In China, the subject of mental health is taboo in many circles, especially among older generations. “China still has an old-school attitude. People are reluctant to admit they are dealing with mental illness, and it is rarely discussed in most family conversations,” Jojo Zhang, a 27-year-old in Beijing who has lived with undiagnosed obsessive-compulsive disorder (OCD) from a young age, told KrASIA. “This taboo leads to a lack of understanding with it comes to mental illness. Chinese society needs to be educated about mental health and take it as seriously as physical ailments.”
With few options for therapy, Zhang found help in an unexpected place—an app. “Apps like Ease can help improve day-to-day stress management and provide useful info for better mindfulness,” she said.
Founded by Hou Xi, a former Goldman Sachs banker, Chengdu-based Ease is a localized version of Calm, a US-based service that is popular in its home market and Europe, and which provided initial funding to Ease’s endeavor. Ease has four main functions: to relieve pressure, improve sleep, support meditation, and provide personalized self-care advice. The main idea is to host a rich array of content to foster users’ self-awareness and understanding of mental health. To “relieve pressure,” for instance, Ease plays soothing audio content in sub-categories to allay stressors related to work, family life, or studies.
Ease’s content contains a smattering of emotional management advice, as well as inspirational and self-help talks. Sections like the one on family life, which provide direction for users to navigate complex familial relationships, are an example of Ease’s localized approach.
Over the past 40 years, the sheer pace of socio-economic change has left its mark on Chinese society. The World Health Organization estimates that around 54 million people in China suffer from depression, 41 million have anxiety, and 300 million deal with insomnia. In 2011, the Chinese government enacted its first mental health law, and then followed up in 2015 with the National Mental Health Working Plan (2015–2020) to expand coverage and care. Despite these efforts, large portions of China’s mentally ill population do not have access to treatment or other mental healthcare services, according to a nationwide study in BMC Psychiatry.
While traditional attitudes remain, a host of online platforms and apps, like Ease, are tapping into the growing demand for improved mindfulness and mental health, aided by burgeoning interest from young people. These apps formulate services that fit the smartphone usage habits of millennials and Gen Z in China, while costs are kept low to make mental health and self-care resources accessible to a wide user base. But easy access through smartphones isn’t the same as treatment, Zhang cautioned. Apps such as Ease “cannot replace the professional medical opinion of experienced therapists. They fall short in treating more severe cases of mental illness,” she said.
Nonetheless, the market is massive, there is a dearth of online mental health services in China, and investors see a sector that is full of promise.
Putting people at Ease and shaping mental wellness in China
Demand for counseling services swelled during the pandemic when in-person social interactions evaporated, and many people in China felt lonelier than ever. Online counseling gained popularity; the platforms promised privacy, they were easy to access, and there were no other options. One consequence was distance no longer mattered. A patient in a small town in central China could speak with a therapist in Beijing or Shanghai. And with therapy sessions taking place in one’s own home, the stigma of seeking mental health support was lifted.
If those habits in China persist, Ease may see the same degree of success enjoyed by Calm’s meditation and mindfulness app in the west. Calm’s valuation is now north of USD 2 billion. Now, it is hoping to duplicate that accomplishment in China’s vast, relatively untapped mental health market. “Chinese users have always been enthusiastic early adopters of digital platforms. If Ease can do a good job of localizing in the Chinese market, it will have success in the future,” Alexander Will, Calm’s chief strategy officer, told 36Kr.
For apps like Ease to improve their offerings and offer consistent, clinical-level counseling, they will need to cultivate services that provide more than wellness and recruit personnel with proper medical qualifications. This needs to be paired with a sustainable monetization model too. Although Ease is still in its early phases and setting out to prove its value to general users across China, the company must expect an uphill battle in the near future if its aim is to develop the same name recognition as Calm.
Paying for counseling is a significant departure from the dominant attitude toward mental health in Chinese society. Generally, people choose to or are pressured into concealing their illnesses or conditions for fear of judgment or discrimination from others. But a general awareness about the importance of mental health is slowly permeating through the population. People are seeking resources to develop new understandings of the problems they face, and in turn, seek the help they need.
Early movers in the mental health app space in China include startups like Now Meditation. Founded in 2016, the app had more than 4 million users as of March 2020, reporting a surge in downloads during the pandemic. Now Meditation already reached profitability in 2018 and will provide stiff competition for Ease, with similar functions related to stress relief, improving sleep, and meditation.
Ease charges 25 yuan, or just under four dollars, for a premium subscription that includes an expanded content library with audio stories that are updated weekly. Subscribers can also attend scheduled meditation sessions with other users. While the price point is more affordable than the average in-person therapy session with a qualified counselor, which ranges from RMB 400–700 (USD 63–110), cultivating repeat business from China’s thrifty consumers is more of a long-term ambition.
For now, apps like Ease are providing China’s stressed-out youth with a digital solution that might help them cope with the challenges of modern life.
Will Chinese students turn to apps to overcome post-pandemic blues?
The COVID-19 pandemic prompted a resurgence in mental health in the wider public discourse, as citizens had to endure the isolation of lockdowns and other disruptions to normal life. Younger Chinese, especially adolescents contending with the immense pressure to excel in public exams, are feeling the detriments to their mental health. In all, 24.6% of Chinese adolescents suffered from some degree of depression in 2020, per a report on mental health from the Chinese Academy of Sciences released in March, with over 7% experiencing serious symptoms.
But there is cause for optimism. In stark contrast to their parent’s generation, people born after 1990 are more willing to discuss mental health and display a desire to seek help, according to a study from Changsha University. “It is up to the next generation to accept and embrace mental health and try and erase the stigma surrounding it. Apps like Ease can help spread awareness, which is important in changing attitudes,” Zhang said.