Who is helping students? A qualitative analysis of task-shifting and on-campus mental health services in China's university settings

The mental health of university students is a major concern worldwide. Current literature has highlighted workforce shortage as one of the main barriers for delivering mental health care in China and elsewhere. A common strategy to tackle this shortage involves engaging non-specialist health workers and professionals from non-medical backgrounds in mental health promotion within university settings. Yet, there remains limited understanding of how this approach operates in practice and its effectiveness in delivering essential on-campus services to students. This study contributes to narrowing this knowledge gap through the engagement with interdisciplinary mental health service providers (n = 141) at six universities in Shandong, China. We used focus group interviews to explore how task-shift practices operate in the Chinese university context and analyze the main barriers in the practitioners’ delivery of mental health care practices. According to our analysis, (1) competing roles of non-health actors create a trust-privacy dilemma in the delivery of mental health service; (2) knowledge gap and workload issues become new barriers for effective mental health promotion; and (3) the lack of structured intersectoral collaboration creates barriers to establish effective mental health care networks to meet the needs of university students. These results highlight the importance of using a settings approach in designing and assessing mental health interventions based on task-shifting within the contexts of Chinese universities. The study also helps to map out the unique features of the workforce situation in the mental health support system of Chinese universities, offering researchers and practitioners insights on how to better localize their assessment and programming.