Policy Notes: Comprehensively Strengthen and Improve Students’ Mental Health System in the New Era

Mental health issues profoundly impact children and adolescents’ development. In 2019, the global count of individuals suffering from mental disorders was approximately 970 million, with prevalence rates for children aged 5–9 and adolescents aged 10–19 years estimated at 8% and 14%, respectively (3). A comprehensive psychiatric survey in China indicated that the prevalence of various mental disorders among children and adolescents aged 6–16 years was 17.5% [95% confidence interval (CI): 17.2, 18.0] (4). Globally, the 12-month prevalence of non-suicidal self-injury (NSSI) in this demographic was about 19.5% (5). High academic demands and psychological stress among students notably contribute to increasing mental health challenges such as depression and suicide, posing significant risks to adolescents’ well-being. A study involving 15,623 high school students in rural China revealed a 29.2% incidence of NSSI in the preceding year (6). These disorders also impose substantial economic burdens; in 2017, the total cost attributed to mental disorders in children and adolescents was estimated at 1.191 billion United States dollar (USD), with a direct cost of 565 million Chinese Yuan (CNY) (7). The mental health of children and adolescents in China is a critical public health issue with far-reaching implications for the nation’s future (4,8). Accelerated social changes and evolving living conditions, compounded by the effects of the coronavirus disease 2019 (COVID-19) pandemic, have exacerbated these challenges. The implementation of the Special Action Plan is crucial as it not only tackles the current mental health issues but also aims to establish a robust, multi-tiered mental health support framework. It is essential for the government and societal sectors to proactively develop and enforce policies that address these emerging challenges.

The Special Action Plan, initiated under the Chinese Ministry of Education and endorsed by 17 government departments, including the Health Commission, the Ministry of Science and Technology, the Ministry of Public Security, and the Ministry of Finance, is a crucial initiative critical in shaping both policy and practice. The development of the Special Action Plan progressed through four major phases: initial investigation and research, strategic plan drafting, thorough expert debate, and the iterative solicitation of feedback for continual improvement.

In an effort to thoroughly understand the contemporary status of student mental health within China, the Ministry of Education launched an extensive survey project in September 2021. This project, particularly focused on monitoring and surveillance of mental health quality within the framework of national compulsory education (9), employed diverse methodologies including questionnaires and interviews. These questionnaires and interviews involved a broad array of stakeholders, such as students, parents, teachers, mental health educators, and school principals, thereby providing crucial insights. With data and feedback from these extensive surveys, the Ministry of Education refined the Plan’s guiding ideologies, operational principles, goals, methods, and protective strategies, leading to the creation of the “Draft for Comments”. Following this, the Ministry organized multiple symposiums to discuss student mental health, involving prominent experts for the thorough evaluation and further refinement of the draft. The Ministry also actively sought input from relevant governmental agencies including the Health Commission and the Ministry of Public Security. Through detailed research and the integration of various perspectives, the Special Action Plan was iteratively revised and enhanced, ultimately leading to a finalized version ready for distribution and execution.

In October 2016, the Communist Party of China (CPC) Central Committee along with the State Council released the “Outline of the Healthy China 2030 Plan”. This plan underscored the urgent need to improve and standardize the mental health service system. Following this, 12 departments, including the National Health Commission and the Ministry of Education, jointly introduced the “Healthy China Action Plan for Children and Adolescents’ Mental Health (2019–2022)”. This initiative detailed six strategic actions aimed at bolstering mental health in children and adolescents, in accordance with the broader goals of the Healthy China Plan.

The Special Action Plan is designed to significantly enhance mental health initiatives for students in the contemporary era. It highlights the importance of cooperation among government bodies, educational institutions, families, and the community in building an extensive, layered mental health support network. This joint effort is intended to create an environment that promotes students’ mental health literacy and contributes to the broader goal of social harmony and stability. The Special Action Plan adheres to an educational philosophy that places a high priority on health, advocating for the comprehensive development of students. It specifically delineates eight principal tasks and introduces twenty-two detailed measures, as presented inTable 1, to effectively execute and fulfill its goals.

The Special Action Plan, situated within the principles of the contemporary era, emphasizes the critical importance of school health initiatives in bolstering student mental health. Building on foundational recommendations for child and adolescent mental health, the Special Action Plan underlines the essential role educational institutions — colleges, middle schools, and primary schools — play in the educational system. Key responsibilities highlighted include monitoring, early warning systems, psychological counseling, and intervention for students. The plan advocates for comprehensive school-based mental health education, which includes providing operation guides on common psychological issues to parents, principals, teachers, counselors, and other stakeholders, as well as implementing national mental health days for college and middle school students. It also recommends regular mental health classroom instruction and psychological assessments, suggesting that students at various educational levels undergo at least one mental health evaluation annually and that a mental health record be established for each student. Overall, the Special Action Plan offers detailed and systematic recommendations aimed at ensuring the provision of high-quality mental health services within schools.

The Special Action Plan introduces an innovative initiative by recommending the incorporation of psychological peer supporters into high school and college curricula. This represents the first time that the concept of peer support has been formally integrated into a national strategy. Peer support entails the deliberate use of the knowledge, skills, and experiences of children and adolescents organized to aid the development of others with similar experiences (10). Research has shown that adolescents spend nearly one-third of their leisure time interacting with peers (11), underscoring the significant influence that peer support can have on student development. The COVID-19 pandemic prompted countries, including China, to implement isolation measures that effectively contained the virus spread but also posed complex challenges to mental health. Studies have demonstrated a correlation between adolescents’ social isolation during the pandemic and an increase in psychological problems such as social anxiety and depression (12). Recognizing the importance of peer support, various domestic and international organizations have launched programs targeting adolescent mental health, resulting in successful outcomes as evidenced by initiatives like the “Sources of Strength” project and the “I Support My Friends” campaign. As an emerging strategy for promoting well-being, peer or support is expected to play a vital role in the future development of adolescent mental health.

The primary aim of the Special Action Plan is to create a comprehensive “four-in-one” system for student mental health, which includes health education, monitoring, counseling, and intervention measures. This strategy intends to strengthen collaboration between schools, families, the broader community, and pertinent governmental departments. By 2025, the objective is to ensure that 95% of schools are equipped with either full-time or part-time professional mental health educators, and 60% of family education guidance service stations actively participate in mental health education initiatives.

The Special Action Plan prioritizes the psychological needs of Chinese students and emphasizes strengthening organizational leadership. Its objective is to enhance the students mental health working mechanism through interdepartmental collaboration, social engagement, and nationwide involvement. The plan details strategic initiatives for mental health development, ranging from comprehensive planning to detailed implementation. Further strengthening of the plan was achieved through the Ministry of Education’s endorsement on November 6, 2023, via the “Notice on the Establishment of the National Student Mental Health Advisory Committee”. This Committee is charged with significant duties including research, consultation, monitoring, evaluation, outreach, and guidance pertaining to the national mental health programs across universities and schools. At its inaugural plenary meeting on March 21, 2024, the Committee announced that China will develop a cohesive national system for student mental health monitoring and early warning. Its goal is to unequivocally enhance the mental health capabilities of students and advocate for mental health education in this new era and journey. These efforts aim to provide robust organizational support and ensure the effective execution of the Special Action Plan.

The Special Action Plan emphasizes the importance of enhanced coordination at the local level, advocating for comprehensive planning and the optimization of financial structures. It highlights the critical need to secure substantial funding for student mental health initiatives and encourages active support from social organizations. After a practical implementation phase, the plan proposes the creation of master and principal studios for student mental health education, aimed at nurturing and sharing effective practices. Additionally, educational and health management departments at all levels are urged to seamlessly incorporate the plan’s principles into routine activities and school governance. By prioritizing student mental health, these departments are instrumental in promoting students’ overall development.