by Jas Santos and Mary Mulualem

Photo by Jas Santos

The pressures of attending a college hundreds or thousands of kilometers away from home are a point of connection between many students at Duke Kunshan University (DKU). Even more difficult: the academic pressure faced by students entering into such fast-paced learning for the first time. For some, the combination can be too much to bear. Seeking assistance in their emotional well-being, DKU sophomore Zihan Chen reached out to DKU’s Counseling and Psychological Services (CAPS) office. It felt like another punch in the stomach when he found out that he would have to wait at least two weeks in order to have the first appointment with a therapist on campus. 

“My friends and my advisor, they all suggested that I get help from CAPS,” Chen elaborates on the service’s widespread recognition among students and faculty as the primary responder to student mental health issues. 

CAPS serves as the official mental health resource on campus, offering individual and group counseling sessions with licensed therapists in English or Chinese to all members of the DKU community. CAPS employs three full-time therapists to give bilingual care to a student body of over 1500. In an effort to provide more avenues of care, students have pistoned the counseling group Peer For You, but many are skeptical of the capabilities of other students to provide counseling, and stories from other Chinese universities reflect broader apprehensions over privacy and emotional tracking within university programs.

CAPS has experienced multiple turnovers in staff and leadership, with the current director and the clinical services coordinator appointed in August and May of 2023 respectively. One of its full-time therapists, Dr. George Hu, simultaneously attends to his role as the director of service’s overall operations. Hu reassures that “CAPS has grown in terms of the amount of full-time counselors [they] have.” The office continues to operate at a full capacity, with the availability of each therapist consistently fully booked.

Photo by Mary Mulualem

For non life-threatening situations, the average wait time to have an appointment with a CAPS therapist is two weeks with several students recently reporting longer wait times. According to Chen, the first question posed to him centered around immediate harm, and his response ultimately determined whether he would successfully secure an appointment that day. “The experience was disappointing for non-emergency situations. I was hoping to get a 30-minute talk, but what they did was postpone my request. I don’t think it’s a good idea that when someone goes to you for help, you say please just wait for a few more weeks–that’s kind of cruel,” Chen explained. 

When asked about immediate intervention, the CAPS office commented, “Due to the high volume of requests CAPS currently receives, we are not offering walk-in [services] unless there is a life-threatening emergency.” Hu acknowledges that CAPS struggles in “providing care to the culturally and linguistically diverse population” at DKU.

At DKU, CAPS is not the sole resource for students’ mental health; student groups are taking the first step to enhance and support the well-being of their fellow students through peer counseling. Peer For You (PFY), founded in 2019, is a student-run initiative composed of a group of volunteer “peer responders”. These responders are certified in mental health first aid by the Mental Health Association of Hong Kong: they have received training on active listening and crisis evaluation. 

Peer responders work to recognize the signs and symptoms of common mental health disorders, such as panic attacks, depression and risks of suicide. They can identify the severity of a given case, provide initial assistance for emotional regulation, and guide individuals to appropriate professional help if needed. PFY offers both appointments and drop-in sessions for students looking for support in areas such as school-related anxiety, homesickness and student life.

Before joining the club’s executive team, junior Zu Gan spent her afternoons as a peer responder attending to the concerns of students she had been anonymously matched with just hours prior. Similar to professional counseling, Gan is matched with individuals without her prior knowledge and maintains a commitment to strict confidentiality and professionalism with the people she counsels, outside their sessions. In this capacity, she recognized PFY as a “well-needed” resource for DKU students, emphasizing the responsiveness of their drop-in sessions within a 24-hour turnaround time.

Hu brings over two decades of counseling experience in China. Having been in the field since 2008, Hu believes the mental health landscape in China is “varied”. While everyday on-campus resources are still not prevalent in many areas, schools in greatly populated urban centers like Beijing and Nanjing have implemented resources like on-campus psychological counseling centers and telehealth lines for students.

Regardless of the resources available to each school, the shifting landscape around mental health dialogues in China has influenced student expectations especially with regard to the accessibility and timeliness of mental health services. According to the South China Morning Post, mental health awareness has evolved drastically in both Chinese universities and the general population in the past ten years. As of 2022, the Chinese Ministry of Education mandates Chinese grade school students undergo both physical and mental health examinations. Now, many Chinese universities also conduct yearly screenings for mental illnesses mainly focused on depression. 

Hu notes that the provision of mental health services is not solely a campus-wide concern, and rather part of a challenge that extends nationwide. “China has done a good job of providing basic healthcare to a population of 1.4 billion people through the public hospital system.” The CAPS director reflects on lessons to be learned in managing overburden, and believes one improvement that would serve China well would be to implement a more “consistent training and licensing system for mental health practitioners”— one, he says, that “applies to both medical and non-medical settings’.

Now Vice President of PFY, Gan puts these insights to practice, leading the charge in expanding peer responder certification opportunities. She believes that although PFY’s peer responders are not the licensed therapists employed by CAPS, the ability to talk with a fellow student is still valuable. “Students often struggle with problems you and I struggle through–homesickness, academic stress, issues with relationships,” Gan elaborates on the complementary role of PFY to CAPS and their mission to “fill the gaps” in CAPS’ availability: “If anyone wants to come in and talk for a while, they can. They don’t need to make a prior appointment. The peer responder will always be there.”

Photo by Mary Mulualem

Gan finds that the services offered by PFY are still an underutilized resource, stating that they see an average of one student per week. She explains that many students at DKU remain unaware of PFY, and many have reservations towards utilizing it. When asked what was holding students back from utilizing PFY, Gan said that through a survey distributed last summer, the group identified three primary reasons for why students are reluctant to or have yet to seek out counseling with PFY: fear of confidentiality breaches, uncertainties regarding the counseling skills and capabilities of peer responders, and lack of awareness about the initiative.

Gan poses the dilemma that PFY faces in appealing to DKU students: “If I’m already [putting the effort into] talking to a peer responder, I might as well go to CAPS.” As PFY responders are student volunteers, Gan says several students expressed they felt like going to a PFY meeting would essentially be the same as talking with friends, but with the extra task of scheduling or visiting the PFY office.

With the issue of ‘psychological surveillance’, the option of peer counseling presents a double-edged sword. One article from Chinese online news outlet LacanPsychology outlined a slew of incidents where students felt that the implementation of mental health screening felt like an invasive form of emotional tracking, and resulted in several students being subjected to what they felt was an embarrassing invasion of privacy when their parents were called and notified of their counselor’s concerns about their mental health without their consent. 

One DKU student, who wishes to remain anonymous, says they would not be willing to seek out PFY as an alternative to CAPS even if the waiting time was considerably long. They expressed uncomfortability with the members of PFY being other students from a relatively small community pool, highlighting the issue of unclear privacy regulations. The student expressed that it would be “better to [speak to] someone random than someone you’ll see in MATH105 in a few hours after telling them your struggles”, calling PFY’s design “the worst of both worlds”.

However, others see PFY’s distinct role as an informal channel for seeking advice without the need for medical record keeping under the institution. One student emphasized their preference for confiding in peer responders rather than counselors. They explain, “It’s like confiding in teachers. While they may offer better help, I simply don’t feel at ease sharing everything to them. Sometimes I want advice from someone I trust without it being documented or treated like an official visit to the doctor.” The student elaborated, they perceive the counselors as authoritative figures due to their cultural background.

Meanwhile, Gan says PFY is not meant to replace the role of licensed therapists and instead ease the burden of official care channels, “We hope to be the middle person when one is going through a crisis, and be able to spot it, and be able to direct people to the next steps.” In the last three weeks, PFY has increased its collaborations with CAPS under a pilot program called Compassionate Counseling centered on group counseling. 

The momentum behind the PFY movement is in its early stages and is primarily dependent on the dedication of unpaid students. Gan also acknowledges the difficulties in leading a volunteer-based group of university students as the peer responders must balance their dual role as students and as the frontrunners of the campaign for more accessible campus mental health resources.

Gan says, “It’s a labor of care, to actively listen, to be empathetic, to reflect on what others are saying–even if these instincts might come naturally to us.” Because of this, Gan says that there is an emphasis on de-stressing and self-care techniques among the peer responders, in order to ensure that a role like this does not lead to mental health concerns of their own.