NGO CandleX Helps to Shine a Flame on Mental Illness in Beijing

Seeking the right type of help in Beijing can be difficult. The factors that make up living in a foreign country – a reduced support network, hindered communication, additional stress – can be more even pronounced in China, where an understanding of mental health is limited, resources are difficult to access, and illnesses are often stigmatized.

Having come to terms with her own mental illness, Qin Xiaojie recognized these obstacles and decided to found the Beijing-based NGO CandleX (candlex.cn) in 2015. Since its creation, the small organization has helped provide mental health support to Chinese and foreigners through its donation-based peer support groups that take place every second and fourth Tuesday of the month as well as talks and workshops around the city.

CandleX is completely volunteer-run and looks specifically to help those who suffer from depression, bipolar disorder, and anxiety, all afflictions that Qin Xiaojie has first-hand knowledge of and is candid in describing so as to help others who may have also suffered alone. Because the support group mediators aren't necessarily trained mental health professionals, Qin Xiaojie makes no attempt to make the meetings more than what they are: a safe place to share personal thoughts and experiences in a confidential manner.

Qin Xiaojie of CandleX

What may seem like a small opportunity to be frank about living in Beijing with mental illness may in fact be the first step for many in the city to actually seek out significant palliative care, or at least find solace in discussing their problems with a few sympathetic ears in a small group setting.

CandleX's blog (candlex.cn/blog) is also a great resource for those who may not be ready to divulge their anxieties, describing stories of fellow sufferers as well as a means in which to find help, talk openly with friends and family, and prepare contingency plans in the event of deterioration of mental health.

Below, we speak to Qin Xiaojie about what she hopes to achieve with the organization and the results that she has witnessed so far.

First, tell us a little about how you came to found CandleX.
I was diagnosed with bipolar disorder in 2012 and like a lot of other people, had gone through various stages of denial before overcoming the shock of actually being diagnosed with something. When you're in denial, you don't tend to do any research into your mental health.

In my own process of going through it for years, I eventually went to Thailand [to a mindfulness-based retreat center] and I spoke about it for the first time, feeling safe in the knowledge that I would likely never see these people again once I had left and that I wouldn't have to bear the burden of caring how people would react.

That was just a real big turning point for me and being able to talk about it allowed me to start accepting [my mental illness] and I began to get better. At that time, I also did a lot of research on bipolar disorder – why it happens, the prevalence, treatment, and that also aided my getting better.

After a few months, I could really see myself as grounded for the first time in my life, and I thought, why shouldn't I share this? There are so many people like this but they're in a dark corner like I was, so I started doing awareness raising in the community and that's why I started.

Where does the name CandleX come from?
It comes from my love for candles – when I see a candle flicker, it makes me feel alive. One night, when I wrote it out I knew it had to be Candle something but it was late so I left an X as a space holder for the unknown, and it stuck. I really think we have to embrace the unknown – we can't just know everything and we can't always find answers so we may as well just be comfortable with that fact. In that way, candles can shine light onto the unknown.

What did you learn through your experience and how do you utilize this through CandleX?
Every patient becomes their own doctor eventually, so I definitely learned a lot from myself. I also learned a lot from the support group because people discuss medication as well as feelings of shame; how to handle it when your spouse doesn't understand, when you can't talk about it with your parents, when you can't talk about it in the workplace. In that way, the support groups take more of a patient's perspective – it's different to what doctors are doing because their job is to treat and you can't expect them to also be an educator or to create awareness, which is an NGO's job. We use the resources and key messages from therapists and especially the WHO, but it's dependent on people like us – who can hold community events and meet with people face to face – to spread the message at a community level and to advocate.

Describe what takes place during CandleX's group therapy sessions.
The goal is to provide psycho-social support among peers, for people with depression, mania, and severe anxiety. My group is a closed group, so people need to sign up and go through a basic screening. The groups take place for 90 minutes twice a month  and are overseen by one facilitator. There's a focus on sharing, practicing the theory that talking about problems and being able to share is the first step to getting help.

Because of the nature of the expat community, in which people come and go, we can't expect people in the group to participate long-term but we do hope that they can attend four, five, six times and once they feel comfortable, can seek out counselors or start to heal by themselves. It's targeted towards people who may not have support or may be in denial, but are exploring their feelings.

We use a mindfulness approach for people to center themselves at the beginning of each session and help reduce anxiety, still their minds, relax, and foster an environment that is good for sharing.

What are the outcomes that you hope to achieve from running CandleX?
Chinese hospitals have limited support for foreigners. Otherwise, you have to spend 200 dollars at a private hospital or you have nothing. Many of the people that come to our groups are unemployed and so may have limited funds or may have just moved here so they don't have a stable job, which means that they can't afford other options or don't have insurance – we hope to provide an alternative for them. It doesn't replace a doctor or consultation or medicine, rather it's a complementary resource.

Having just completed your second year and in the midst of the second annual review, are there any outcomes that you've been surprised by?
Yes, it's very interesting to look at how the classes break down. At 37 percent, men made up fewer of the participants but were more persistent in their attendance. That may be because women are better at talking about their emotions so they can talk about it with their friends but for men, society stigmatizes male mental health. The majority of attendees (80 percent) were between 18-35 and that's likely because the events where they hear about CandleX are more targeted towards younger people, also expats on the whole tend to be younger.

How do foreigners of different backgrounds deal with mental health issues or seek help as compared to the local Chinese population?
Many people who are here had experienced similar issues in the past and so may already have medication or their illness is moderate. Westerners tend to seek help more. Oftentimes in China it's difficult for individuals to seek help outside of the family and even then, often their parents don't understand. Also, when they speak to their parents, sometimes they can make it worse by saying things like, "Oh, it's in your head, it's not real." There's also the issue that it may bring shame on the family so how can they tell other people? On the flip side, some of the foreigners who have come to our meetings have gone on to become advocates for mental health in the community. I'm moved by how many people are trying to do the right thing for the community.

Are there any common factors that link foreigners in Beijing in terms of their mental health issues, common life events or experiences?
Yes, by extracting the keywords that participants use to map out their experiences and how many people are affected by the same life events (a single happening) or life situations (an ongoing situation). Half quote romantic relationships being the reason that they're attending the group, about a quarter say employment (career stagnation or stresses of a new job, etc.). There's also change, which includes cultural adjustment – some people don't find it as easy to adapt to changes. Depression history is another factor – some people know their trigger signs and so will come to check in.

How much do people cite the day to day stresses of life in China as a reason they've come in?
To be honest, not much. People of course talk about it. Some people talk about cultural adjustment – they don't understand their colleagues, but it doesn't stand out as much as you might think. We also consider lack of support being a factor and one that nearly a fifth of participants quote as being an issue, which includes having no one to talk to and a feeling that no one understands. From my friends' experience, there's a difference between "having no one to talk to" and feeling like "no one can understand and therefore I never told anybody." For example, there have been cases where people have shared and were surprised to find that they were are all understanding, so sometimes a person may feel like they have a lack of support but that's only because they didn't go and seek it out. Other factors may be physical illness, anxiety (which can progress to depression so it's best to attend to at the early stages), low self-esteem, and dysthemia [persistent depressive disorder].

How is the view of mental health changing in China – at the street level and through professional channels?
On a governmental and national level, there's definitely more of an effort being put into mental health awareness and support, as indicated by the 2015-2020 mental health plan. In practice, I've also seen some changes. For example, the certification for counseling used to be controlled by a professional skills department that focused on lower-end nutritional matters that didn't need the rigorous training that, say, counseling requires. This year, those matters moved to another department where the threshold for training as well as the process would be a lot better. There's also talk about opening universities that allow for counseling majors, rather than confining them to the medical universities.

In terms of awareness, I was really excited this year to see community boards in my neighborhood in Sanlitun, which usually post information regarding reproduction or oral hygiene, etc. for the first time publicize information regarding early childhood care and child development. What was special was that the first slide focused on the mother, which may seem like a small detail, but is actually fantastic because it was highlighting the effects of post-natal depression. There's also more public discussion and NGOs popping up that are taking a mental health focus, and even in the commercial sector there are platforms where people can talk about mental health and for counseling.

Awareness is a key part of Qin Xiaojie's work within the community

What advice would you give someone in Beijing who is suffering from mental health issues?
The first point is that you have to find a way to know it's ok. So if you're talking to someone who is already suffering, they need to know that it's ok to struggle and feel bad – it's part of being human. Acceptance is the first stage.

The second point is, there are options out there. Usually if someone is suffering from depression, you have this tunnel effect where there appears to be no other options and the tunnel seems endless. Each time you're there it may seem like you're not going to make it or nothing is going to work [for example, they may say], "Medication? I don't think so – so many people who take it still end up killing themselves." So it's really important to know that there are options to talk to different people – try to be open and explore, find support, and don't carry it all by yourself. Talk to your friends, talk to your parents, but also be aware that if they don't react in the way that you expect them to do, how do you deal with that possibility?

Some people only go for treatment but you need to take a holistic approach – you may need to adjust your life; maybe you're in a bad relationship, maybe you're in a job that's not good for you – you need to be able to make the changes and at that point you may not be able to. Some people have episodes and the best time for them to adjust their life is when they are just coming out of one. At that point, you can adjust your life and make yourself less vulnerable to depression.

Also, try to slow down. This can be really hard since it's cool to be busy but not everyone can be busy. I think society should cultivate a means to be slower. For me, I have to do yoga at least four times a week and I do meditation as well to make me feel grounded. I suggest that you plan for your rest time first because other things will always be there. Don't let them take over the time that you need for yourself – take a vacation, be with people that you care about, don't talk about work, stay away from your phone. For people with depression, it can be very difficult for them to do these things.

How can people get involved in CandleX?
Go to our website and get in touch. For the kind of work that we do, I try to also make it fun because the content is already pretty heavy. So, in support groups for example, some people just break down and cry but also there are times when we talk about really heavy issues in a brighter light. When you're alone, your mind may spiral into darkness but when you're with others, you may find yourself able to joke about it.

It's also important that we provide an opportunity for people to grow [when volunteering] because we don't pay anybody. So when people leave CandleX it's good that they have a sense that they've improved their skills. Roles are divided into the media team (writing, WeChat), technical team (trained mental health professionals), and operational team (event coordinators, PR etc.)

Finally, are there any other resources you'd recommend?
The crisis page on CandleX lists all of the numbers you can call (bilingual and Chinese). People must also create a crisis plan for themselves while feeling stable. For example, when things get really bad, part of my crisis plan is to inform my friends that they should check in with me and if they see that I am showing signs of XYZ then they should take me to the hospital. I know that once I'm depressed, I woouldn't be able to come up with a plan like that.

If you'd like to attend CandleX's peer support group, which takes place 7.30-9pm every second and fourth Tuesday of the month in the CBD, scan the QR code above. To find out more about volunteering opportunities, go here: candlex.cn/join-us.

Images: Pere Ibanez, CandleX

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