A Brief Outline of Online Mental Health Services in China During the COVID-19 Outbreak

Research Paper Title

Online Mental Health Services in China During the COVID-19 Outbreak.


At the start of 2020, the 2019 coronavirus disease (COVID-19), originating from Wuhan in Hubei province, started to spread throughout China. As a result of the rapidly increasing numbers of confirmed cases and deaths, both medical staff and the public have been experiencing psychological problems, including anxiety, depression, and stress. Since January 2020, the National Health Commission of China have published several guideline documents, starting with the notification of principles for emergency psychological crisis intervention for the COVID-19 epidemic on 26 January, then the notice on establishing psychological assistance hotlines for the epidemic on 02 February, and most recently, guidelines for psychological assistance hotlines during the COVID-19 epidemic on 07 February 7.

During the severe acute respiratory syndrome epidemic in 2003, internet services and smartphones were not widely available. Therefore, few online mental health services were provided for those in need. The popularisation of internet services and smartphones, and the emergence of fifth generation (5G) mobile networks, have enabled mental health professionals and health authorities to provide online mental health services during the COVID-19 outbreak. Fast transmission of the virus between people hinders traditional face-to-face psychological interventions. By contrast, provision of online mental health services is safe. To date, several types of online mental health services have been implemented widely for those in need during the outbreak in China.

Firstly, as of 08 Febreuary 2020, 72 online mental health surveys associated with the COVID-19 outbreak could be searched for via the WeChat-based survey programme Questionnaire Star, which target different populations, including medical staff (23 of the surveys), patients with COVID-19 (one survey), students (18 surveys), the general population (nine surveys), and mixed populations (21 surveys); in Hubei province (five surveys), other provinces (15 surveys), all provinces, municipalities, and autonomous regions (36 surveys), and unspecified areas of China (16 surveys). One such multi-centre survey involving 1563 medical staff, with the centre at Nanfang Hospital, Southern Medical University (Guangzhou, China) as one of the study sites, found the prevalence of depression (defined as a total score of ≥5 in the Patient Health Questionnaire-9) to be 50·7%, of anxiety (defined as a total score of ≥5 in the Generalized Anxiety Disorder-7) to be 44·7%, of insomnia to be 36·1% (defined as a total score of ≥8 in the Insomnia Severity Index), and of stress-related symptoms (defined as a total score of ≥9 in the Impact of Events Scale-Revised) to be 73·4%. These findings are important in enabling health authorities to allocate health resources and develop appropriate treatments for medical staff who have mental health problems.

Secondly, online mental health education with communication programmes, such as WeChat, Weibo, and TikTok, has been widely used during the outbreak for medical staff and the public. In addition, several books on COVID-19 prevention, control, and mental health education have been swiftly published and free electronic copies have been provided for the public. As of 08 February, 29 books associated with COVID-19 have been published, 11 (37·9%) of which are on mental health, including the “Guidelines for public psychological self-help and counselling of 2019-nCoV pneumonia”, published by the Chinese Association for Mental Health.

Finally, online psychological counselling services (eg, WeChat-based resources) have been widely established by mental health professionals in medical institutions, universities, and academic societies throughout all 31 provinces, municipalities, and autonomous regions in mainland China, which provide free 24-h services on all days of the week. Online psychological self-help intervention systems, including online cognitive behavioural therapy for depression, anxiety, and insomnia (e.g. on WeChat), have also been developed. In addition, several artificial intelligence (AI) programmes have been put in use as interventions for psychological crises during the epidemic. For example, individuals at risk of suicide can be recognised by the AI programme Tree Holes Rescue, by monitoring and analysing messages posted on Weibo, and alerting designated volunteers to act accordingly.

In general, online mental health services being used for the COVID-19 epidemic are facilitating the development of Chinese public emergency interventions, and eventually could improve the quality and effectiveness of emergency interventions.


Liu, S., Yang, L., Zhang, C., Xiang, Y., Liu, Z., Hu, S. & Zhang, B. (2020) Online Mental Health Services in China During the COVID-19 Outbreak. Lancet Psychiatry. 7(4), pp.e17-e18. doi: 10.1016/S2215-0366(20)30077-8. Epub 2020 Feb 19.

Book: The Big Disconnect – Protecting Childhood And Family Relationships In The Digital Age

Book Title:

The Big Disconnect – Protecting Childhood And Family Relationships In The Digital Age.

Author(s): Catherine Steiner-Adair.

Year: 2013.

Edition: First (1st).

Publisher: Harper.

Type(s): Hardcover and Paperback.


Clinical psychologist Catherine Steiner-Adair takes an in-depth look at how the Internet and the digital revolution are profoundly changing childhood and family dynamics, and offers solutions parents can use to successfully shepherd their children through the technological wilderness.

As the focus of the family has turned to the glow of the screen – children constantly texting their friends or going online to do homework; parents working online around the clock – everyday life is undergoing a massive transformation. Easy access to the Internet and social media has erased the boundaries that protect children from damaging exposure to excessive marketing and the unsavoury aspects of adult culture. Parents often feel they are losing a meaningful connection with their children. Children are feeling lonely and alienated. The digital world is here to stay, but what are families losing with technology’s gain?

As renowned clinical psychologist Catherine Steiner-Adair explains, families are in crisis as they face this issue, and even more so than they realise. Not only do chronic tech distractions have deep and lasting effects but children also desperately need parents to provide what tech cannot: close, significant interactions with the adults in their lives. Drawing on real-life stories from her clinical work with children and parents and her consulting work with educators and experts across the country, Steiner-Adair offers insights and advice that can help parents achieve greater understanding, authority, and confidence as they engage with the tech revolution unfolding in their living rooms.

Education: Text-based Coaching Protocols for Digital Mental Health Interventions

Research Paper Title

Guidance on defining the scope and development of text-based coaching protocols for digital mental health interventions.


A body of literature suggests that the provision of human support improves both adherence to and clinical outcomes for digital mental health interventions.

While multiple models of providing human support, or coaching, to support digital mental health interventions have been introduced, specific guidance on how to develop coaching protocols has been lacking.

In this Education Piece, the authors provide guidance on developing coaching protocols for text-based communication in digital mental health interventions.

Researchers and practitioners who are tasked with developing coaching protocols are prompted to consider the scope of coaching for the intervention, the selection and training of coaches, specific coaching techniques, how to structure communication with clients and how to monitor adherence to guidelines, and quality of coaching.

Their goal is to advance thinking about the provision of human support in digital mental health interventions to inform stronger, more engaging, and effective intervention designs.


Lattie, E.G., Graham, A.K., Hadjistavropoulos, H.D., Dear, B.F., Titov, N. & Mohr, D.C. (2019) Guidance on defining the scope and development of text-based coaching protocols for digital mental health interventions. Digital Health. doi: 10.1177/2055207619896145. eCollection 2019 Jan-Dec.