes the principles of mental health care,” Sciencecat told Sixth Tone, adding that such services should aim to help students rather than monitor or control them.

According to the mental health blogger, students’ traumatic stories have instilled in her a deep sense of disillusionment with schools’ mental health services.

“One student from Tsinghua University told me that although the school offered to cover 90% of her medical expenses, she opted to pay full price at hospitals for fear of her personal information being leaked, and her being monitored by school administrators.”

Liang Lingyan, director of the Shanghai-based mental health center Know Your Heart, told Sixth Tone that in practice, many schools have been evaluating students’ mental health for the past decade or more. According to her, school counselors will usually reach out to students whose psychological evaluations point to depression.

“There is no such thing as a perfect policy. The important thing is how it’s implemented — such as whether education authorities hire professionals,” said Liang, who has 16 years of experience as a mental health counselor to university students. “For us, we will never reveal the student’s information unless there are suicidal thoughts or other criminal concerns.”

Liang stressed the importance of schools enlisting specialists to evaluate students’ mental health.

“If students are bullied or have issues with teachers, then a third party would be a better choice (than an in-house counselor),” Liang said, alluding to a potential conflict of interest. “For example, in some countries, student counseling services are contracted out to third-party organizations.”

A Beijing-based counselor with three years of experience at one of China’s top universities told Sixth Tone that although he believes the NHC’s initiative is good-intentioned — especially as a response to a spate of teen suicides during the pandemic — he also understands people’s concerns.

“As therapists working in schools, we’re often faced with a dilemma: On one hand, the school wants to strengthen management and control; on the other hand, students want their privacy protected,” said the counselor, who agreed to be interviewed on condition of anonymity due to the sensitivity of the matter. “Professional staff must strike a delicate balance between the two — that is, keeping in line with school policy without violating students’ trust.”

Editor: David Paulk.

(Header image: E+/People Visual)