Report: Advancing equity in mental health with technologies: lessons from the United States and China

Globally, the COVID-19 pandemic has magnified the risk factors associated with poor mental health, including financial distress, racial disparities, stigmatization and access to health services. The World Health Organization (WHO) reported that the global prevalence of anxiety and depression grew by 25 percent in the first year of the pandemic alone (WHO 2022). But even before the pandemic, many experiencing mental illness did not receive the care they needed due to a host of reasons, including lack of access to care and a shortage of trained professionals. While the public health crisis created shocks and disruptions to the healthcare delivery system, it has also driven urgent steps to make telehealth and digital interventions affordable and accessible. Growing acceptance and institutionalization of telehealth has in turn accelerated the adoption of digital tools for mental health.

Although relatively better understood in the United States than in China, mental health care remains a significant challenge in the U.S., particularly in the wake of COVID-19, as disparities in access to appropriate care and treatment persist. In 2020, the prevalence of mental illness among adults was 21 percent in the United States, and only half of them actually received treatment (National Institute of Mental Health n.d.). China’s case is unnerving—the percentage of adults experiencing mental disorders jumped twofold, from 16.6 percent pre-pandemic to 35 percent, exacerbated by China’s strict pandemic measures, and a mere 10 percent received treatment (The Lancet 2022; Huang et al. 2019). Although mental health is an emerging priority for policymakers and healthcare providers in China, the country continues to struggle with an acute shortage of mental health professionals and low public awareness of treatment options.

This short report seeks to dig deeper into the promises and perils of using digital tools to bridge the mental health disparity as well as the hurdles to mainstreaming them in both the United States and China. In this report, health disparities are defined as imbalances affecting access, quality and outcomes of behavioral health care. Unlike country-to-country comparative studies, this paper highlights lessons and developments informed by the numerous consultations the Bush China Foundation has conducted with U.S. and Chinese academics, health and policy practitioners, entrepreneurs and app developers in the last six months, with an eye toward supplementing the growing evidence base surrounding digital mental health. In doing so, it fills a gap in understanding the role of digital mental health solutions from the lens of best practices and knowledge-sharing between the U.S. and China. The goal is to help raise much-needed awareness around mental health disparities and spark discussions and collaborative opportunities for building better digital mental health ecosystems for people in both countries.