Mental health in Chinese schools [electronic resource] : adapting global paradigms in policy and practice
Keywords: Education.

Mental health is an urgent global health challenge, and schools worldwide are increasingly tasked with promoting child and adolescent psychological well-being. In China, policymakers and practitioners have collaborated with institutions such as the World Health Organization to design school-based mental health education programs. This requires navigating tensions between global and local discourses of mental health, and evidence suggests disparities between policy rhetoric and the reality of practice in schools. In this multi-level, mixed-methods study, I employed a combination of complementary theoretical approaches to explore the emergence of mental health education in China since the 1990s, with the aim of linking the macro-sociological processes described by institutional theory with the micro-level processes described by structuration theory. I first conducted a comparative content analysis of WHO publications on mental health and Chinese national mental health education policy documents, to explore how paradigms from global mental health discourse are encoded in Chinese national policies. Second, I interviewed students in the psychology and education departments of a Beijing university to investigate how policy-level paradigms are enacted by school counselors in training as they develop their practices and professional identities. Finally, I conducted a mini-case study at a Beijing middle school to understand how teachers and counselors navigate tensions between new and traditional educational paradigms during the process of piloting a progressive model of mental health education. I found that certain global paradigms of mental health were also pervasive in Chinese education policy and practice. This included an emphasis on individual adaptive development, which mirrors broader movements towards individualism in Chinese education reform. In other areas, China's policy discourse diverged from global paradigms. For instance, while Chinese policy documents espoused a scientific approach to mental health education that resembled global discourse, clinical terms were rarely used to describe mental health problems among adolescents. The absence of scientific language at the policy level echoed a tendency for schools to overlook the importance of hiring professional, trained mental health educators with backgrounds in psychology, which emerged during interviews with school counselors in training. Highly trained school counselors, therefore, struggled with managing their career aspirations in an educational climate that challenged the professional legitimacy of their occupational status. In addition to areas of discursive convergence and divergence, instances of discursive transformation also emerged. For example, while global mental health discourse stressed equity, social justice and human rights, Chinese national policy documents avoided those terms and focused more on the importance of mental health for individual outcomes and national development objectives. However, during interviews, I found that school counselors actually engaged deeply with themes of equity and social justice as they discussed the issues of stigma, shame and exclusion that surround mental health problems in Chinese society. Meanwhile, the idea of morality was absent from the global mental health discourse, but emerged as a particularly complicated feature of mental health education in China. National education policies promote integrating mental health education into existing moral education departments and curricula, but the school counselors I interviewed struggled to reconcile the principles of moral education with their professional training in mental health. Many expressed the feeling that moral education was more suitable for teaching "right and wrong" as opposed to helping students make individual adaptive choices, while at the same time expressing the belief that separating mental health and moral education would be impossible in China. Meanwhile, I found in my school case study that when challenged to implement a progressive model of mental health education, many teachers embraced the innovative subject matter while simultaneously enacting more traditional forms of pedagogy that resembled those of moral education. A persistent theme that emerged throughout the study was the conceptual struggle between rights and duties. While global mental health discourse is driven by the concept of rights, the Chinese educational landscape retains a historically rich tradition of emphasizing duty, which pervades both mental health and moral education discourse. I suggest that for mental health education to become an institutionalized feature of Chinese schooling, moral education and the notion of duty must be negotiated as an entry point. Moral education is a long-established component of Chinese schooling, and enacting mental health policy recommendations will likely depend on delineating the objectives of mental health and moral education, while establishing ways for the two types of education to coexist effectively in schools. This process happens organically to a certain extent in school settings, where educators find ways to localize externally imposed models of mental health education, but the process can leave both counselors and educators feeling confused about the results and unsatisfied with their level of success. Mental health continues to grow as an urgent global health concern. Policymakers and professionals in diverse settings will increasingly face the challenges of adapting global paradigms of mental health to develop educational policy and models that work in local contexts. Schools will continue to be important settings for this work, and understanding how to navigate conflicting features of the discursive terrain can help educators in China and other countries develop mental health education programs that embrace innovation while honoring tradition.