China struggles with children 'left behind' by government's one-child policy

Yes, it is just a simple stuffed toy. But put it into a child's arms and watch as he pretends to feed it, talks to it, even crowns it as a monarch. First, it gives him security; then it allows him to role-play and develop social skills.

Chinese authorities hope tips like these, included in a book for parents and nursery teachers, will help to stem mental health problems among the country's young. While budgets for child and adolescent mental health services are being frozen or cut in the UK, China is seeking to expand provision, promote psychotherapeutic approaches and adopt preventative measures.

Since 2012 Beijing nurseries and schools have promoted mental health as well as physical fitness. Last year China passed its first mental health law and told paediatricians to screen patients for warning signs: Do the three-month-old baby's eyes follow moving objects? At 18 months, can she make eye contact? Officials have also enlisted foreign psychotherapists to help train specialists and increase awareness.

"The government is paying a lot of attention to psychological health," said Dr Zheng Yi, president of the Chinese Society for Child and Adolescent Psychiatry and deputy director of Beijing Anding Hospital at Capital Medical University.

The preliminary results of research he has overseen, to be released later this year, suggest around 15% of Chinese children have mental health problems. He said that compared favourably with a rate of around 20% elsewhere, but noted that some problems, such as anxiety disorders, appear to be on the increase.

Rising living standards have allowed more parents to focus on their children's emotional wellbeing, but development has also brought new problems, including dramatic changes in family structures and increased educational and social pressure. "For a lot of children, economics are not a problem. The problem is that opportunities to play are fewer," said Zheng.

Others cite the impact of the generation gap created by China's transformation and the impact of the "one child" policy. Only children may enjoy better care but can become over-indulged "little emperors", or suffer loneliness because they lack company their own age.

Viviane Green of the department of psychosocial studies at Birkbeck College, one of the international experts developing the training programme, said cases were often similar to those in the UK, with "acting out teenagers; early attachment issues".

But she added: "What probably is slightly different is how emotions are expressed, because the culture is different and filial piety is very strong. People do have conflicts – but the sense of self is not an individualised model as we have here – [the idea] that good mental health is about separating and moving away. It's much more about duty to the family of origin and the links you keep with them."

Psychotherapy is growing fast in China, but the country's specialists must "help these new ideas to relate to other kinds of experience they have got from local culture, as well as people like psychiatrists," said Dr Wang Qian, who has organised the international training as director of the executive office of the national psychoanalytical unit.

Dr Sverre Varvin, who chairs the China committee of the International Psychoanalytical Association and has trained Chinese professionals for years, added: "China is a really metaphorical culture and you have to spend some time to discover what the metaphors are."

Serious problems remain in the provision of services. There is a dearth of child psychiatrists in China, which Zheng said would be addressed by training paediatricians and general doctors in early diagnosis and basic treatment.

Services are scarcest of all in the countryside, where they may be most needed. Many migrant workers leave their offspring at home when they move, because China's "household registration" system means they struggle to get services such as education in the cities. Most are reunited once a year at best.

Almost 50% of these "left-behind" children suffer depression and anxiety, compared with 30% of their urban peers, according to a new study funded by the Heilongjiang provincial government. They are also more likely to suffer from mood swings and stress. The lead researcher, Yang Yanjie of Harbin Medical University, said their psychological problems tended to be more complex: "Left-behind children usually have inferiority complexes, lower self-esteem and lower confidence. Many appear to lack security and are too afraid or feel too much anxiety to interact with other people," she said.

Some are effectively raised by single parents; in other cases, both parents work, and they are reared by grandparents who may lack the time and energy to nurture them. Guardians were often focused on material support and ignored children's emotional needs, said Yang.While there is little funding for programmes targeting vulnerable groups at present, the appetite for them is striking. Save The Children initially provided "psychological first aid" in emergencies such as natural disasters, offering basic support and identifying those who need further assistance. But Pia MacRae, its China director, said staff and partners then requested it extend training to workers at centres for street children.

Zheng believes attention must be focused on prevention as well as cure. Social changes need not be damaging if people adapt appropriately: making sure only children spend time with other boys and girls their own age; perhaps alternating stints as migrant workers so that there is always one parent at home.

But the first big challenge, he said, was to tackle perceptions so that mental health problems no longer carried a stigma for children. "If we can get rid of that, seeing a psychiatrist will be like seeing a doctor if you have a fever," he said.