Perspectives: The Role of Peer Support in Promoting Mental Health of Chinese Adolescents

The importance of mental health in children and adolescents cannot be overstated, given its potential for reversibility and its tendency to present in clusters. Peer support is critically important in addressing the mental health needs of adolescents, as supported by current data and evidence.

Peer support among adolescents, initially introduced in the 1970s in the United States as an innovative method to enhance mental health and well-being, has expanded globally. This approach gained traction in Canada and Australia during the 1980s and is now employed in numerous countries, including the United Kingdom (UK), Italy, Spain, Finland, Japan, New Zealand, Saudi Arabia, Norway, the Netherlands, and South Africa (1). In 2005, Street and Herts articulated a comprehensive definition of peer support as “using the knowledge, skills, and experience of children and young people in a planned and structured way to understand, support, inform, and help develop the skills, understanding, confidence, and self-awareness of other children and young people with whom they have something in common” (2).

The concept of “peer support” encompasses various activities, and its benefits for children and adolescents are extensively recognized, particularly in academic environments. While traditionally centered on academic assistance within educational frameworks, the scope of peer support has shown wide-ranging positive impacts. For instance, in the UK, peer tutoring is advocated by the Education Endowment Foundation (EEF) Teaching and Learning Toolkit (3).

The available evidence supporting peer support programs aimed at enhancing mental health and well-being among children and adolescents remains limited. However, a meta-analysis conducted by Podmore et al. (4) identified the characteristics of successful mentoring and peer support programs that support well-being in these groups, and help prevent emotional and behavioral challenges. Research by James (5) found that peer leaders not only embraced healthier coping attitudes and norms but also established stronger connections with adults. They were four times more likely to refer peers to adults after participating in a peer support program. Additionally, James (5) highlighted that increased willingness to seek help and improved protective factors positively influence the school environment, consequently reducing the risk of suicide. During the coronavirus disease 2019 (COVID-19) pandemic, Pavarini et al. (6) observed that peer support training led to noteworthy benefits for young individuals, including improved capabilities in aiding others, better mental health and well-being, and enhanced agency, marked by increased self-efficacy and civic engagement. These findings underscore the potential of peer support programs to foster positive mental health outcomes among youths, especially during crisis periods.

Numerous international organizations have introduced peer support programs targeting adolescent mental health, which have demonstrated a variety of beneficial effects. The “Source of Strength” program, for example, leverages peer social networks to foster healthy norms and cultures aimed at preventing suicide, violence, bullying, and substance abuse (7). This initiative thrives on principles of diversity, inclusivity, and collaboration, involving both adult counselors and youth peer leaders in efforts to cultivate positive social norms and cultural transformations.

Another initiative, “I Support My Friends,” (8) is aimed at equipping children and adolescents aged nine and above with the skills and knowledge necessary to provide support based on the principles of psychological first aid (PFA) (9). This program emphasizes the importance of observing, listening, and connecting or referring individuals to more specialized support when necessary.

These international examples offer valuable insights for projects in China. Additionally, it is crucial to explore ways to implement peer support initiatives for adolescent mental health that are tailored to the specific conditions of China.

The mental health issues among children and adolescents in China are increasingly recognized. Although numerous studies have focused on mental health within higher educational institutions, research on peer support for adolescent mental subdivisions remains insufficient.

In China, the initiation of peer support for mental health primarily originated within colleges and universities. Dong Xue et al. (10) noted that Tianjin University was the first to propose and implement a crisis intervention rapid response mechanism centered on peer support in 2004. Following this, other educational entities progressively developed peer education programs. Over time, these frameworks have evolved and have been incorporated into various educational institutions across China.

Recent progress has been made in the domain of adolescent mental health peer support in China, guided by the National Health Commission and United Nations International Children's Emergency Fund and implemented by the National Center for Mental Health. The Adolescent Mental Health Development Project seeks to amalgamate international experiences to enhance technical support for adolescent mental health, with substantial contributions from Peking University in research and content development.

The objectives of the project are to develop essential peer support technologies, training programs, and organizational management processes customized for China’s specific context. The aim is to bolster the knowledge and skills of peer supporters by creating an extensive peer support network. This network will encompass several mediums such as student associations, radio stations, social media platforms, youth centers, and homes. These platforms will play a crucial role in raising mental health awareness among adolescents, promoting engagement with and use of mental health services both in and outside school settings.

The peer support initiative seeks to extend its coverage to 100 schools across 10 provincial-level administrative divisions (PLADs) in China. Within these regions, both adolescent and adult peer supporters will be recruited to develop a peer support network. Objectives include training at least 1,000 adolescent peer supporters in pilot schools and ensuring that a minimum of 80% of these schools implement a peer support system for adolescent mental health.

Peer support for adolescent mental health presents unique aspects distinct from other age groups. Critical characteristics to consider include: First, case studies should be rooted in the typical issues and situations faced by adolescents, redesigned with their input to maintain authenticity and relevance. Second, educational methods should focus on fostering inspiration, interaction, and independent thought. Third, a diverse range of activities should be implemented to enhance mental health within schools. Paramount to these efforts is the commitment to adhering to child and adolescent protection principles, thereby ensuring their safety.

This new strategy for adolescent mental health peer support emphasizes the roles of both adolescent peer supporters and their adult counterparts. It includes resources specifically designed for the Chinese context, such as a Theory and Implementation Guide, a Work Manual for Adolescent Mental Health Peer Supporters, and a Work Manual for Adult Supporters. Critical skills for adolescent peer supporters — observing, listening, and linking — are highlighted. These skills, essential for conducting advocacy activities on campus, will be developed under the guidance of adult supporters, as illustrated inFigure 1.

Figure 1.

Adolescent mental health peer support toolkits.

Currently, the primary challenges encountered in peer support work for adolescent mental health include a limited understanding and recognition of the peer support concept within societal contexts. Additionally, there is a deficiency of holistic technical strategies and authoritative institutions to back this concept. Moreover, the effective implementation of peer support programs for adolescents necessitates collaboration across multiple sectors, particularly health and education.

Strengthening certain aspects can significantly improve adolescent mental health. It is crucial to acknowledge that peer support is beneficial not only for the recipients but also for the providers. Engaging in peer support allows adolescents to reinforce their knowledge and fosters a heightened sense of responsibility and personal growth. Overall, peer support offers valuable benefits to educational environments and positively influences the lives of young people.

The future of adolescent mental health peer support, both internationally and domestically, appears promising. As societal focus on the well-being of youth intensifies, there is an anticipated increase in demand for innovative methods to meet their mental health requirements. Adolescent mental health peer support offers a distinctive avenue for young individuals to engage with peers who share similar experiences and provide meaningful support and guidance.

Adolescent mental health is essential for overall human health and crucial for enhancing population quality. Consequently, fostering a supportive social environment that prioritizes adolescent mental health is imperative. Advancing key technologies to enhance adolescents’ mental well-being and maximizing the benefits of peer support represent promising future directions.

No conflicts of interest.