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A hotline operator for a free counselling service answers a phone while wearing a face mask, as the country is hit by an outbreak of the novel coronavirus, in Shenyang, Liaoning province, China.STRINGER/Reuters

Tens of millions of people in China are still under lockdown to prevent the spread of a deadly virus. Many more have been unable to return to work. Businesses have begun to teeter into bankruptcy. Censors have struck critical comments from the internet.

But even as Chinese authorities restrict avenues for public expression and gainful employment, they have opened a raft of counselling hotlines and online psychological assistance services. Across China, thousands have been appointed to help people in distress with offers of free therapy that can also blunt public anger – which is dangerous to the rule of a central government that has made “psychological harmony” one of its objectives.

“The state wants to make you feel like it not only cares about your body, not only cares about your material needs, it also cares about your mind,” said Hsuan-Ying Huang, a scholar at the Chinese University of Hong Kong who has studied the development of psychotherapy in China.

In late January, just three days after authorities effectively shut down Wuhan, the city at the epicentre of the novel coronavirus outbreak, the Chinese Psychological Society published advice on providing psychological assistance in the middle of an epidemic.

A week later, China’s State Council, the country’s cabinet, issued a notice requiring provincial regions to create a psychotherapy hotline and local regions to publicize it. “Free 24-hour psychological service is required,” it said. Local officials, trade unions, women’s federations and provincial psychology groups raced to comply. More than 60 universities opened hotlines for teachers and students. Across the country, governments posted cellphone numbers for volunteer therapists.

In Wuhan, the Coronavirus Psychological Consulting Hotline has 72 operators to pick up calls and 200 counsellors to provide help. “People are mainly working from home and taking shifts to answer the phone calls. The work is 24/7. We must keep the line available to people at all times, every day,” said Xiao Jinsong, who chairs the Hubei Psychological Consultant Association.

Epidemics give rise to uncertainty and stigmatize the ill, often producing a heavier mental-health burden than other illnesses. Anxiety, insomnia, panic attacks and even psychotic symptoms are common. During the SARS outbreak, almost 60 per cent of those hospitalized were diagnosed with a psychiatric disorder, while a third of those who were quarantined experienced symptoms of post-traumatic stress and depression.

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In Wuhan and surrounding Hubei province, in particular, “people are suffering from heavy psychological pressure,” Dr. Xiao said.

For years, Chinese planners have sought to build up mental-health services in the country, often battling stigmas among those reticent to seek help for non-physical ailments.

Epidemics and other disasters have played a key role in that effort. The first major government-backed push for psychotherapy hotlines came during the SARS outbreak in 2003, Prof. Huang said. A devastating earthquake in Sichuan province in 2008 and a deadly bullet train crash in 2011 were also met with offers of free therapy. “This has become quite routinized,” he said.

Outside crises, meanwhile, demand for such services has risen rapidly. Over the past two decades, some 1.3 million people in China have obtained state-issued counselling certificates through courses whose brevity – as short as two months – has put their effectiveness into question. But roughly 100,000 people currently practise counselling, Prof. Huang said.

For Chinese authorities, the rise of such services has become useful. Domestic scholars and state media have pointed to the value of psychological support for “stability maintenance,” the term used to describe the wide-reaching Communist Party imperative to maintain social control and quell challenges to its rule. The Feb. 2 notice from the State Council says hotlines should be established both to provide support and to “prevent extreme events caused by psychological pressure.”

If “the public’s negative emotions are continually bottled up, an out-of-control situation may break out,” Wu Zhengyan, director of a mental-health services centre at the Guangji Hospital in Suzhou, told state media. It’s a question of maintaining stability, he said.

At the same time, the COVID-19 outbreak has led to widespread hardship.

“For many people in Wuhan, the psychological trauma may be much more difficult to cure than the virus,” one person wrote on China’s Twitter-like Weibo service. Alongside the angst was anger at official narratives that have lionized heroism and diminished suffering. “People need to vent, they need to cry, they need to complain, they need to be comforted,” one person wrote. “The pain in Wuhan is not relieved by shouting slogans.”

Living under lockdown for more than 40 days in Wuhan has left Sail Yuan, 22, desperate. “So many days locked at home, who can bear this?” he said. COVID-19 has left “so many people on the brink of mental collapse,” he said, particularly among those unable to earn a living.

Mr. Yuan has no interest in calling a hotline. “Psychological assistance to ease the pressure of a mortgage and car loan payment? That won’t bring much help.”

He’s not alone. The Wuhan hotline overseen by Dr. Xiao has been in operation since Jan. 23. It is designed to help people across Hubei, a province of 58 million, but has received fewer than 1,800 calls.

“It may not be clear to some how talking about the anxiety and stresses associated with issues of quarantine and employment at this time is beneficial,” said Vickie Mays, a clinical psychologist at the University of California, Los Angeles, who has written about the development of mental-health services in China. “Individuals want answers from companies who have sent them home for weeks or a month to know if they will have a job when they return.”

Still, the hotlines proliferate. At one established by trade unions and women’s groups in the northern Shanxi city of Shuozhou, 70 professionals have been brought on to take calls.

“They would call us for advice or simply tell us what is annoying them,” said Xie Jun, who leads the Shuozhou Psychological Health Consultant Centre. He plans to maintain the hotline for at least six months.

“Many people still haven’t realized they might be affected by negative emotions,” he said. “My goal is to encourage them to speak out.”

With reporting by Alexandra Li

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