# Participation for mental health service development in China: Conditions, challenges, facilitators, and outcomes

## TL;DR

This study explores how people with mental illnesses in China can help shape their own mental health services, despite a traditionally top-down system.

## Contribution

It identifies specific conditions and strategies that enabled participatory service development in a paternalistic mental health context.

## Key findings

- Participation relied on local change-makers, trust, and institutional support.
- Service users faced challenges like comprehension and technology barriers.
- The process led to more culturally responsive services and shifts in professional attitudes.

## Abstract

This study analyzes a participatory project to develop peer support services for people with serious mental illnesses (SMIs) in China. Drawing on interviews with psychiatrists, social workers, service users, and a family caregiver, it examines the conditions, challenges, facilitators, and outcomes of participation in a paternalistic context unfamiliar with such approaches. Participation was made possible by local calls for change, personal trust, and institutional endorsements. Challenges included service users' difficulties understanding technical materials, reticence in group settings, technology barriers, and limited institutional support. To address these, professionals adjusted meeting formats and communication styles, offered emotional and material support, and helped service users engage with project content. Participants recommended including government officials and expanding the team's diversity in future efforts. The process produced a culturally responsive manual integrating diverse stakeholder perspectives, particularly those of service users. It also fostered emerging shifts in professional reflexivity, service user empowerment, and mutual relationships, setting the stage for second‐order change. However, participation remained shaped by structural inequalities and lacked sufficient institutional backing for long‐term transformation. This case highlights the potential and limits of participatory processes in hierarchical systems and offers strategies to make them more inclusive and transformative for disabled populations in China and beyond.

Studied participatory service development in China's paternalistic mental health system.Participation hinged on change‐makers, trust, and backing from institutional authorities.Challenges included service user reticence, comprehension, and tech issues rooted in marginalization.Professionals supported participation by offering space, respect, and individualized support.Participation shaped responsive services and shifted attitudes, capacities, and relationships.

Studied participatory service development in China's paternalistic mental health system.

Participation hinged on change‐makers, trust, and backing from institutional authorities.

Challenges included service user reticence, comprehension, and tech issues rooted in marginalization.

Professionals supported participation by offering space, respect, and individualized support.

Participation shaped responsive services and shifted attitudes, capacities, and relationships.