Editor’s note: This is the first part of a two-part article that addresses the efforts of the People’s Liberation Army (PLA) to deal more effectively with the challenges of mental health, which can have serious impacts on the morale and readiness of individual service members—and therefore, on the combat readiness of the PLA as a whole. Part 1 of this article will provide a summary overview of psychological issues in the PLA as revealed by internal surveys and assessments by Chinese military medical personnel, as well as discussion of the policy responses under consideration by PLA leaders. Part 2 of the article, to appear in our next issue, will provide a more detailed examination of the stresses presented by particular operating environments, and the resulting impacts on the psychological health of service members assigned to those environments.
The soldiers of the Chinese People’s Liberation Army (PLA) have consistently been represented in official propaganda as the best of Chinese society: brave, loyal and dedicated individuals always on guard to protect the national interest. The image of PLA soldiers presented in Chinese media is one of selfless individuals ready to sacrifice for the people, and resolute fighters overcoming all difficulties in training for war. However, like any other member of society, soldiers are emotional human beings rather than cold, steely war machines. Beyond the fierce public image, what is going on in the minds of PLA service members when serving out their daily duties?
The PLA is now giving more attention to the morale and mental well-being of service members and their families. One possible explanation for this is that the PLA high command has recognized the challenges it faces regarding military mental health: according to studies conducted by China’s leading military psychologists, over a quarter of service members in the PLA—which has not fought a war since 1979—are experiencing some kind of psychological problem.  This is a percentage comparable to the U.S. military, which has been engaged in global combat operations for nearly two decades (U.S. Defense Health Agency, January 2017).
Writing in the Journal of Third Military Medical University, China’s most esteemed military psychologist Feng Zhengzhi, and co-author Liu Xiao, state that a service member’s mental health is defined by “the service member’s adaptation to the military environment in a positive and cheerful way. This is specifically expressed in good cognition, positive and stable emotions, noble feelings, strong will, good character and harmonious interpersonal relations.”  This definition stresses the importance of a service member’s coping mechanisms, and the ability to adapt to a fast-changing military environment. Especially useful are the six criteria used to assess the mental wellbeing of a service member: cognition, emotion, feelings, will, character and interpersonal relations.
Military mental health is a topic rarely explored topic in the field of PLA studies, but it is critical to troop morale and combat readiness—and therefore to overall military capabilities. Given the high tempo, intensity, and stressful nature of modern warfare, military mental health cannot be disregarded. This article is focused on several key questions: What is the state of mental well-being in the PLA? What are the trends and patterns? Why do problems persist? What are the challenges facing leaders seeking to ameliorate the situation? And, how are the challenges being addressed amid China’s comprehensive military reforms?
Research for this article draws extensively from medical and mental health surveys conducted by Chinese military doctors. This research contends that despite major reforms to the military system since 2016, old problems still exist in the realm of military mental health, to include: shortages of mental health service professionals; conflicting leadership interests; a lack of high-level attention in improving the mental health care system; and disagreements between competing advocates of professional psychological assistance and ideological conditioning. Notably, reform in the PLA’s mental health sector has adopted a bottom-up strategy, wherein the top leadership has given theater commands a free hand in devising solutions to mental health problems.
Trends in PLA Mental Health as Revealed by Comprehensive Surveys
To produce an accurate picture of mental health patterns and challenges among its two million members, the PLA requires comprehensive surveys. The most extensive and recent survey of PLA mental health is one published by Feng Zhengzhi and colleagues in September 2016. The researchers interviewed 53,847 service members, who were randomly chosen from 56 units among five components of the PLA: the Army, Navy, Air Force, Rocket Force, and Strategic Support Force.  The surveys indicated that 29.7 percent of respondents experienced “various kinds of minor adverse psychological reactions” (gezhong qingwei de buliang xinli fanying, 各种轻微的不良心理反应). Moreover, 7.1 percent of interviewees showed signs of “obviously visible mental problems” (mingxian xinli wenti, 明显心理问题). These rates were higher compared to the previous major survey in 2005, which found the prevalence of mental problems among 14,300 PLA service members to be 16.5 percent. 
Female PLA service members have a higher prevalence of mental health problems (36.5 percent) than their male counterparts (28.6 percent). This differs from previous studies, where female service members consistently scored better than male service members with respect to mental problem prevalence. This anomaly is possibly due to ongoing military reforms, which are drastically altering the roles of female service members. Combat-focused restructuring has increased training intensity and downsized the numbers of non-combat personnel in entertainment and other roles (China Brief, October 16, 2016). Furthermore, the traditional burdens of maintaining a professional life and family obligations have also been augmented as a result of the ongoing changes, which have impacted women more than men. 
When ranked by service, the Strategic Support Force turns out to be the healthiest mentally, followed by the Army, Navy, Air Force and Rocket Force. This is likely due to the highly educated backgrounds of Strategic Support Force members, a less pressured work environment, and a less physically demanding training program.  Compared to the Strategic Support Force, the Army, Navy, Air Force and Rocket Force face heavier demands in physical aptitude. Furthermore, their work environments are sometimes found in remote locations such as remote windswept plateaus, far-flung islets, underground facilities, etc.  (These factors will be addressed further in the second part of this article.)
When categorized by grades, the study finds that cadets and officers have higher mental health scores than noncommissioned officers and enlisted personnel. This is likely due to the relative number of negative experiences that noncommissioned officers and enlisted personnel encounter in the military: their lack of decision-making power in training, job assignment, upper level management, family affairs, and their own future career all create stress. 
A study assessing major life events among 10,505 PLA and People’s Armed Police (PAP) service members also produced informative results. As an immediate source of stress, the report’s authors define life events (shenghuo shijian, 生活事件) as “various forms of life changes that people experience in the natural environment and in daily social life, such as promotion, divorce, death of relatives and friends, chronic diseases and sudden traumatic experiences.”  Studies have concluded that negative life events are closely associated with depression and suicide in the Chinese military. 
The report finds that 50.4 percent of respondents have experienced at least one negative life event when serving in the armed forces.  One in five interviewees are stressed about future employment, and believe that their current workload is heavy. The top five negative experiences are: pressure to secure long-term employment (19.1 percent); heavy academic and professional workload (17.8 percent); getting punished or criticized (14.6 percent); family difficulties (12.1 percent); and dissatisfaction with work or academic performance (12 percent). 
Members of the Navy tend to have more experiences with both positive and negative life events, while PAP troops have the least. Currently, the Navy is going through tremendous changes, with sailors training harder and going further abroad in their missions. However, the Navy also receives better benefits packages and high prestige, which explains the Navy’s lead in experiencing both positives and negatives. The PAP’s ties to local areas and ability to receive timely social support explain why its members experience the least number of negative life experiences. 
Causes of Existing Problems
According to one study, 90 percent of PLA service members interviewed would like to learn more about psychology, 77 percent would like to know more about their own mental well-being, 67 percent hope to receive psychological training, and around 20 percent are interested in speaking to a psychiatrist.  This proves that demand for professional mental health service is strong in the Chinese armed forces. However, the PLA is facing complications in the realm of mental health services: namely, the shortage of mental health service professionals, conflicting leadership interests, and a lack of high-level attention in improving mental health services.
As of now, the number of trained military mental health workers is insufficient. In the PLA, there are about 700 professional mental service staff (zhuanye de xinli fuwu renyuan, 专业的心理服务人员); 2,700 part-time psychiatrists (jianzhi xinli yisheng, 兼职心理医生); 4,000 psychological “backbone cadres” (xinli gugan, 心理骨干) (i.e., trained service members who provide mental health services at the platoon and squad level); and 2,800 certified national second-level counselors (guojia erji xinli zixunshi zige, 国家二级心理咨询师资格).  In other words, there is only one counselor per 714 PLA service members, and one psychiatrist per 740. Additionally, not all staff have received long-term professional training. Investigation of one work unit discovered that those with extended experience make-up only 14.3 percent of all counselors.  Fifty-seven percent of mental health service staff are part-time political workers, and 28.6 percent hold a part-time position in some other technical office. Furthermore, ten percent of staff are self-trained. 
These numbers tell us that the PLA’s mental health staff is a mixed bag of trained, untrained, and self-trained individuals deeply associated with the political work establishment. Historically, political and ideological indoctrination have been used in the PLA as a substitute for counseling. Today, political work departments still lead mental health work in the PLA, and there is an ongoing debate between two opposing camps on how better to approach military mental health. The faction supporting the modern clinical approach appears to winning, but the school of prioritizing political and ideological indoctrination nonetheless has its supporters. 
The Leadership Response and Reform Experiments
A recent article penned by General Han Weiguo (韩卫国), the Commander of the PLA Army, demanded that service members must take leave and return home under three circumstances: when their parents are ill and dying, when their spouse is about to give birth, and when their children are going to take school entrance examinations. The article goes so far as to propose investigating service members who do not take good care of family members (CNR News, January 31, 2018). General Han’s article shows a noteworthy shift in thinking from previous times, when PLA service members were asked to sacrifice their own “small family” for the sake of the nation.
Although the armed forces reforms have a top-down approach with the Central Military Commission in the lead, reforms in the mental health service sector have been led by theater commands (zhanqu, 战区). Theater commands have been allowed to experiment with their own models of mental health service and to formulate their own mental health-related regulations, and they have produced a range of creative models. The most popular organizational model is one where professional psychiatrists work at the division, brigade and regimental level; counselors work at the battalion and company level; and mental “backbone cadres” serve at the platoon and squad level (PLA Daily, May 20, 2018).
Helping service members de-stress after extensive work and training is first on the reform agenda. In the 80th Group Army of the Northern Theater Command, special forces are taking popular yoga courses to relax their minds and bodies (China Youth, December 30, 2017). One Army combined brigade has created games not only to help service members relax, but also to build team spirit and mutual support between soldiers.  Mental health seminars and group therapy services are also being offered to service members. The military has also enlisted the help of outside mental health professionals as part of its “double support” (shuangyong, 双拥) initiative to strengthen ties between the military and civilian mental healthcare communities. Psychologists and psychiatrists have been invited to give talks at military units, and to provide counseling and treatment to the troops (The Fourth School of Clinical Medicine, May 22, 2018). In October 2018, Central Theater Command Air Force established its Mental Health Service Center (xinli fuwu zhongxin, 心理服务中心)—the first institution of such kind in the PLA Air Force—to centralize leadership in “counseling services, psychological emergency support, mental backbone cadre training, work guidance, and decision-making reference” (People’s Daily, October 12, 2018).
Mental resilience training is also being conducted to condition troops for the shocking horrors of war. In the Eastern Theater Command, virtual reality technology is being employed to train troops for battle (PLA Daily, January 17, 2017). In the 73rd Group Army in Xiamen, soldiers drill in specially built facilities with blood-spattered chambers and mannequins with gruesome wounds aimed to desensitize warfighters. Soldiers must face their fears in driving over dummies resembling fallen comrades, fight dizziness in rocking containers, learn how to calmly defuse explosives, and toughen up their minds by sleeping over at an unkempt graveyard (Sohu Military, June 13, 2018).
While the effectiveness of current reform measures will be proven in time, existing mental health problems will have multiple short-term implications. In spite of rapid advancements in hardware capabilities, the PLA’s wartime effectiveness could be impacted by persistent mental health issues. Although unmanned combat systems are on the rise, human combatants will continue to play the leading role in warfighting, and the high stress of a future conflict could add enormous pressure to PLA soldiers.
Within the PLA, modern ways of conceptualizing and grappling with military mental health have so far prevailed over traditional methods that emphasize political and ideological indoctrination. However, the latter approach still has supporters in the military establishment. Furthermore, the shortage of trained mental health workers, and the political work establishment’s continuing leadership role in mental health affairs, are both major hurdles for constructing a modern military mental health system. Current reform efforts, which have adopted a bottom-up approach, are conducive to encouraging experimentation in military mental health practices. Ultimately, however, further policy support from the Central Military Commission is needed—both to support successful models, and to tackle serious issues such as mental health stigma and discrimination.
Zi Yang is a Senior Analyst at the China Programme, S. Rajaratnam School of International Studies, Nanyang Technological University, Singapore. Follow him on Twitter @ZiYangResearch.
 Zhengzhi Feng et al., “Woguo junren zhengzhuang zipingliang biao 2016 ban changmo de jianli” [Establishment of Norm of Symptom Check List 90 (2016 edition) for Chinese Military Personnel], Journal of Third Military Medical University No. 20 (2016), p. 2211.
 Zhengzhi Feng and Xiao Liu, “Zhong-Mei junren xinli jiankang gainian, pingjia he xunlian bijiao fenxi” [China and US Military Mental Health: A Comparative Analysis on Concepts, Evaluation and Training], Journal of Third Military Medical University No. 22 (2015), pp. 2218–2219.
 Feng et al., “Establishment of Norm of Symptom Check List 90 (2016 edition) for Chinese Military Personnel,” p. 2211.
 Feng et al., “Establishment of Norm of Symptom Check List 90 (2016 edition) for Chinese Military Personnel,” pp. 2213–2214.
 Ibid., p. 2214.
 Ran Yu et al., “Junren shenghuo shijian renkouxue tedian fenxi” [Analysis of the Demographic Characteristics of Life Events in the Chinese Military], Translational Medicine Journal No. 4 (2016), p. 235.  Haobo Wang et al., “Fuxing shenghuo shijian dui Zhongguo nanxing junren zisha yinian yingxiang de duoxinsu yanjiu” [Multi-factor Study on Effects of Negative Life Events on Male Service Members’ Suicidal Ideation], Space Medicine & Medical Engineering No. 3 (2015), p. 179.
 Yu et al., “Analysis of the Demographic Characteristics of Life Events in the Chinese Military,” p. 236.
 Ibid., p. 237.
 Shaobing Huang, Kaichen Huang and Zaiwang Xia, “Jiceng xinli fuwu gongzuo xianzhuang ji tantao” [The Status Quo and Discussion of Grassroots Psychological Service Work], Disaster Medicine and Rescue (Electronic Edition) No. 1 (2017), p. 57.
 Wenjun Chen, “Junnei wangluo yachuanboquan shiyu xia de xinli fuwu” [Psychology Service Under Perspective of Sub-transmission Circle of Military Network], Journal of Military Transportation University No. 7 (2017), p. 78.
 Huang, Huang and Xia, “The Status Quo and Discussion of Grassroots Psychological Service Work,” p. 57.
 Shuying Hui and Wenxing Zhou, “Zuohao xinxihua zhanzheng zhong de jundui shiqi jili gongzuo” [Doing Better in Morale Motivation during Informationized War], Theoretical Studies on PLA Political Work No. 2 (2017), pp. 98–99.
 “Lujun mou hechenglü jiji kaizhan xinli fuwu gongzuo” [A Certain Combined Brigade of the Army Actively Carrying out Mental Service Work], Sohu Military, published December 23, 2017. Available at http://www.sohu.com/a/212302624_600540.