China’s middle class is stressed. Can its growing mental health industry lend a helping hand?


In the past few years, psychological counsellor Huang Jing has watched her business thrive.

With any other industry, that would be cause for celebration – China has made private enterprise a priority as it pushes for sustained economic recovery – but a higher demand for mental health services carries other, more troubling implications.

Huang set up her first counselling company, Better Family, in Shanghai in February 2022 – not long before the city’s notorious two-month lockdown began. Business recovered quickly when quarantine lifted in June, and her practice broke even three months later. Six months after that, she opened two more offices there.

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Now, she has expanded to Hangzhou, operating three offices in the Yangtze Delta tech hub.

The rapid growth in businesses like Huang’s, lucrative though it may be, reflects a rise in conditions like anxiety and depression among the public – including the middle class, widely regarded as foundational to China’s economic growth and social progress.

“People cannot help but wonder why the Chinese economy has ground to a halt,” she said. “We’ve seen a sea change in the property market, disillusionment of young people, and, particularly, mountains of pressure from parents: to make money, save money, rigid education [standards] and dim outlooks for their children’s future.”

The World Health Organization has estimated 54 million people in China suffer from depression and 41 million suffer from anxiety disorders. In recent years, health authorities have also made attempts to address the issue.

These phenomena are motivating people to seek psychological therapy and self-help in larger numbers, leading to a tenfold increase in the number of counselling institutions from 2011 to 2020 according to data from Qcc.com, a corporate credit information provider. The number soared by more than 60 per cent year on year in 2022, reaching 30,700.

[Counselling] is expensive, and ordinary wage-earning classes can’t afford it ... Only the affluent can
Huang Jing

The state-run newspaper Legal Daily reported more than 160,000 companies in China had business profiles which included psychological counselling as of the end of last year.

“I studied psychology in 2001 when the market was very small”, said Huang, whose centres charge clients 600 yuan per hour or above. “Because [psychological counselling] is expensive, and ordinary wage-earning classes can’t afford it. Only the affluent can.”

She added those clients’ interests are mostly personal or familial. “Solving psychological stress is their immediate need,” she said. “Our customers are mainly from families which have encountered marriage problems and issues in child-rearing and education.”

A gap between expectations and reality could be the cause for many people who seek counselling, Huang said. “Parents of many teenagers were raised after China kicked off reform and opening-up in the 1980s, rode the crest of the economic boom and had high hopes their children would replicate their success,” she said. “[They are] deeply averse to the idea [their children could] fail to achieve their full potential in school or not land an ideal job.”

Industry insiders and scholars said the coming two years may be the peak period for anxiety among Chinese families, with previously unseen pessimism over careers and income in the bumpy post-pandemic economy driving the counselling industry’s expansion.

Anxiety, a sense of meaninglessness and depression were the most commonly reported psychological problems for the Chinese public last year, according to a mental health report that featured the results of a survey of 40,000 people.

Annual expenditures on counselling over the past three years averaged 6,500 yuan ($US898) per person, and 90 per cent of clients have a bachelor’s degree or higher, the survey population said. The group was polled as part of the 2023-2024 Mental Health and Industry Population Insight Report, jointly released by Jiandanxinli.com – a platform that connects therapists with clients- and the CBNData Business Data Center.

The rise in potential clients has also generated interest in therapy as a career from those entering the job market. More people aged 30 to 40 are considering entering the profession, according to those surveyed, with more than 30 per cent of beginner counsellors age 20 to 29 and 51.6 per cent age 30 to 39.

Lu Fang, a senior translator in her 40s who lives in Guangzhou, has been dealing with stress over fears of being laid off and suffering losses on investments. In a further blow to her mental well-being, the US$300,000 she has saved to support her now 12-year-old daughter to eventually study overseas appears insufficient to cover the high costs of living in the United States or Europe.

The worry almost broke her, and was enough to motivate her to seek professional help in February. She bought a package of eight one-hour in-person sessions at 850 yuan each.

“I started receiving psychological counselling once a week,” Lu said. “It was worth the money. Although it’s hard to say how helpful it was in the end, I feel relieved.

“I would recommend counselling to my friends, despite the fact that it is quite expensive,” she said. “It can help change perspectives on personal problems. Things have changed too fast, which has led to a loss of years of effort by families and a dramatic shift of their plans.”

China has developed so fast over the past 40 years, which resulted in dramatic changes in lifestyles but also a rise of anxieties
Shen Jiake

A crisis in the property market, erratic post-pandemic economic recovery and shaky job prospects – along with higher costs for medical care and education – have amplified mental distress and a sense of helplessness among China’s middle class.

Shen Jiake, a writer of psychological novels from the central province of Hubei, has also heard from readers across the country that anxiety was a prevalent issue – a trend he said is indicative of intensifying competition in society as a whole.

“China has developed so fast over the past 40 years, which resulted in dramatic changes in lifestyles but also a rise of anxieties,” Shen said. “These include the clash between Western lifestyles and traditional Chinese family values, the sudden onset of epidemics and economic uncertainties, and a rising sense of anxiety among the younger generation.”

Additionally, he attributed the rise in mental health problems to the “curse of 35” – a toxic perception that white-collar workers are too old for new job opportunities once they reach a certain age – as well as the growing population of young women who have chosen not to marry, leading to a rapid decline in fertility rates.

“The sense of meaninglessness is now more apparent than ever before, especially among the middle class and young people,” Shen said.

Huang with Better Family warned that parents’ anxieties could easily pass to their children. After the fast-paced economic growth of their youth which benefited them greatly, she said, they want the same for their children – and are shocked if it does not happen. “Some even think that if their first child does not excel in school, they can simply have another child and focus on the younger one, neglecting the first child’s development.”

The 2023 Blue Book on China’s Mental Health – a report jointly drafted by the China National Narcotic Drugs Association and Haoxinqing, an online platform for psychiatric services – determined the detection rate of depression among high school students was 40 per cent, 30 per cent for junior high school students, and only 10 per cent for those in primary school. From 2010 to 2021, China’s suicide rate in children aged 5 to 14 increased annually at an average of nearly 10 per cent.

Shen expected significant growth for psychological counselling services in the future, as more individuals become open to seeking professional help.

Concurrent with increases in internet use – China is already the world’s largest consumer base for online services – the counselling industry is adding remote functions to turbocharge its development in the digital age, he said.

Overseas professionals have an advantage in the Chinese market because psychological counselling systems and training methods are of Western origin, Shen said – though some adaptation will be required to fine-tune those practices to account for essential differences in culture.

“As long as the localisation problem is solved, counselling services are expected to become more popular.”

If you have suicidal thoughts or know someone who is experiencing them, help is available. In Hong Kong, you can dial 18111 for the government-run Mental Health Support Hotline. You can also call +852 2896 0000 for The Samaritans or +852 2382 0000 for Suicide Prevention Services. In the US, call or text 988 or chat at 988lifeline.org for the 988 Suicide & Crisis Lifeline. For a list of other nations’ helplines, see this page.

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