Mental Health Concerns Everyone: an Interview with Xiaojie Qin

The following interview was carried out in Beijing by CDB’s Gabriel Corsetti on May 22, 2018.

Xiaojie interviewed by CCTV  

Until recently, mental health was a topic that received little attention from the Chinese government and public. Cultural reticence, lack of awareness and lack of sufficient qualified staff for such a large population all meant that mental health issues tended to go unrecognized and undiagnosed. Although things are changing, the topic is still surrounded by stigma and misunderstanding.

Originally from Sichuan, Xiaojie Qin has been living in Beijing and working in international nonprofits since 2008. After experiencing problems with her mental health a few years ago, Xiaojie sought out the mental health services available in the Chinese capital, but she found it hard to be satisfied with the approach taken by the local healthcare providers. Looking for services that made use of a more Western approach, she failed to find any.

Xiaojie, who has numerous personal and professional ties to Beijing’s expat community, realized from this experience that there was a gap in terms of the social and professional support provided to the English-speaking community in the city. Living and working in China can be extremely stressful for foreigners, who find themselves thrust in an unfamiliar environment bereft of their usual points of reference and support networks, and usually quite unfamiliar with the language and culture. Mental health problems can be triggered or intensified by the new surroundings.

While Western-style mental health services in English are available in the city’s fancy international hospitals, the cost of such services is extremely high, and unaffordable for anyone but the highest earning of expats. In addition, there is a growing number of Chinese with international experience who may find the local mental health services unsatisfactory and too culturally-specific, as Xiaojie herself did.

After becoming aware of this problem, Xiaojie decided to step in and create an organization that could address the gap. Named CandleX, it was founded in April 2015. The organization’s basic mission is to provide accessible mental health support in English to teenagers and adults in Beijing, provide education and raise awareness. Its services include a fortnightly peer-support group that offers a safe space for those going through depression and anxiety, talks and workshops in communities and schools, and a collaborative art project to raise awareness of bipolar disorder.

The work of CandleX is driven forward by volunteers and by Xiaojie herself, who continues to work a full-time job in an international NGO. It is hard for the organization to find sustainable sources of funding, since Chinese foundations may be unfamiliar with mental health work and tend to be more comfortable supporting projects that help the poor. Especially given that many of the recipients of CandleX’s support come from the foreign community, it can be hard to convince potential donors of the need to fund such programs.

I met with Xiaojie in a cafe’ near her home in Sanlitun, Beijing’s lively embassy district.

Why did you decide to create CandleX?

Xiaojie: It goes back to the old story of my own experience with mental health issues, when I suffered from such issues and I couldn’t find enough support in the society. Another thing is that China has developed very fast, so we have started to have this group of people living here that is more international, including both expats and Chinese who move in the same sort of culture. Within this space there hasn’t been much effort made to raise awareness, reduce the stigma, or provide social support, so I decided, why wait for other people do it? I should do it myself, rather than hoping someone else would.

And how did you actually go about founding the organization?

Xiaojie: I started it around three years ago, on the first of April 2015. Back then there wasn’t really much planning, because I did not have the investment and funding to put a system in place first. So the approach I took was just to start with what I could do, which is providing some sort of help. I started to do community awareness-raising, basically providing workshops and talks in the community through the networks that I already had, which were mainly through my friends. 

I also started doing some work in schools, where my friends thought that the students needed some more knowledge on these issues. In some international schools in China they have a psychology class, and I went there to do some talks. I also did a lot of talks in the community, for instance in the “Beijing Women’s Network,” in “French Lab”, and in other kinds of organizations that have space to deal with mental health.

What are CandleX’s main activities at the moment?

Xiaojie: We have four major programs. The first one is community talks and presentations, which are open to everybody and for free. We have worked with the British Council and Bearapy, to name but a few. Our second program is the teenage program, because the teenage years are the time when mental illness has the highest onset. So we really need to do early intervention by providing knowledge to students, since currently the educational system both in China and in international schools here in Beijing has limited activities in place to support student’s mental health. We’ve worked with international schools, and are also working with companies who work with the students.

One type of workshop we provide is for Chinese high school graduates who are going to schools in the States and other parts of the world, to provide them with basic ideas on mental health. So when they are transitioning to being adult and living away from home in a foreign city, they are more aware of their emotional responses and they know where resources are available if they are in a certain situation where they need extra help. We’ve also started providing education to their parents so they are equipped with the knowledge of how to support their children long-distance through the tough transition.

Our third program is a campaign on bipolar disorder. That project is through art, to create a space for people to understand and know about bipolar disorder, because the prevalence is pretty high. From some data that we’ve gathered it is more or less as prevalent as autism, but in China people know about autism but not really about bipolar disorder. So the project is really to campaign through art for bipolar disorder awareness.

Then the fourth project we have is on public education, which is online. We created columns for people with mental health issues to write about their own experiences, and they are posted on our website. It is to facilitate a healthy conversation on mental illness, rather than having people shaming it. Another column that we have is to educate people on depression, so we published 19 articles and it includes everything people need to know medically about depression, including how to treat it and how to spot the signs. It’s all in that column.

We also have a peer support group, which is one of our core projects. In Beijing in the past you couldn’t find a mental health support group in English that is only among peers, so we have been running one for coming up to three years now. More than 100 people have come to the support group. The goal is to provide a safe space for people to talk about their issues, relate to each other, cultivate compassion towards themselves and towards each other, and cultivate patience, because that’s really needed for people with mental struggles.

(Xiaojie and a colleague conduct a workshop on depression)

What are CandleX’s main sources of funding and support？

Xiaojie: We don’t really have funding. That’s why we are an organization that’s volunteer-based. But it’s really important to find a way to make the organization sustainable. So we are trying out to see if a fee-for-service model would work. Currently we are transitioning to that. 

Our second source of funding is from donations, which we find is really difficult, because most foundations and organizations tend to do poverty alleviation. They work for people who are poor, for people with physical disabilities, people who live in the rural areas. Mental health however is a big issue for everybody, regardless of your income, regardless of your culture and background. But the donors don’t always think this group of people needs money or extra support, so they won’t donate for this. They think “it’s going to the expat community, where they should be able to pay for themselves.” So it’s really difficult to get the funding.

This doesn’t mean that we do not need donations. For instance for the campaigns that we do on moodlab on bipolar disorder, a renowned artist was kind enough to do the project on a pro bono basis, but operating the project still costs money. So if we can’t find these volunteers, we won’t be able to continue our work. So I hope that there can be an awareness of the need to donate into mental health regardless of who the recipients of the services are, and whether they are rich or not. Most of the time we are spending the money on raising awareness, so that the people who have problems know that they have them and can take action.

So you decided to focus your activities specifically on the English-speaking community in Beijing. How would you say this differs from focusing on the broader public in Beijing and in China in general?

Xiaojie: I think culturally China is a really diverse country. You will find people trying to reach the same goal with different populations using different approaches. We also have minorities, right? Their culture is quite different. So, for me it’s to create an approach that’s appropriate for an international community. 

I think that for the Chinese population there’s an even longer way to go, because the awareness of mental health is lower, and also there’s a lot more stigma, which prevents people from having these conversations. So one thing is to create a topic that’s packaged in a way that people who come to a lecture or receive support feel that they can relate to, rather than just turning off, which is easy to do when you think mental health is never your problem, as a lot of people in China do. “Mental health” is just a key word that turns a lot of people off.

When it comes to the international community within China we don’t have to worry so much about this, because at least the people have some sort of sense of what mental health is, and are more willing to come and get support. For the limited knowledge that I actually have, in the Chinese community the social support network is not as strong. If someone has depression, they feel they cannot access their friends or family, because they are afraid that their friends or family will judge them. In the international community people are more willing to talk about it, and more likely to have friends that are understanding. So those are, I would say, the main differences. The baseline for the international community and the Chinese community is different.

Would you say the level of awareness of mental health issues in China has changed over the years that you’ve been involved in this field? Have you noticed an improvement?

Xiaojie: Well, I haven’t worked with the Chinese population that much, but as a Chinese in the community, my own experience is that things are definitely moving forwards at a fast pace. It just can never be fast enough. You can see the changes from a few things. First of all, the government is putting a lot of money and attention into mental health. There is an ongoing national plan on healthcare for five years called the 2015-2020 National Mental Health Work Plan of the People’s Republic of China, and mental health is in there. So it’s good to see that the government on the national level is paying attention to it.

And then under that you can see how the whole medical industry is trying to bridge the gap, because we don’t have enough psychiatrists and counsellors. A lot of the time, the system is not rigid enough to make sure that the counsellors are well qualified. But starting last year, there has been a shift from certifying counsellors who just do a short-term period of occupational training, to a more rigid sort of system. So far nobody is too clear about the new system, because the transition started last year, but you can at least see some effort on the government level to ensure the industry can educate professionals to a level where they are more qualified. So you can see that policy and planning for mental health is there, in place.

The second thing I really want to bring out is how the Chinese media are now making more effort to raise awareness. For instance, last year I saw one of those promotional posters in our community, and it was on children and children’s development. What was really exciting was that the first page started with postpartum depression. That was a really good thing to see in our community. And of course on TV you will see a lot more campaigns on depression.

Do you know of any other NGOs or organizations that do this sort of work in China?

Xiaojie: There are many. One well-known organization in the mental health sector is the Shangshan Foundation (尚善基金会). They are a Chinese organization that works on mental health, and their story is that Shang Yubo, the founder’s son and a well-known actor, committed suicide when he was 28 years old. So his mother then started this organization. Another one is Shanghai Lifeline, which provides services to Chinese and expats through hotlines, and organizes workshops in the community.

On the personal level, as well as running CandleX you still have a full-time job in an international NGO. Juggling the two things must be quite exhausting. What keeps you going?

Xiaojie: I think the first thing is that this is my mission in life. I didn’t find my mission, the mission found me. When it finds you, you have this internal drive. I cannot explain it, because sometimes I don’t even want to work on it, since it can be so stressful and take up so much of my time, but I still have this drive. So I would say this is the first thing that really helps me to tough it out in some really difficult situations.

And the second thing is to really know how to balance yourself. If you want to advocate for mental health, you can’t drive yourself crazy by promoting something when it is harming you, right? So work and life balance is one golden rule that I have. It doesn’t matter if I do one thing, or two things, or three jobs, but the important thing is that you need to let your emotions be a compass for you to know how much to work and how much to relax. So I try to do that myself. That’s why I’ll go on vacations, hang out with my friends and all that. 

I think it’s a constant balance you have to find. It’s not like once you are balanced, for the next three years you are balanced. It’s a daily practice that you have to keep in mind. To me, meditation and yoga are what help me strike that balance. Mindfulness helps me to process things with as little effort and energy as possible. Then just having a supportive social network, so you can check in with other people. Your friends can give feedback to you on how you feel, so you are not driving yourself crazy by juggling two jobs.

I see. And what are your plans for the future, both for yourself and for CandleX as an organization?

Xiaojie: That’s a very good question. It’s something I’m trying to find an answer to myself. For now I only have a few hopes. One is for CandleX to be sustainable. So I imagine myself not in Beijing anymore, and the community is still carrying out its services when needed. That’s why I’m trying to find a model or a funding opportunity to hire full-time people for CandleX. That way once I’m not there, there is still going to be a director.

Other than that, CandleX is a big part of my life. And I think my mission in life is to utilize my time to the fullest. So whatever I can do to work on mental health would be things that I’m interested in. It’s not limited to CandleX. I might be working with other NGOs or my current NGO more on mental health, or working in a more strategic role that can allow me to mainstream mental health in an organization that provides services to the community. So whatever opportunities are out there, I just need to answer the questions: is it a good use of my time, and can I can have the leverage to really increase the impact of my work?

Over the years you’ve been working on mental health issues and raising awareness in Beijing, are there any particular anecdotes or stories that really stand out that you feel you can share with us?

Xiaojie: There are so many. Most of them share a common thread: someone uses our services and comes to the support group, and feels like they really want to help other people too, so they join the organization. They become advocates for mental health. Either they become coordinators of our projects and campaigns, or a spokesperson that goes out with me to the community.

One example is Marco. He started coming to the support group two years ago, and around then I started not having enough time to do community work and talks, so I asked him if he would be able to go. He went through a phase where he wasn’t so sure, because it is such a difficult step to tell everybody about your own experiences with mental illness. But in the end he did it, and then he continued to help other people. When his friends were not feeling well they would text him, and he provided a space for them to feel that someone was listening. Then he joined the campaign on bipolar disorder that we did, and he became one of the models for the campaign, and provided his own story. Eventually it is going to become a book.

Other than that he is also a drummer, he has moved to Shanghai now but when he was here he played a lot of gigs on the weekend and sometimes also fundraised, and guess where the money would go? It would go to CandleX, so we could have the operational money to keep the organization running. So it really is quite a story, and you can see how when you start to let yourself know that whatever you are experiencing is normal, you are much stronger and you are able not to only help yourself but also help others.