120 Million Depression Patients Need a 'Listening Ear': 50-Minute Sessions Cost $1,000 – Corporate B2B Procurement and Insurance Coverage Emerge as Key Trends

Editor’s Note: This article is from Times Finance, authored by Li Aohua. Republished with permission by VCBeat.

Late-Night Emotional Distress Among Young Adults Becomes the Norm: 280 Million People with Depression Need a “Tree Hollow”

October 10, 2022, marked the 31st World Mental Health Day, a day established by the World Psychiatric Association (WPA) to raise public awareness of mental and developmental disorders, share scientific and effective knowledge about these conditions, and eliminate public stigma. The theme for this year’s World Mental Health Day is “Creating a Supportive Environment for Shared Mental Well-being.”

According to the World Health Organization (WHO), mental disorders are clinically characterized by significant disturbances in an individual’s cognition, emotional regulation, or behavior, including conditions such as anxiety disorders, depression, bipolar disorder, post-traumatic stress disorder, and schizophrenia. As of 2019, the global number of people with mental disorders reached 970 million, meaning one in every eight individuals was affected. Anxiety disorders and depression were the most prevalent, with 301 million and 280 million cases, respectively.

Although effective treatments for mental disorders are currently available, and appropriate psychological interventions can effectively prevent the onset of mental illness, an estimated 75% of patients in low- and middle-income countries do not receive effective treatment due to high costs and a shortage of professionals, according to the World Health Organization (WHO). Improving the accessibility of psychotherapy and psychological counseling is therefore an urgent priority.

LeadLeo Research Institute points out that mental health care measures can be divided into the diagnosis and treatment of psychiatric disorders in the medical field, and psychological products/services in the non-medical field, with the latter including psychological counseling, psychological courses, etc.

Ren Huimin, Deputy Director of the EAP Division at Zhongmeng Psychology and a brand under Wanxin Psychology, told Tianxia Caijing that psychotherapy targets individuals with specific mental health conditions—such as depression, anxiety disorders, and neurotic disorders—which require diagnosis and treatment by qualified psychiatrists in specialized psychiatric settings. In contrast, psychological counseling is more broadly applicable to the general population; anyone encountering obstacles in their work or daily life may seek support through psychological counseling.

“Psychological counseling is not equivalent to having a mental illness,” emphasized Ren Huimin.

Whether it is psychotherapy or psychological counseling, “expensive” is the first impression many people have. The 2022 Blue Book on National Depression, released by the Depression Research Institute, points out that 52% of patients do not consider psychotherapy due to high costs.

After noticing frequent unexplained low mood, Mu Mu (a pseudonym), who works in a first-tier city, sought treatment at a local psychiatric specialty hospital and was diagnosed with moderate depression, with estimated treatment costs reaching tens of thousands of yuan. Mu Mu told Times Finance that her income is quite ordinary, and the five-figure treatment cost far exceeds her financial capacity. After much deliberation, Mu Mu ultimately did not accept the doctor’s initial treatment plan and instead only obtained prescriptions for medication costing 400 yuan.

Zhu Jinsong, a deputy to the Jiangsu Provincial People's Congress, a member of the Standing Committee of the Provincial People's Congress, and Chairwoman of the Provincial Women's Federation, stated in an interview with the media that psychological disorders are currently showing a trend of increasing prevalence, making mental health services increasingly important. However, treatment costs have become a significant factor limiting access to care for patients with psychological disorders.

“Taking Nanjing Brain Hospital as an example, a single 50-minute psychotherapy session costs 800 yuan for specialists with senior professional titles or above, as approved by the price control authorities,” said Zhu Jinsong. Psychotherapy is typically administered once a week and often requires multiple consecutive sessions, with some patients undergoing treatment for several years. This imposes a significant financial burden on patients, preventing a substantial number of individuals with mental health disorders from receiving timely treatment.

The pricing at psychological counseling agencies is also substantial. It is understood that current fees for psychological counseling generally range from 500 to 1,000 yuan per 50-minute session; for the same duration, some senior psychological counselors charge as much as 1,500 yuan, or even 2,000 yuan.

“Psychological counseling fees vary across cities; on average, it is normal for individuals to spend around RMB 10,000 per year on counseling services,” Ren Huimin told Times Finance.

Although many clients are deterred from seeking psychological counseling due to cost, another aspect of the industry’s reality is that China still faces a significant shortage of mental health professionals. According to the World Health Organization’s recommendation that “one counselor per 1,000 people represents the equilibrium point for a healthy society,” China would need at least 1.4 million psychological counselors. However, the country currently has approximately 1.3 million certified practitioners.

Ren Huimin pointed out that the time and financial costs of training a psychological counselor are substantial. It takes anywhere from 3 to 5 years for a novice to become a mature practitioner, and in some cases, 5 to 7 years. First, they must undergo 2 to 3 years of systematic training, costing between RMB 10,000–20,000 and RMB 50,000–80,000. Second, to become a psychological counselor, one must also receive personal counseling, with at least 50 hours of consultation experience. At a rate of RMB 400 per hour, this alone requires a minimum investment of RMB 20,000.

“Psychological counselors also require supervision. So-called supervision refers to professional guidance provided during the professionalization process of psychological counselors and psychotherapists who have been engaged in psychological counseling for a long time. In particular, novice counselors need more frequent supervision. With supervision fees charged at 400 yuan per session, the total cost amounts to at least 10,000 yuan,” said Ren Huimin.

The “Healthy China Action (2019–2030)” designates “promoting mental health” as one of its 15 special initiatives, setting forth targets such as raising residents’ mental health literacy to 20% by 2022 and 30% by 2030, and slowing the upward trend in the prevalence of anxiety disorders, depressive disorders, and insomnia disorder.

With the rise in public awareness of mental health, the accessibility of psychotherapy and psychological counseling has also garnered attention.

Recently, the Jiangsu Provincial Healthcare Security Administration proposed to include psychological diagnosis and treatment services not currently covered by medical insurance into the basic medical insurance payment scope. The province will unify the payment categories, reimbursement ratios, and payment standards, with implementation planned before the end of October this year. The proposal to systematically incorporate psychotherapy into the medical insurance payment scope was put forward by Zhu Jinsong at this year’s Jiangsu Provincial Two Sessions.

Zhu Jinsong suggested that Jiangsu Province strengthen investigation and research, learn from and draw on the practices of Guangdong Province, and promptly incorporate psychotherapy into the scope of medical insurance reimbursement in an orderly manner. This would effectively alleviate the financial burden on patients, benefit more individuals with mental disorders, facilitate early detection and treatment, and substantially reduce the rate at which common mental disorders progress to severe mental illnesses.

Effective August 15, 2021, Guangdong Province officially began reimbursing psychotherapy services under its basic medical insurance scheme, becoming the first province in China to include psychotherapy in its medical insurance coverage. According to the reimbursement guidelines previously issued by the Guangzhou Medical Insurance Bureau, psychotherapy has been incorporated into the general outpatient benefits of Guangzhou’s social insurance program. The reimbursement amounts are RMB 200 per session at tertiary hospitals, RMB 180 per session at secondary hospitals, and RMB 160 per session at primary hospitals.

Beijing’s efforts to include psychotherapy in medical insurance began even earlier. As early as 2016, Haidian District in Beijing launched mental health service initiatives, authorizing the first batch of 34 community health service centers to establish psychological counseling rooms, with related services covered by medical insurance. According to information disclosed by the Beijing Municipal Health Commission to the media, Beijing has actively promoted the construction of its mental health system in recent years, continuously improving and perfecting the four major service systems for mental disease prevention and control, medical treatment, rehabilitation, and mental health. The city has strengthened the three-tier professional mental health service network at the municipal, district, and street/township levels, achieving 100% coverage of prevention and treatment services, and successfully establishing the National Medical Center for Mental Diseases in Beijing.

“After being included in the national health insurance scheme, the psychological treatment and counseling industries will become more standardized. However, this may also lead to an influx of clients who only require psychological counseling into the health-insurance-covered psychological treatment system. To better address this surge in demand, policy guidance is needed to designate private psychological counseling studios with relevant qualifications and service capabilities, such as Talk Time Counseling Center, as approved providers under the national health insurance program,” Ren Huimin pointed out to Times Finance.

In fact, besides medical insurance coverage, another effective way to address the high cost of counseling is for employers to purchase psychological counseling services for their employees.

Lin Shan (a pseudonym) shared with Times Finance her experience of undergoing psychological counseling in 2021. According to Lin’s recollection, she noticed that during a fixed time slot each evening, she would feel inexplicably downcast and prone to emotional outbursts, even displaying aggressive behavior toward friends around her. Unsure of the source of her mood swings, Lin believed that psychological counseling might provide answers, so she scheduled an appointment.

“It was mostly me talking, with the counselor guiding me and occasionally asking questions, which prompted me to analyze my own situation. Although it wasn’t about directly solving my problems or giving me ready-made answers, the process of rational self-analysis was deeply healing. It made me realize that I do have the capacity to understand myself,” said Lin Shan.

What also made Lin Shan feel she had “gotten a great deal” was the cost of this psychological counseling session. Lin Shan told Times Finance that, because her husband’s company has a partnership with a third-party psychological counseling agency—providing free counseling services to employees and their families—this highly effective session did not cost her a penny.

“Our appointments are free, whereas the market rate is 700–800 yuan per hour. To be honest, I initially felt that it would be a waste not to take advantage of the offer, and even considered going once or twice a month. However, the contracted agencies were all too far from my home, and after just one consultation session, my mood improved significantly, so I didn’t persist,” said Lin Shan.

LeadLeo Research Institute points out that China’s psychological counseling market can be segmented by customer type into B-side clients (group psychological counseling) and C-side clients (individual psychological counseling), with B-side clients primarily consisting of large enterprises. These enterprises purchase Employee Assistance Program (EAP) services from EAP providers to offer psychological counseling to their employees, aiming to alleviate negative emotions encountered in work and daily life, reduce factors impairing work efficiency, stimulate employee enthusiasm, enhance productivity, and promote the healthy development of the enterprise.

Zhongmeng Psychology’s EAP program, where Ren Huimin works, is a typical representative in the B2B psychological counseling sector. Ren Huimin stated that many enterprises now purchase psychological counseling services from EAP providers. This group-purchasing approach significantly reduces the cost borne by individuals, allowing them to access more comprehensive and systematic mental health services for just RMB 100–500.