The roles of mental health education teachers (MHETs) in China: A content analysis of policy documents

The roles of mental health education teachers (MHETs) in China: A content analysis of policy documents | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article The roles of mental health education teachers (MHETs) in China: A content analysis of policy documents Huabing Liu, Xingyu Cai, Nayila Tuerxun This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6870592/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 13 You are reading this latest preprint version Abstract In China, Mental Health Education Teachers (MHETs) are the primary agents responsible for implementing school-based mental health education, yet growing policy attention has intensified ambiguity and conflict regarding their roles. Although previous studies have explored these role-related challenges, most rely on personal experiences and lack alignment with current policy frameworks. We thereby investigated the roles prescribed to MHETs in national mental health education policies through a content analysis of 29 policy documents issued between 2012 and 2024. Findings reveal five core roles: Instructor, Guide, Monitor, Counselor, and Collaborator. The emphasis on each role varies according to the psychological needs of three student groups: all students, students with general psychological problems, and students with severe psychological problems. While policy has long prioritized instruction, guidance, and counseling, recent documents increasingly highlight psychological monitoring and home–school–community collaboration. We have also made comparisons with school counselors in Western countries, which provide additional context for understanding the unique aspects of the MHET roles in China. These findings help clarify MHET responsibilities, mitigate role ambiguity and conflict, and promote more effective mental health education practices. The study also calls for more comprehensive policy frameworks that articulate the roles and responsibilities of MHETs, as well as enhanced pre-service and in-service training to support their professional development. Social science/Education Social science/Psychology Figures Figure 1 Figure 2 Figure 3 1. Introduction In China, Mental Health Education Teachers (MHETs) are the primary agents of mental health education and play a critical role in enhancing its quality (Deng et al., 2018 ; Guo & Zhang, 2021 ). As China places greater emphasis on student mental health, MHETs in K-12 education are assuming expanded roles and garnering increased attention in China. The Healthy China—Action Plan for Children and Adolescents’ Mental Health (2019–2022) , issued by National Health Commission (NHC) and other departments in 2019, underscored the significance of youth mental health as a vital part of China’s national health strategy such as the Healthy China Initiative (NHC et al., 2019). In April 2023, the Action Plan for Comprehensive Strengthening and Improvement of Student Mental Health in the New Era (2023–2025) , released by Ministry of Education (MOE) and other 16 departments, set target ratios for schools to staff MHETs and promoted diverse strategies for their professional growth (MOE et al., 2023). Within this context, academic research has increasingly focused on the professional landscape of MHETs, examining their work conditions, competencies, and pathways for professional growth (Guo & Zhang, 2021 ; Ruan & Zhang, 2024 ; Zhou et al., 2024 ). Despite ongoing improvements in policies and studies, Chinese MHETs continue to face significant challenges in practice. Research highlights several obstacles to their professional growth, including limited access to training resources, difficulties in career promotion, high levels of job-related stress, and insufficient societal recognition (Fan & Du, 2024 ; Ruan & Zhang, 2024 ; Zhao, 2019 ). These challenges severely impact their work performance, career motivation and psychological well-being. Among these issues, role ambiguity and conflict are particularly prominent (Bian et al., 2018; Cui, 2009 ; Wang, 2004 ; Xu & Tao, 2021 ). The lack of formal, standardized job definitions and professional guidelines leaves many MHETs without a clear understanding of their roles (Huang, 2007 ; Liu & Gu, 2004 ). On the other hand, existing studies also reveal considerable variability in how MHETs and other stakeholders, such as administers and homeroom teachers, perceive and interpret their roles and responsibilities (Deng et al., 2018 ; Qiu & Wei, 2022 ; Wang et al., 2015 ), leading to diverse and often inconsistent operational models, which further exacerbate role conflict. Such role ambiguity and conflict may hinder MHETs’ ability to effectively balance their multifaceted duties, which not only diminishes their teaching efficacy and the quality of student support but also poses a significant barrier to improving student mental health outcomes. 1.1 Who are Mental Health Education Teachers? The term Mental Health Education Teacher (MHET) may be relatively unfamiliar to scholars outside of China, while it is increasingly common in Chinese educational and mental health context. It was first officially proposed in 2002 in the Guidelines for Mental Health Education in Primary and Secondary Schools , which standardized the term “Mental Health Education” in national and provincial policies and formally introduced “Mental Health Education Teacher” in policy framework (MOE, 2002a ). This term refers to teachers who possess professional knowledge and skills and responsible for mental health education in China (MOE, 2002b ). The Guidelines for Mental Health Education in Primary and Secondary Schools (Revised in 2012) explicitly stipulated that at the primary and secondary education level “each school should be equipped with at least one full-time or part-time MHET”, which significantly promoted the development of the MHET workforce in primary and secondary schools (MOE, 2012 ; Ye & Ye, 2020 ). It is also advocated in academia that the standardized term “Mental Health Education Teacher” should replace previous terms such as “Psychological Teacher” and “Mental Health Teacher” (Ruan & Zhang, 2024 ). In this study, we use this term and specifically focus on MHETs working within the primary and secondary school context. The primary objective of MHETs is to enhance students’ mental health, foster positive and healthy psychological qualities, and promote their overall well-being (MOE, 2012 ). In Western countries such as United States and Canada, term “School Counselor” is a common term used to refer to certificated educators in pre-K-12 school context who work for the success of all students through implementing school counseling programs (American School Counselor Association, ASCA, 2019 ; Canadian Counselling and Psychotherapy Association, 2014 ). Historically, it has been thought that Chinese MHETs and school counselors differ only in nomenclature, and that MHETs often look to school counselors as reference for their professional development (Hong, 2008 ; Wang, 2004 ). However, it is crucial to recognize the distinct role and significance of MHETs. Despite the overlapped duties with school counselors, MHETs possess unique characteristics and functions that warrant specific consideration in both research and practice. For instance, Chinese MHETs are mandated to deliver mental health courses regularly in classroom setting (Guo & Zhang, 2021 ; MOE, 2012 ; Tan & Peng, 2021 ). Although school counselors in Western countries are also tasked with the development, design, and delivery of the school counseling curriculum, they are not required to be the sole instructors and the curriculum is not confined to the classroom environment (ASCA, 2019 ; Nelson & Tarabochia, 2020 ). Beyond specific duties, the expected roles of Chinese MHETs may also differ from those of school counselors in Western countries. For example, in the Chinese sociocultural and instructional context, teachers are perceived as role models and moral agents, and are expected to garner respect both inside and outside the classroom (Lai et al., 2015 ), while school counselors in Western cultures are expected to be more supportive and accepting (ASCA, 2019 ). While MHETs differ significantly from school counselors, existed research on mental health educators primarily centers on school counselors and is rooted in Western psychological theories. As a result, findings from these studies may not accurately reflect the reality of Chinese MHETs and could even lead to misconceptions about their roles and effectiveness. Therefore, we aim to address the research gap by focusing specifically on MHETs within the Chinese educational context, examining their unique roles and responsibilities, and offering actionable insights to inform policy and practice in the professional development of MHETs. 1.2 Role ambiguity and conflict among MHETs MHETs in China have long faced role ambiguity and conflict, which hinder their motivation, smooth fulfillment of responsibilities, and professional development (Hong, 2008 ; Kang & Wan, 2017 ; Wang, 2004 ). Role theory posits that roles significantly influence individuals’ attitudes and behaviors (Allen & van de Vliert, 1984; Bates & Harvey, 1975 ; Turner, 1979 ). A role is commonly defined as a set of behavioral expectations associated with a specific position within an organized social structure, such as an organization or community (Merton, 1957 ; Stryker, 2007 ). These expectations, often prescriptive and external, guide behavior, shape role occupants’ self-perception, and can be negotiated through social interactions (Sluss et al., 2011 ). Role ambiguity, marked by unclear or incomplete expectations, and role conflict, arising from the simultaneous presence of incompatible expectations (Biddle, 1986 ), are particularly detrimental. These challenges can lead to heightened stress, diminished job performance, reduced creativity, and increased resignation rates (Tang & Chang, 2010 ; Wu & Norman, 2006 ; Zhou et al., 2014 ). For a prolonged time, MHETs have experienced role conflicts with administrators, moral education teachers, and subject teachers (Huang, 2007 ; Liu & Gu, 2004 ). Some MHETs identify themselves primarily as subject teachers who disseminate psychological knowledge, inadvertently neglecting the development of students’ mental health literacy (Huang, 2007 ). Others fail to distinguish between moral education and mental health education, prioritizing discipline and management over respect and communication, which erodes students’ trust in MHETs (Liu & Gu, 2004 ). These conflicts often result in MHETs taking on additional moral education and administrative duties, which greatly increases their workload (Fan et al., 2013 ; Zhou et al., 2024 ). However, mental health education differs fundamentally from moral education and student management. The former requires educators to remain value-neutral, avoid judgments, and not compel compliance, while the latter entails clear value orientations, public evaluation of student behavior, and guiding students to adhere to specific norms (Liu & Gu, 2004 ; Wang, 2004 ). Furthermore, there is ongoing debate about whether MHETs should assume the role of counselors, with some advocating that the counseling work of MHETs should be limited to adaptive and developmental guidance, while others emphasize their unique advantages over professional counselors in addressing psychological issues among primary and secondary school students (Xu & Tao, 2021 ). In addition to the unclear or conflicting perceptions MHETs may have about their own roles, there are also discrepancies in how school administrators, homeroom teachers, and other stakeholders view these roles. MHETs emphasize individual and group counseling, while administrators focus on high-efficiency, wide-reaching mental health programs or lectures. (Deng et al., 2018 ). As another key player in mental health education, homeroom teachers are primarily responsible for managing classroom dynamics, and their sensitivity to specific psychological problems is generally lower than that of MHETs (Deng et al., 2020 ). Additionally, many homeroom teachers and administrators still undervalue the role of MHETs, often reducing their responsibilities to simply chatting with students. This perception severely undermines the motivation and enthusiasm of mental health teachers (Cheng & Liang, 2010 ). These role perception discrepancies among stakeholders point to a lack of communication. It is thus crucial to clarify the roles of MHETs and their relationships with homeroom teachers and other stakeholders, strengthen communication and coordination, and improve the quality of school-family cooperation (Deng et al., 2020 ). 1.3 Role frameworks of MHETs and school counselors Existing research has identified a range of roles that MHETs perform in their professional contexts. As advisors for student learning, they guide students in navigating academic challenges while addressing psychological needs (Huang, 2003 ; Lin & Wei, 2001 ). They also act as vocational guides, helping students explore career paths and personal development opportunities (Lin & Wei, 2001 ). A significant aspect of their work involves serving as instructors who design and implement mental health education courses tailored to the needs of their students (Chen, 2018 ; Liu, 2019 ; Wang, 2017 ). Additionally, MHETs perform the role of counselors, providing individualized support to students facing psychological problems (Hong, 2008 ; Huang, 2003 ; Wang, 2017 ). Beyond these functional roles, MHETs are also expected to be role models for psychological well-being who embody positive mental health practices (Cui, 2009 ; Fan, 2016 ). They advocate for the mental health of all students, championing the importance of a healthy school environment (Bian et al., 2018; Liu, 2019 ). MHETs also collaborate extensively with teachers and parents to implement holistic approaches to student well-being (Bian et al., 2018; Fan, 2016 ). They are expected to act as supporters of moral education, reinforcing ethical behavior among students (Lin & Wei, 2001 ). As assistants to homeroom teachers, they provide guidance on managing student’ emotional and psychological needs (Gao, 2021 ; Wang, 2017 ). Despite the valuable insights provided by existing studies on the roles of MHETs, several gaps and limitations warrant attention. Many of these studies rely heavily on personal observation or experiences, which may lack empirical rigor and fail to capture the complexities of MHETs’ professional roles and responsibilities. Additionally, some findings are contradictory, such as the emphasis on MHETs as both counselors and assistants to homeroom teachers, which may sometimes create practical conflicts. Certain proposed roles, like serving as role models for psychological well-being, may appear outdated or impractical in the modern educational context. Moreover, the prescribed roles often fail to align with the evolving realities of contemporary school mental health, leaving MHETs struggling to balance their diverse responsibilities effectively. Role ambiguity and conflict is also prevailing among school counselors, resulting in non-counseling duties that detract them from concentrating on counseling duties and cause heightened stress, higher burnout and reduced job performance (Astramovich et al., 2013 ; Liberman, 2004). The introduction of comprehensive school counseling programs like the ASCA National Model provides school counselors with well-defined structures to guide their counseling activities with students (Dahir, 2004 ; Dollarhide & Saginak, 2017 ). For instance, the ASCA National Model divides counselor responsibilities into quadrants: foundation, management, delivery, and accountability, and recommends that 80% or more of a school counselor’s time be spent directly related to the delivery of services to students (ASCA, 2019 ). These structured frameworks significantly mitigate role ambiguity and conflict by offering clear guidelines on the scope of school counselors’ responsibilities and prioritizing activities directly related to student support. This clarity empowers counselors to advocate for their role within the school system, ensuring their time and expertise are utilized effectively (Havlik et al., 2019 ). Research shows that school counselors in schools implementing the ASCA model experience improved job satisfaction, reduced burnout, and enhanced counseling outcomes for students (Dahir, 2004 ; Gysbers & Stanley, 2014 ). However, directly adopting the ASCA model in China may not be feasible due to differences in role expectations, cultural factors, and resource constraints. Instead, China can gain valuable insights from the ASCA model while recognizing the need to adapt it to local contexts. Unlike the United States, where a unified framework exists, China currently lacks an official, standardized prescription for the roles of MHETs. Given the pivotal importance of educational policies in shaping practices within the Chinese education system, role expectations outlined in policy documents provide a crucial foundation for understanding and guiding the work of MHETs. 1.4 This study To address the role ambiguity and conflict among Chinese MHETs, we aim to clarify and synthesize their roles as prescribed in Chinese national policies. By anchoring the analysis in official frameworks, we seek to provide a more systematic understanding of MHET responsibilities and roles, bridging the gap between theoretical propositions and practical implementation. This policy-based approach will offer clearer role definitions and actionable recommendations, ensuring MHETs’ contributions align with national goals and the evolving needs of modern education. Additionally, clarifications at the policy level can help build consensus among MHETs, students, parents, and other stakeholders, creating a more supportive environment for MHETs’ professional development. This study also contributes to a deeper understanding of the unique roles and responsibilities of Chinese MHETs within the global context, promoting international collaboration in school counseling and advancing the development of school mental health professionals worldwide. In this study, we plan to address following research questions: Research Question 1 What specific responsibilities are delineated for MHETs in current Chinese mental health education policies? Research Question 2 What roles are outlined for MHETs in current Chinese mental health education policies? 2. Method In this study, we utilized a content analysis approach (Krippendorff, 2018 ) to code the prescribed responsibilities and roles of Chinese MHETs outlined in Chinese educational policy documents. Content analysis is a commonly used method for systematically analyzing textual materials to uncover patterns and themes (Bowen, 2009 ). By classifying words in texts into content categories, researchers can gain a condensed yet comprehensive description of a phenomenon and conduct further analysis (Elo &Kyngäs, 2008 ). 2.1 Data collection and inclusion criteria To find relevant policy documents, we used “student mental health”, “mental health education” and “mental health education teachers” as keywords respectively to search on the websites of the State Council, the Ministry of Education, and the National Health Commission of the People’s Rebuplic of China. These governmental bodies are primary authorities overseeing mental health education in China, with their websites serving as primary platforms for disseminating relevant policy documents, as noted in previous research (Yu & Ju, 2018 ). Policy documents included in the study were limited to those published between January 1, 2012 and December 1, 2024. The year 2012 was chosen as a starting point due to the issuance of the Guidelines for Mental Health Education in Primary and Secondary Schools (Revised in 2012) , a pivotal policy document guiding mental health education development over the past decade (Yu & Ju, 2018 ; Dong & Yu, 2024 ). Additionally, China’s mental health education policies underwent significant development around 2012, characterized by a transition towards diversified and legally institutionalized frameworks (Wang et al., 2019 ; Yu & Ju, 2018 ). Therefore, analyzing policies enacted after 2012 can offer deeper insights into the current state of Chinese mental health education and the roles of MHETs. Furthermore, included policy documents should meet the following criteria: 1) They must be regulatory policies; policy interpretations, news reports, and conference announcements were excluded. 2) They must pertain to primary and secondary education; policies focused solely on higher education were excluded. The screening and inclusion process followed the PRISMA guideline framework (Moher et al., 2010 ) to ensure a systematic and transparent selection of relevant policies. Initially, a keyword search yielded 2,265 policy documents. During the first stage, we excluded 2,002 documents that were either non-regulatory policies or unrelated to mental health education in primary and secondary schools. Next, we conducted a detailed review of the remaining policies and excluded 235 documents that did not contain content explicitly related to the responsibilities or roles of MHETs. This step left 28 policies for inclusion. To ensure no relevant documents were overlooked, we manually checked the results and identified one additional policy issued by the Ministry of Education in May 2024, which was subsequently included. This brought the final total to 29 policies, as depicted in Fig. 1 . Figure 1 Screening and inclusion process following PRISMA guideline 2.2 Data analysis and inter-coder reliability The coding process adhered to the framework proposed by Elo and Kyngäs ( 2008 ), involving three phases: preparation, organization, and reporting. During the preparation phase, we thoroughly reviewed the policy documents to familiarize ourselves with the data and identify the analysis unit, which was determined to be sentence. In the organization process, we first documented 148 text segments related to MHET responsibilities as initial codes. Building on this, we grouped these codes to form categories, resulting in seven sub-categories pertaining to MHET responsibilities. We further consolidated closely related responsibilities, ultimately synthesizing them into five main categories that represent the primary roles of MHETs. Throughout the coding process, we encountered challenges due to the nuanced nature of Chinese policy discourse. Some sentences within the policies lacked explicit subjects, or only addressed responsibilities of schools, without clearly specifying whether these responsibilities fell under the duties of MHETs or other teachers. To address this ambiguity, we employed two strategies: Given that MHETs are the direct implementers of school mental health education (Deng et al., 2018 ), we assumed that responsibilities assigned to schools in the policies necessitated the involvement of MHETs. Consequently, we coded all responsibilities articulated with “school” as the subject. For unresolved responsibilities, we sought consultation with a MHET with approximately ten years of experience working in a secondary school in China. To ensure reliability, the coding process was conducted by two graduate students majoring in education, both of whom had experience in content analysis. Inter-coder reliability was calculated according to the guidelines set by O’Connor and Helene (2020). Both coders participated in two training sessions to improve coding consistency. In the first session, the coders independently coded five sample documents and then discussed any discrepancies or challenges that arose. This process resulted in a 90.8% inter-coder agreement, which exceeds the commonly accepted threshold for qualitative research (Krippendorff, 2018 ). In the second session, the coders revisited the discrepancies identified in the initial coding, addressed problematic areas, and clarified any questions with their supervising tutor. The remaining documents were then evenly distributed between the two coders. Each coder independently analyzed their assigned documents, ensuring consistent application of the agreed-upon coding criteria. While efforts were made to ensure reliability, we acknowledge potential sources of bias, such as differences in how coders interpreted the nuanced language of the policies or the contextual differences between documents. Additionally, one of the researchers, who is also the supervising tutor of the coding, has an academic and professional background in psychology in the United States and may have interpreted Chinese policies through the framework of American school counselors’ roles and responsibilities. To mitigate this potential bias, the coding responsibility was assigned to the other researcher, who did not have this specific background, and a collaborator. Moreover, regular communication and clarification were maintained throughout the coding process to ensure consistency and accuracy. 3. Results and discussion The names of included policy documents, issuing institutions, and publication years are listed in Table 1 . Table 1 Basic information of included policies No. Year Issued by Policies Z1 2012 SC 1 Opinions on Further Promoting the Balanced Development of Compulsory Education Z2 2012 SC Opinions on Standardizing the Layout Adjustment of Rural Compulsory Education Schools Z3 2012 MOE 2 Notice on Issuing Guidelines for Mental Health Education in Primary and Secondary Schools (Revised in 2012) Z4 2012 NHC 3 Guidelines for Mental Health Education in School Z5 2013 MOE et al. Opinions on Strengthening Care and Education for Left-behind Children in Rural Areas during the Compulsory Education Stage Z6 2013 MOE Notice on Issuing Guidelines for Implementing the Spirit of the 18th National Congress of the Communist Party of China in Moral Education Courses in Secondary Vocational Schools Z7 2014 MOE Notice on Issuing Guidelines for Moral Education in Secondary Vocational Schools (Revised in 2014) Z8 2014 MOE Opinions on Further Strengthening Moral Education in primary and secondary Schools to Cultivate and Practice the Socialist Core Values Z9 2014 SC Notice on Issuing National Plan for Child Development in Poverty-Stricken Areas (2014–2020) Z10 2014 MOE Notice on Implementing the Initiative for Establishing Model Schools for Mental Health Education in Primary and Secondary Schools Z11 2015 MOE Notice on Issuing Guidelines for the Construction of Counseling Rooms in Primary and Secondary Schools Z12 2016 SC Opinions on Strengthening Care and Protection for Left-Behind Children in Rural Areas Z13 2016 SC Notice on Conducting Special Intervention of School Bullying Z14 2016 MOE et al. Guidelines on Preventing Bullying and Violence in Primary and Secondary Schools Z15 2017 SC Notice on Issuing National Education Development Plan (2016–2020) Z16 2017 SC Youth Development Plan (2016–2025) Z17 2017 NHC et al. Opinions on Strengthening Mental Health Services Z18 2017 MOE Notice on Issuing Guidelines for Moral Education in Primary and Secondary Schools Z19 2018 NHC et al. Notice on Issuing the Pilot Work Plan for the National Social Mental Health Service System Construction Z20 2019 NHC et al. Notice on Issuing Healthy China - Action Plan for Children and Adolescents’ Mental Health (2019–2022) Z21 2021 MOE Notice on Issuing Action Plan for Preventing Bullying in Primary and Secondary Schools Z22 2021 MOE Notice on Strengthening Student Mental Health Administration Z23 2021 MOE Regulations on the Protection of Juveniles in Schools Z24 2021 SC Guidelines on Children Development (2021–2030) Z25 2021 MOE Notice on Issuing National Compulsory Education Quality Monitoring Plan (Revised in 2021) Z26 2021 MOE Notice on Launching the Work for Promoting High-Quality and Balanced Compulsory Education at the County Level Z27 2022 MOE Action Plan for the Prevention and Treatment of Prominent Psychological Problems Among Students during COVID-19 Pandemic Z28 2023 MOE et al. Notice on Issuing Action Plan for Comprehensive Strengthening and Improvement of Student Mental Health in the New Era (2023–2025) Z29 2024 MOE Notice on Launching the First National Student Mental Health Promotion and Education Month 1 SC = State Council of the PRC 2 MOE = Ministry of Education of the PRC 3 NHC = National Health Commission of the PRC After data coding and analysis, we identified a total of 148 codes related to the responsibilities of MHETs. From these, we coded seven main responsibilities and five primary roles of Chinese MHETs. Table 2 demonstrates the frequency of MHETs’ primary roles and respective responsibilities. “Frequency” refers to the number of occurrences of each responsibility across all included policies, while “Number of policies mentioning this responsibility” indicates the number of policies mention the particular responsibility. Table 2 Roles, responsibilities of MHETs and the frequency across included policies Roles Responsibilities Frequency Numbers of policies mentioning the responsibility Instructor Teach courses in mental health 38 17 Guide Offer developmental guidance 24 15 Monitor Assess and record student mental health 20 9 Counselor Provide counseling 20 12 Collaborator Collaborator I: Support 15 10 Collaborator II: Liaison 7 6 Collaborator III: Emergency response coordinator 24 9 Figure 2 illustrates the distribution of MHETs’ roles across different student groups. Based on the varying degrees of students’ psychological problems, we categorized the student groups into three levels: all students, students with general psychological problems, and students with sever psychological problems, and use three concentric circles to visually reflect their hierarchical and inclusive relationship. Notably, the term “psychological problems” is adopted because it is a direct translation of the wording used in the original policy text. Our classification method is similar to the one used in the U.S. Multi-Tiered System of Supports (MTSS) (ASCA, 2019 ; Stoiber & Gettinger, 2015). In our model, the roles of MHETs at each level can be further divided into two categories: direct roles and indirect roles. The direct roles are located on the left side of each circle, including Instructor, Guide, Monitor, and Counselor. These roles require direct interaction with students, providing face-to-face services such as education, guidance and counseling. The indirect role, Collaborator, is located on the right side of each circle, and is divided into Supporter, Liaison and Emergency Response Coordinator, with each corresponding to the respective student group. This role emphasizes the interaction and collaboration between MHETs and parties outside the student group, aiming to create a supportive environment conducive to student mental health through multi-party cooperation. Figure 2 Multiple roles of MHET across different student groups As shown above, the primary roles of MHETs outlined in included policies are Instructor, Guide, Counselor, Monitor, and Collaborator. The following sections will delve into a more detailed description of each role, exploring their specific responsibilities and the extent to which they are addressed in relevant policies. 3.1 Instructor: Teach courses in mental health Instructor is one of the most important and unique roles of Chinese MHETs. The corresponding responsibility, “Teach courses in mental health,” has 38 codes, accounting for 25.7% of the total number of codes, making it the most frequently mentioned responsibility. Among the 29 policies, 17 mention this role, with the first reference appearing in Z3 (2012). This role refers to educators responsible for teaching mental health courses in schools, whose primary task is to impart mental health knowledge to students through curriculum design and delivery. Course instruction serves as the primary avenue for conducting mental health education in primary and secondary schools. MHETs should “base their instruction on the local or school curriculum systems” (Z3, 2012). Generally, each class should “have one mental health lesson every two weeks” (Z10, 2014). The core curriculum content encompasses basic mental health knowledge and methods, such as “emotional regulation, interpersonal communication, learning to learn, life and growth” (Z27, 2022). Meanwhile, MHETs are expected to tailor the curriculum to suit different age groups and school types. For instance, primary school curricula may focus on “self-awareness and sexuality”, while secondary school curricula extend to “character and personality, career planning, emotion regulation and adolescent mental health, etc”. And vocational schools should emphasize “psychological qualities related to career development” (Z4, 2012). In cases of significant events, such as campus bullying, or under special circumstances like COVID-19 pandemic, MHETs are required to adapt their teaching to address students’ unique needs. For example, Z27 (2022) stipulates that during the pandemic, MHETs should: Use a variety of methods to spread knowledge and skills related to pandemic prevention, helping students learn to cope rationally with the setbacks and difficulties caused by the pandemic, and avoid excessive worry or panic. Additionally, MHETs should adopt diverse pedagogical methods and emphasize experiential learning and the application of knowledge when delivering courses (Z3, 2012). They can also leverage community resources including public cultural institutions, mental health service centers, and youth centers to organize various practical activities (Z3, 2012; Z18, 2017). To enhance the quality of mental health education, MHET is also encouraged to actively engage in research activities. This includes attending research conferences or workshops, receiving expert supervision (Z3, 2012), and conducting educational research on the mental health of children and adolescents (Z3, 2012; Z10, 2014; Z11, 2015; Z20, 2019). The role of Instructor holds particular significance for Chinese MHETs. Unlike school counselors in the United States, Chinese MHETs are mandated to place greater emphasis on teaching mental health courses. In 2017, the MOE introduced mental health education in the Teacher Qualification Examinations for primary, middle, high schools, and secondary vocational schools, which required MHETs to obtain the Mental Health Education Teacher Qualification Certificate before assuming their positions (MOE, 2017 ). The emphasis on delivering courses significantly differs from the training focus and primary responsibilities of school counselors. For instance, in the United States, the main duties of middle school and high school counselors do not include instruction though courses (Trolley, 2011 ). According to the 2024 Council for Accreditation of Counseling and Related Education Programs (CACREP) Standard, key areas of foundational counselor preparation curriculum do not encompass curriculum design and delivery. Additionally, the topic of school counseling curriculum and lesson plan development is mentioned only once in this document (p.24). In contrast, a textual analysis of mental health education policies across 31 provinces in China reveals that “curriculum development” is a central keyword in Chinese policies (Tan & Peng, 2021 ). Furthermore, mental health education courses are recommended to be based on direct experiences and emphasize student participation and reflection (Yu & Hou, 2015 ; Yu, 2024 ), thereby imposing unique requirements on MHETs’ pedagogical skills. Current challenges in course design and implementation include unclear course objectives, insufficient class hours, lack of standardized and high-quality teaching materials, monotonous teaching methods, and low teacher quality (Lin et al, 2022 ; Zhang & Wang, 2018 ). 3.2 Guide: Offer developmental guidance Guide is one of the core roles of Chinese MHETs, reflecting its proactive and central position in implementing mental health education. As Guides, MHETs are expected to offer developmental guidance to all students. This responsibility is mentioned in 15 policies, with the earliest appearance in Z3. The related codes amount to 24, accounting for 16.2% of the total codes. MHETs play a proactive role in supporting students’ psychological well-being, addressing their needs promptly to prevent psychological problems. This proactive approach aligns with the principle of positive psychology that emphasizes the prevention of mental illnesses through fostering positive psychological qualities (Bian et al., 2018; Meng, 2008 ). As Guide, MHETs’ primary responsibilities include providing developmental guidance in areas such as “academics, daily life, interpersonal relationships, and career development” (Z7, 2014; Z22, 2021). As outlined in Z7: [MHETs should] provide guidance or assistance to address potential psychological problems students may encounter in areas such as academics, daily life, and career development, strengthen care and support to cultivate students’ positive psychological qualities and promote their overall mental and physical well-being. When providing guidance, MHETs should prioritize a combined approach of universal student care with tailored supports for specific student groups, involving economically-disadvantaged students, children from single-parent or migrant households, left-behind rural children, students with learning difficulties, and victims of school bullying (Z5, 2013; Z9, 2014; Z18, 2017; Z20, 2019; Z24, 2021; Z29, 2024). When possible, they may also offer developmental guidance to students’ family members and school staff, such as supporting third-year high school students and their parents facing academic pressure (Z20, 2019). In addition to preventing psychological problems, another key goal of MHETs as Guide is to foster a school environment conducive to students’ mental health. To achieve this, they can adopt various approaches, such as organizing student psychology clubs (Z4, 2012; Z10, 2014), conducting mental health promotion activities (Z4, 2012; Z17, 2017; Z29, 2024), and carrying out themed mental health education activities (Z10, 2014; Z29, 2024). For example, Z10 (2014) states: Each semester, diverse mental health education activities should be organized though mental health education months, student psychology clubs, school bulletin boards or broadcasts, television, and online platforms, creating a positive atmosphere for mental health education. The most prominent characteristic of Guide is its proactive and preventative approach. Both MHETs and school counselors emphasize a proactive stance in their work. For example, within the MTSS framework, programs provided for students who are in the general education population (Tier 1), such as social-emotional learning (SEL) programs, reflect a preventative nature of school counseling (Stoiber & Gettinger, 2015). Similarly, in other multi-tiered school counseling systems in the United States, such as Response to Intervention (RTI), school counselors are also required to serve in a proactive and accountable manner (Ockerman et al., 2012 ). Their interactions with students primarily take place in classrooms, large groups, small groups, and individual settings, using direct engagement to influence students’ attitudes and behaviors (ASCA, 2019 ; Berg et al., 2017 ). In China, while the MHET-to-student ratio is comparatively lower, efforts are being made to enhance proactive mental health education in schools despite existing challenges. A 2024 survey of 422 primary and secondary schools in Shanghai showed that approximately 64% of schools were staffed with only one full-time MHET, who is confronted with common challenges include heavy non-counseling burdens and limited contact with students (Wang et al., 2024 ). However, China has been actively addressing these issues by improving policy support and gradually enhancing the allocation of MHETs. MHETs have also leveraged broader platforms such as mental health promotion activities and mental health months to deliver school-wide mental health education. 3.3 Monitor: Assess and record student mental health Another key role of MHETs targeting all students is Monitor. As Monitor, MHETs are required to conduct and record student mental health assessment regularly. This responsibility is mentioned in nine policies, first appearing in Z3 in 2012. There are 20 relevant codes, accounting for 13.5% of the total codes. Regular mental health monitoring is crucial for safeguarding students’ psychological well-being. MHETs are responsible for assessing mental health status of all students and, when possible, teachers as well (Z11, 2015; Z19, 2018; Z23, 2021; Z28, 2023). These assessments help identify potential mental health issues and facilitate targeted interventions (Z11, 2015). Additionally, the analysis of assessment results serves as a foundation for effective prevention and management of mental health crises (Z21, 2021). MHETs are expected to conduct at least one assessment per year for students in upper primary, junior high, senior high, and secondary vocational schools (Z28, 2023). In conducting assessments, MHETs must adhere to ethical guidelines, exercise caution when using testing scales, and refrain from coercing students into undergoing assessments. The use of any instruments that could potentially harm students’ mental well-being is strictly prohibited (Z3, 2012). Additionally, MHETs are responsible for ensuring the security and confidentiality of assessment data (Z27, 2022; Z28, 2023). Besides external evaluation, MHETs can also encourage students to engage in self-assessments using common psychological scales for children and adolescents (Z27, 2022). When analyzing data, a comprehensive approach should be taken, considering factors such as academic performance, social interactions, and family dynamics (Z27, 2022). After completing assessments, MHETs are required to systematically document results to establish “student mental health profile” for each student. This profile should include basic personal information of students, assessment results, and intervention plans. According to Z27 (2022): Student mental health profiles and a list of major psychological problems should be established. For each student with severe psychological issues, [MHETs should] maintain a targeted profile to ensure thorough and precise mental health support. Our analysis indicates that the role of Monitor has received increasing policy attention in recent years, particularly in the wake of the COVID-19 pandemic. Notably, Z27 (2022), introduced as a key initiative to address students’ psychological problems during the pandemic, explicitly positioned mental health assessment as a core component of its objectives. In the post-pandemic era, policies such as Z28 (2023) have further institutionalized mental health assessment practices by promoting the normalization and standardization of psychological monitoring, along with the widespread adoption of student mental health profiles. The role of Monitor receives special attention in China, since understanding the mental health status of students and identifying potential psychological problems are fundamental to improving students’ psychological well-being (Xiong et al., 2021 ). While school counselors in countries such as the United States also conduct assessments, their scope extends beyond social-emotional development to encompass academic progress and career planning. For instance, ASCA National Model designates “Appraisal and Advisement” as one of three key direct student services of school counselors, requiring them to “analyze and evaluate students’ abilities, interests, skills, and academic achievements”, and “provide recommendations [...] to support future decision-making” (ASCA, 2019 , p. 148). This responsibility emphasizes helping students gain insight into their interests and strengths, plan their academic and career paths, and access relevant resources (Levy & Lemberger-Truelove, 2021 ). On the contrary, in China, the primary concern of conducting psychological assessments is to understand students’ psychological status, identify underlying mental health issues, and provide a basis for improving related counseling and teaching practices (Xiong et al., 2021 ). Furthermore, school counselors typically conduct assessments on an individual or small-group basis, rather than organizing assessments for all students, whereas Chinese policies emphasize comprehensive, school-wide assessments. Despite its importance, psychological monitoring in China still faces several challenges, including mismatches between psychological assessment tools and students’ real-life experiences, inconsistency and lack of scientific rigor in assessment result analysis, and heavy workloads for MHETs (Ye, 2018 ; Zhang et al., 2021 ). Scholars have been exploring the use of artificial intelligence and Internet-based technologies to facilitate the implementation of psychological assessments (Gao et al., 2020 ; Jiang et al., 2021). 3.4 Counselor: Provide counseling When students encounter psychological or developmental problems, MHETs should promptly intervene, taking on the role of Counselor. Out of the 29 reviewed policies, 12 reference this role, with the earliest mention found in Z1. This role is associated with 20 codes, making up 13.5% of the total. As Counselor, MHETs are responsible for applying professional counseling knowledge and skills to provide scientifically effective counseling for students in need (Z3, 2012). All students are entitled to counseling services provided by MHETs. However, unlike the role of Guide, which is featured by the proactive and preventative nature, the role of Counselor highlights corrective interventions after identifying psychological problems. In this capacity, MHETs support students experiencing psychological issues through individual or group counseling (Z10, 2014; Z11, 2015). For instance, Z11 (2015) prescribes: [MHETs should] provide individual and group counseling to help students address and resolve psychological and behavioral issues related to learning, life, self-awareness, emotional adjustment, interpersonal relationships, and further education or employment. In China, the primary setting for providing counseling is the school counseling room, which must be open for at least 10 hours per week for individual or group counseling (Z10, 2014). During counseling sessions, MHETs are required to maintain comprehensive records, including analyses, intervention plans, and evaluations of counseling outcomes (Z10, 2014). Similar to school counselors, MHETs do not provide long-term therapy. If a student’s psychological issues require specialized clinical intervention, MHETs should facilitate referrals to external professionals (Z11, 2015). As Counselor, MHETs’ primary responsibility is to intervene when students show signs of psychological problems. However, unlike school counselors, MHETs must navigate the dual roles of both Counselor and Instructor, and often need to balance counseling duties with responsibilities in moral education. Given that Chinese policies place great emphasis on the teaching duties of MHETs, they may carry authoritative attitudes from the classroom into counseling sessions, which can undermine the sense of equality and inclusivity essential for effective psychological support (Yang, 2014 ). Additionally, in China, mental health education is considered an integral part of moral education (Z3, 2012). As Counselor, MHETs are expected to integrate moral education values into their practice (Yu & Jin, 2022 ). However, research suggests that disciplinary approaches in counseling may reduce its effectiveness and hinder the development of a trusting counselor-student relationship (Liu & Gu, 2004 ; Liu & Xue, 2021 ; Yang, 2014 ). Additionally, excessive moral education responsibilities may increase MHETs’ workload. The ASCA ( 2019 ) explicitly states that “performing disciplinary actions” is an inappropriate duty for school counselors, as it interferes with their ability to address students’ psychological needs (p. 130). However, Chinese MHETs are often expected to take on moral education or even homeroom teacher duties in practice (Zhang et al., 2020 ). Furthermore, many school mental health offices are supervised by the moral education department (Peng et al., 2021 ), which may intensify conflicts between their counseling duties and administrative or disciplinary expectations. 3.5 Collaborator Collaborator is an important role of MHETs in coordinating internal and external resources to enhance student mental health. As collaborator, MHETs engage with a diverse array of collaborators, including guardians, school staff, and medical institutions. Overall, this role is mentioned in 14 policies, with the first reference in Z1. The associated coding count is 46, accounting for 31.1% of the total coding count. 3.5.1 Collaborator I — Supporter: Provide supportive resources To promote psychological well-being of all students, MHET empowers key stakeholders, guardians and school staff, by equipping them with supportive resources. Studies show that parent-child relationships and the school environment are crucial micro-system variables influencing adolescent mental health (Elgar et al., 2013 ; Chapman et al., 2013 ; Yu et al., 2018 ). Accordingly, MHETs, as professionals in school mental health education, are expected to offer supportive resources to enhancing these stakeholders’ ability to address students’ psychological needs and effectively manage related challenges. Supportive resources include mental health training, guidance on addressing psychological issues, and written materials on student mental health (Z3, 2012; Z10, 2014; Z20, 2019; Z27, 2022; Z28, 2023; Z29, 2024). For example, Z20 (2019) mandates that MHETs should “organize at least one annual mental health training session for parents during parent-teacher meetings”. 3.5.2 Collaborator II — Liaison: Promote communication about student mental health When students exhibit mental health or developmental problems, MHETs are required to promptly inform guardians and homeroom teachers. This responsibility not only aligns with the Mental Health Law of the People’s Republic of China (SC, 2018 ), but also helps coordinate family and school resources to address psychological concerns effectively (Z22, 2022; Z27, 2023). If students have been diagnosed with psychological disorders, MHETs should also inform guardians of the intervention plan (Z23, 2021). In the United States, confidentiality is recognized as a foundational principle in counseling practice (American Counseling Association, 2014 ). In the Chinese context, this principle is explicitly outlined in both the professional ethical guidelines for counselors (Chinese Psychological Society, 2018 ) and the Mental Health Law of the People’s Republic of China (SC, 2018 ). However, adolescents’ limited developmental capacity to accurately assess risks, articulate their experiences, or care for themselves may hinder their ability to disclose potential harmful situations (Ren et al., 2024 ). In such cases, the Law of the People’s Republic of China on the Protection of Minors mandates that MHETs report any suspected threats to a minor’s physical or psychological well-being to the appropriate authorities without delay (SC, 2020 ). In alignment with this legal framework, our reviewed policies further stipulate that if a student exhibits behavior harmful to themselves or others, MHETs should override confidentiality and inform both the homeroom teacher and guardians promptly (Z11, 2015; Z22, 2021; Z23, 2021). 3.5.3 Collaborator III — Emergency Response Coordinator: Facilitate referral and crisis management When students’ mental health problems are assesed at high risk, MHETs are responsible for promptly referring them to professional mental health institutions (Z3, 2012; Z10, 2014; Z11, 2015; Z20, 2019). Due to the limited medical resources available in schools and the often insufficient expertise of MHETs to address complex psychological problems, referrals are essential to ensure that students receive the appropriate treatment (Yang, 2013 ). Additionally, timely referrals help make better use of external resources and promote the integration of education and healthcare (Zhang, 2016 ). During the referral process, MHETs are required to maintain detailed records, assist parents with the referral, and collaborate with professional institutions. For instance, Z11 (2015) mandates: For students with serious mental disorders, or when other referral needs are identified, they should be promptly referred to the relevant medical institutions. The referral process must be thoroughly documented, and a tracking and feedback system should be established. When a student’s mental health issues lead to crisis, MHETs need to cooperate with school staff to manage the situation effectively. Reviewed policies primarily address crises such as bullying (Z14, 2016), student self-harm or harm to others (Z11, 2015; Z27, 2022), and major emergencies triggered by natural disasters, accidents, or public health events (Z28, 2023). In the crisis intervention process, MHETs work alongside school administrators, homeroom teachers, and medical staff (Z27, 2022), with moral education directors and grade team leaders also playing important roles (Cao, 2017 ; Lin et al, 2023 ). MHETs are primarily responsible for providing short-term interventions and supporting long-term recovery (Z3, 2012; Z11, 2015; Z14, 2016; Z27, 2022; Z28, 2023). Collaborator is also a central role of school counselors, reflected in various responsibilities such as serving on school/district committees, organizing parent workshops, and taking on leadership roles in crisis response (ASCA, 2019 ). A key similarity between school counselors and Chinese MHETs in collaboration is their shared focus on providing supportive resources and emphasizing timely communication with relevant parties, in order to foster a conducive environment for student mental health. However, there are notable differences in the collaborative practices. Unlike the systematic and institutionalized structures in the United States, such as school counseling advisory councils (ASCA, 2019 ), Chinese schools have yet to establish similar permanent committees dedicated to student mental health. In some cases, schools do not even have a specialized mental health department (Peng et al., 2021 ; Zhang et al., 2016 ). While school counselors in the United States are typically expected to assume leadership roles during crises (ASCA, 2016 ), Chinese MHETs often play a supportive role in such situations. During crises, parents are most commonly perceived as the primary agent of intervention, followed by key school personnel such as homeroom teachers and school administrators, and then MHETs or psychologists (Gao et al., 2023 ). The organization and leadership of crisis intervention teams in Chinese schools are typically handled by administrators, such as principals or vice principals (Cao, 2017 ; Pang, 2009 ), with MHETs mainly providing support rather than leadership (Cao et al., 2021 ; Cui & Xie, 2018 ). Their responsibilities include crisis detection, short-term intervention, timely reporting, and referral assistance (Cao et al., 2021 ; Ju et al., 2022 ). Additionally, due to their involvement in moral education and subject teaching, MHETs often face challenges in fully dedicating themselves to mental health services (Peng et al., 2021 ; Zhang et al., 2016 ). This dual role, coupled with their marginalization within school structures, may limit their ability to effectively initiate or guide mental health initiatives (Feng et al., 2024 ). 3.6 The trend of roles Figure 3 The trend of MHETs’ roles in mental health education policies (2012–2024) Figure 3 presents the changes in the coding frequencies associated with different roles of MHETs. As illustrated in Fig. 3 , the frequency of most roles is notably high in 2012 and 2014. This corresponds with the publication of the Guidelines for Mental Health Education in Primary and Secondary Schools (Revised in 2012) , a milestone policy that clearly defined the basic principles, objectives, tasks, main content, approaches, methods, and implementation for mental health education in Chinese primary and secondary schools (Yu, 2018 ). In 2014, multiple policies related to mental health education were issued, including Implementing the Initiative for Establishing Model Schools for Mental Health Education in Primary and Secondary Schools , which has greatly promoted the deepening of mental health education across primary and secondary schools (Yu, 2018 ). Most roles experience a significant decrease around 2015 and 2019. However, there is a general upward trend for all roles during 2020–2021. This likely occurred because during the COVID-19 pandemic, delayed school openings led to increasing academic pressure and family conflicts, which negatively affected the mental health of children and adolescents (Cheng & Liu, 2021 ). As a result, the government increased its focus on mental health in schools and issued documents such as Strengthening Student Mental Health Administration and Action Plan for Comprehensive Strengthening and Improvement of Student Mental Health in the New Era (2023–2025) to standardize mental health education in primary and secondary schools. During this period, the roles of Instructor, Monitor, and Collaborator increased significantly, indicating that recent policies have emphasized the importance of mental health curriculum, mental health monitoring, and collaborative efforts between schools, families, and communities in mental health education. 4. Conclusion and implications By synthesizing the roles and responsibilities of Chinese MHETs as prescribed in national policies from 2012 to 2024, this study provides several significant findings. Firstly, national policies outline Chinese MHETs five primary roles: Instructor, Guide, Monitor, Counselor, and Collaborator. The emphasis on each role varies depending on the specific needs of the student groups they serve. Secondly, policy emphasis has long been placed on delivering mental health courses, providing developmental guidance, and conducting counseling. However, psychological monitoring and home-school-community collaboration have emerged as focal points in recent policies. Thirdly, compared to school counselors in Western countries, Chinese MHETs are expected to place greater emphasis on classroom instruction and school-wide psychological assessment. Moreover, they are expected to undertake supportive rather than leading roles in collaborative efforts. Our study provides valuable insights for MHETs, students, schools, parents and other stakeholders by offering a clearer understanding of MHETs’ roles and responsibilities. This clarity can help mitigate role ambiguity among MHETs, reduce misunderstandings, and promote more effective collaboration in mental health education. Furthermore, this study reveals that some policy statements lack definite subjects, which may result in misinterpretation of MHET roles and practical challenges. Although we attempted to address this issue by referring to relevant literature and consulting front-line MHETs, gaps remain in the clarity and precision of policy language. Additionally, while we have outlined a framework of MHET roles, certain responsibilities, such as the effective utilization of psychological assessment results, are still insufficiently defined in current policies. To address these gaps, we recommend that policymakers develop more specific guidelines, alongside clearer and more precise policy language. Additionally, we encourage further empirical research to deepen the understanding of MHET roles, identify specific challenges in their implementation, and help refine policy frameworks. Finally, our research suggests that existing MHET education and in-service training programs may not fully align with the roles and responsibilities outlined in current policies. For example, while the roles of Instructor, Monitor, and Collaborator are increasingly emphasized, current pre-service and in-service programs are not sufficiently developed to meet these policy requirements. Therefore, we recommend that these programs be more closely integrated with policy priorities, particularly in areas such as classroom instruction, psychological assessments, and home-school-community collaboration. Furthermore, society should provide greater support through resources and professional development opportunities to help MHETs continuously enhance their skills and adapt to the evolving demands of mental health education. 5. Limitations and future directions This study has several limitations that must be taken into account when interpreting the results. Firstly, our analysis is confined to policies issued after 2012, which may exclude earlier documents that shaped the current mental health education landscape and limit the exploration of policy evolution over a longer historical trajectory. Moreover, the implementation and establishment of mental health education policies vary across different Chinese provinces. Analyzing and comparing these provincial policies would be valuable for gaining a comprehensive understanding of the current state of MHETs. While we briefly compared MHETs with school counselors in the United States, which have presented certain unique aspects of Chinese MHETs, these comparisons were not comprehensive enough to fully capture the differences between these two professions across educational systems. Besides, given the variance in socio-cultural contexts, some of these comparisons may introduce some biases. We hope that future research will more thoroughly explore the similarities and differences between MHETs and their counterparts in Western countries, which would deepen our understanding of school mental health in diverse contexts and contribute to the global development of school mental health professionals. Declarations Competing interest The authors declare no competing interests. Funding Declaration Author Contribution H.L. and X.C. drafted the main manuscript text. X.C. searched and included the policy documents used for analysis. X.C. and N.T. conducted the policy coding, under the supervision of H.L. All authors reviewed the manuscript. Data Availability Data is provided within the supplementary information files. References Allen VL, Vliert E (eds) (1984) Role transitions: Explorations and explanations, vol 23. Springer Science & Business Media, New York American Counseling Association (2014) ACA Code of Ethics. 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Surv Educ 10(11):90–93. https:doi.org/10.16070/j.cnki.cn45-1388/g4s.2021.11.024 (In Chinese) Zhang C, Zhao S, Zhang X et al (2020) Occupational cognition investigation and countermeasures of psychological teachers in secondary vocational schools. Communication Vocat Educ, (12):88–93. (In Chinese) Zhang H (2016) Exploring the integration of medical and educational approaches in university mental health services: Evidence from Shanghai universities. Ideological Theoretical Educ 0190–93. https://doi.org/10.16075/j.cnki.cn31-1220/g4.2016.01.016 (In Chinese) Zhang J, Wang B (2018) Problems and strategies in implementing mental health education courses in high schools. J Anyang Normal Univ 03107–109. https://doi.org/10.16400/j.cnki.kjdks.2016.04.085 (In Chinese) Zhang T, Zhang T, Yang Z et al (2016) Research on the current situation of mental health education in middle and small city schools: Take Hebei Hengshui as an example. Educational Psychol 10179–181. https://doi.org/10.16400/j.cnki.kjdks.2016.04.085 (In Chinese) Zhao (2019) Problems and solutions in the professional development of mental health education teachers in primary and secondary schools. Western China Qual Educ 5(08):102–103. https://doi.org/10.16681/j.cnki.wcqe.201908062 (In Chinese) Zhou G, Liu X, Yue Q et al (2024) Investigation and analysis of the current situation of mental health education in primary and secondary schools: A study on mental health education teachers in Changchun). J Changchun Educ Inst 40(01):5–9 (In Chinese) Zhou Y, Zeng W, Hu Y, Xi Y, Tan L et al (2014) The Relationship among role conflict, role ambiguity, role overload and job stress of Chinese middle-level cadres. Chin Stud 3(01):8–11. https://doi.org/10.4236/chnstd.2014.31003 Additional Declarations No competing interests reported. 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18:45:34","extension":"xml","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":211465,"visible":true,"origin":"","legend":"","description":"","filename":"ca09156094b04481a004e60a2ad060821structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-6870592/v1/46dc258f7434de7d5ed94376.xml"},{"id":98625846,"identity":"9942f44e-7d62-40f2-8b5f-664bab5c2989","added_by":"auto","created_at":"2025-12-19 17:09:22","extension":"html","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":221491,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-6870592/v1/79e8de77a1b85355cc000485.html"},{"id":98545251,"identity":"a889d3ff-eccb-45cd-a254-b14c97de4166","added_by":"auto","created_at":"2025-12-18 18:45:34","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":173653,"visible":true,"origin":"","legend":"\u003cp\u003eScreening and inclusion process following PRISMA guideline\u003c/p\u003e\n\u003cp\u003eThis figure illustrates the selection process of policies included in the analysis, following the PRISMA flow diagram (Moher et al., 2010). It presents the number of policy documents identified, screened, assessed for eligibility, and included in the final synthesis. The process was visualized using Microsoft PowerPoint.\u003c/p\u003e","description":"","filename":"Fig.1ScreeningandinclusionprocessfollowingPRISMAguideline.png","url":"https://assets-eu.researchsquare.com/files/rs-6870592/v1/12c226a3849ef947ed7c7166.png"},{"id":98545247,"identity":"277bd8d2-dfae-4668-bb69-91daac893951","added_by":"auto","created_at":"2025-12-18 18:45:34","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":162121,"visible":true,"origin":"","legend":"\u003cp\u003eMultiple Roles of MHET across Different Student Groups\u003c/p\u003e\n\u003cp\u003eThis figure displays the multiple roles of MHETs across three student groups, represented by three concentric circles. For each group, the left half of the circle shows direct roles—those involving direct interaction with students—while the right half shows indirect roles, which support student mental health through engagement with parents, school staff, and other stakeholders. The diagram was created using Microsoft PowerPoint.\u003c/p\u003e","description":"","filename":"Fig.2MultiplerolesofMHETacrossdifferentstudentgroups.png","url":"https://assets-eu.researchsquare.com/files/rs-6870592/v1/d5eb4af919e19c36a146353f.png"},{"id":98626948,"identity":"94b9b593-2e6c-42ea-bb73-828e39672826","added_by":"auto","created_at":"2025-12-19 17:10:03","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":118376,"visible":true,"origin":"","legend":"\u003cp\u003eThe Trend of MHETs’ Roles in Mental Health Education Policies (2012-2024)\u003c/p\u003e\n\u003cp\u003eThis figure shows the evolving emphasis on different MHET roles in mental health education policies from 2012 to 2024. Each colored line represents a distinct role, enabling comparison of trends over time. The line graph was generated using Microsoft Excel.\u003c/p\u003e","description":"","filename":"Fig.3ThetrendofMHETsrolesinmentalhealtheducationpolicies20122024.png","url":"https://assets-eu.researchsquare.com/files/rs-6870592/v1/7bf5a4addccfbf078a8e3804.png"},{"id":98631936,"identity":"251aabec-753e-4f0b-8f1a-cf37f4cfc610","added_by":"auto","created_at":"2025-12-19 17:20:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1422606,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6870592/v1/91ecbc3b-3b93-46f5-8999-d72e93cc60a7.pdf"},{"id":98626092,"identity":"8c126720-1ca7-47cb-9b68-696dd2f5352d","added_by":"auto","created_at":"2025-12-19 17:09:31","extension":"xlsx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":30223,"visible":true,"origin":"","legend":"","description":"","filename":"policycoding.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-6870592/v1/b4d97d17eb063d4c59bc5f44.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"The roles of mental health education teachers (MHETs) in China: A content analysis of policy documents","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eIn China, Mental Health Education Teachers (MHETs) are the primary agents of mental health education and play a critical role in enhancing its quality (Deng et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Guo \u0026amp; Zhang, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). As China places greater emphasis on student mental health, MHETs in K-12 education are assuming expanded roles and garnering increased attention in China. The \u003cem\u003eHealthy China\u0026mdash;Action Plan for Children and Adolescents\u0026rsquo; Mental Health (2019\u0026ndash;2022)\u003c/em\u003e, issued by National Health Commission (NHC) and other departments in 2019, underscored the significance of youth mental health as a vital part of China\u0026rsquo;s national health strategy such as the Healthy China Initiative (NHC et al., 2019). In April 2023, the \u003cem\u003eAction Plan for Comprehensive Strengthening and Improvement of Student Mental Health in the New Era (2023\u0026ndash;2025)\u003c/em\u003e, released by Ministry of Education (MOE) and other 16 departments, set target ratios for schools to staff MHETs and promoted diverse strategies for their professional growth (MOE et al., 2023). Within this context, academic research has increasingly focused on the professional landscape of MHETs, examining their work conditions, competencies, and pathways for professional growth (Guo \u0026amp; Zhang, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Ruan \u0026amp; Zhang, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Zhou et al., \u003cspan citationid=\"CR103\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite ongoing improvements in policies and studies, Chinese MHETs continue to face significant challenges in practice. Research highlights several obstacles to their professional growth, including limited access to training resources, difficulties in career promotion, high levels of job-related stress, and insufficient societal recognition (Fan \u0026amp; Du, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Ruan \u0026amp; Zhang, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Zhao, \u003cspan citationid=\"CR102\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). These challenges severely impact their work performance, career motivation and psychological well-being.\u003c/p\u003e \u003cp\u003eAmong these issues, role ambiguity and conflict are particularly prominent (Bian et al., 2018; Cui, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Wang, \u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e2004\u003c/span\u003e; Xu \u0026amp; Tao, \u003cspan citationid=\"CR87\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). The lack of formal, standardized job definitions and professional guidelines leaves many MHETs without a clear understanding of their roles (Huang, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2007\u003c/span\u003e; Liu \u0026amp; Gu, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2004\u003c/span\u003e). On the other hand, existing studies also reveal considerable variability in how MHETs and other stakeholders, such as administers and homeroom teachers, perceive and interpret their roles and responsibilities (Deng et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Qiu \u0026amp; Wei, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Wang et al., \u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e2015\u003c/span\u003e), leading to diverse and often inconsistent operational models, which further exacerbate role conflict. Such role ambiguity and conflict may hinder MHETs\u0026rsquo; ability to effectively balance their multifaceted duties, which not only diminishes their teaching efficacy and the quality of student support but also poses a significant barrier to improving student mental health outcomes.\u003c/p\u003e \u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003e1.1 Who are Mental Health Education Teachers?\u003c/h2\u003e \u003cp\u003eThe term Mental Health Education Teacher (MHET) may be relatively unfamiliar to scholars outside of China, while it is increasingly common in Chinese educational and mental health context. It was first officially proposed in 2002 in the \u003cem\u003eGuidelines for Mental Health Education in Primary and Secondary Schools\u003c/em\u003e, which standardized the term \u0026ldquo;Mental Health Education\u0026rdquo; in national and provincial policies and formally introduced \u0026ldquo;Mental Health Education Teacher\u0026rdquo; in policy framework (MOE, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2002a\u003c/span\u003e). This term refers to teachers who possess professional knowledge and skills and responsible for mental health education in China (MOE, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e2002b\u003c/span\u003e). The \u003cem\u003eGuidelines for Mental Health Education in Primary and Secondary Schools (Revised in 2012)\u003c/em\u003e explicitly stipulated that at the primary and secondary education level \u0026ldquo;each school should be equipped with at least one full-time or part-time MHET\u0026rdquo;, which significantly promoted the development of the MHET workforce in primary and secondary schools (MOE, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Ye \u0026amp; Ye, \u003cspan citationid=\"CR91\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). It is also advocated in academia that the standardized term \u0026ldquo;Mental Health Education Teacher\u0026rdquo; should replace previous terms such as \u0026ldquo;Psychological Teacher\u0026rdquo; and \u0026ldquo;Mental Health Teacher\u0026rdquo; (Ruan \u0026amp; Zhang, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). In this study, we use this term and specifically focus on MHETs working within the primary and secondary school context.\u003c/p\u003e \u003cp\u003eThe primary objective of MHETs is to enhance students\u0026rsquo; mental health, foster positive and healthy psychological qualities, and promote their overall well-being (MOE, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). In Western countries such as United States and Canada, term \u0026ldquo;School Counselor\u0026rdquo; is a common term used to refer to certificated educators in pre-K-12 school context who work for the success of all students through implementing school counseling programs (American School Counselor Association, ASCA, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Canadian Counselling and Psychotherapy Association, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). Historically, it has been thought that Chinese MHETs and school counselors differ only in nomenclature, and that MHETs often look to school counselors as reference for their professional development (Hong, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Wang, \u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e2004\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHowever, it is crucial to recognize the distinct role and significance of MHETs. Despite the overlapped duties with school counselors, MHETs possess unique characteristics and functions that warrant specific consideration in both research and practice. For instance, Chinese MHETs are mandated to deliver mental health courses regularly in classroom setting (Guo \u0026amp; Zhang, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; MOE, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Tan \u0026amp; Peng, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Although school counselors in Western countries are also tasked with the development, design, and delivery of the school counseling curriculum, they are not required to be the sole instructors and the curriculum is not confined to the classroom environment (ASCA, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Nelson \u0026amp; Tarabochia, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Beyond specific duties, the expected roles of Chinese MHETs may also differ from those of school counselors in Western countries. For example, in the Chinese sociocultural and instructional context, teachers are perceived as role models and moral agents, and are expected to garner respect both inside and outside the classroom (Lai et al., \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2015\u003c/span\u003e), while school counselors in Western cultures are expected to be more supportive and accepting (ASCA, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWhile MHETs differ significantly from school counselors, existed research on mental health educators primarily centers on school counselors and is rooted in Western psychological theories. As a result, findings from these studies may not accurately reflect the reality of Chinese MHETs and could even lead to misconceptions about their roles and effectiveness. Therefore, we aim to address the research gap by focusing specifically on MHETs within the Chinese educational context, examining their unique roles and responsibilities, and offering actionable insights to inform policy and practice in the professional development of MHETs.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e1.2 Role ambiguity and conflict among MHETs\u003c/h2\u003e \u003cp\u003eMHETs in China have long faced role ambiguity and conflict, which hinder their motivation, smooth fulfillment of responsibilities, and professional development (Hong, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Kang \u0026amp; Wan, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Wang, \u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e2004\u003c/span\u003e). Role theory posits that roles significantly influence individuals\u0026rsquo; attitudes and behaviors (Allen \u0026amp; van de Vliert, 1984; Bates \u0026amp; Harvey, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e1975\u003c/span\u003e; Turner, \u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e1979\u003c/span\u003e). A role is commonly defined as a set of behavioral expectations associated with a specific position within an organized social structure, such as an organization or community (Merton, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e1957\u003c/span\u003e; Stryker, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e2007\u003c/span\u003e). These expectations, often prescriptive and external, guide behavior, shape role occupants\u0026rsquo; self-perception, and can be negotiated through social interactions (Sluss et al., \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). Role ambiguity, marked by unclear or incomplete expectations, and role conflict, arising from the simultaneous presence of incompatible expectations (Biddle, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e1986\u003c/span\u003e), are particularly detrimental. These challenges can lead to heightened stress, diminished job performance, reduced creativity, and increased resignation rates (Tang \u0026amp; Chang, \u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Wu \u0026amp; Norman, \u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e2006\u003c/span\u003e; Zhou et al., \u003cspan citationid=\"CR104\" class=\"CitationRef\"\u003e2014\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFor a prolonged time, MHETs have experienced role conflicts with administrators, moral education teachers, and subject teachers (Huang, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2007\u003c/span\u003e; Liu \u0026amp; Gu, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2004\u003c/span\u003e). Some MHETs identify themselves primarily as subject teachers who disseminate psychological knowledge, inadvertently neglecting the development of students\u0026rsquo; mental health literacy (Huang, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2007\u003c/span\u003e). Others fail to distinguish between moral education and mental health education, prioritizing discipline and management over respect and communication, which erodes students\u0026rsquo; trust in MHETs (Liu \u0026amp; Gu, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2004\u003c/span\u003e). These conflicts often result in MHETs taking on additional moral education and administrative duties, which greatly increases their workload (Fan et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Zhou et al., \u003cspan citationid=\"CR103\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). However, mental health education differs fundamentally from moral education and student management. The former requires educators to remain value-neutral, avoid judgments, and not compel compliance, while the latter entails clear value orientations, public evaluation of student behavior, and guiding students to adhere to specific norms (Liu \u0026amp; Gu, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2004\u003c/span\u003e; Wang, \u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e2004\u003c/span\u003e). Furthermore, there is ongoing debate about whether MHETs should assume the role of counselors, with some advocating that the counseling work of MHETs should be limited to adaptive and developmental guidance, while others emphasize their unique advantages over professional counselors in addressing psychological issues among primary and secondary school students (Xu \u0026amp; Tao, \u003cspan citationid=\"CR87\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn addition to the unclear or conflicting perceptions MHETs may have about their own roles, there are also discrepancies in how school administrators, homeroom teachers, and other stakeholders view these roles. MHETs emphasize individual and group counseling, while administrators focus on high-efficiency, wide-reaching mental health programs or lectures. (Deng et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). As another key player in mental health education, homeroom teachers are primarily responsible for managing classroom dynamics, and their sensitivity to specific psychological problems is generally lower than that of MHETs (Deng et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Additionally, many homeroom teachers and administrators still undervalue the role of MHETs, often reducing their responsibilities to simply chatting with students. This perception severely undermines the motivation and enthusiasm of mental health teachers (Cheng \u0026amp; Liang, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). These role perception discrepancies among stakeholders point to a lack of communication. It is thus crucial to clarify the roles of MHETs and their relationships with homeroom teachers and other stakeholders, strengthen communication and coordination, and improve the quality of school-family cooperation (Deng et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e1.3 Role frameworks of MHETs and school counselors\u003c/h2\u003e \u003cp\u003eExisting research has identified a range of roles that MHETs perform in their professional contexts. As advisors for student learning, they guide students in navigating academic challenges while addressing psychological needs (Huang, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2003\u003c/span\u003e; Lin \u0026amp; Wei, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2001\u003c/span\u003e). They also act as vocational guides, helping students explore career paths and personal development opportunities (Lin \u0026amp; Wei, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2001\u003c/span\u003e). A significant aspect of their work involves serving as instructors who design and implement mental health education courses tailored to the needs of their students (Chen, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Liu, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Wang, \u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Additionally, MHETs perform the role of counselors, providing individualized support to students facing psychological problems (Hong, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Huang, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2003\u003c/span\u003e; Wang, \u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Beyond these functional roles, MHETs are also expected to be role models for psychological well-being who embody positive mental health practices (Cui, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Fan, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). They advocate for the mental health of all students, championing the importance of a healthy school environment (Bian et al., 2018; Liu, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). MHETs also collaborate extensively with teachers and parents to implement holistic approaches to student well-being (Bian et al., 2018; Fan, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). They are expected to act as supporters of moral education, reinforcing ethical behavior among students (Lin \u0026amp; Wei, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2001\u003c/span\u003e). As assistants to homeroom teachers, they provide guidance on managing student\u0026rsquo; emotional and psychological needs (Gao, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Wang, \u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite the valuable insights provided by existing studies on the roles of MHETs, several gaps and limitations warrant attention. Many of these studies rely heavily on personal observation or experiences, which may lack empirical rigor and fail to capture the complexities of MHETs\u0026rsquo; professional roles and responsibilities. Additionally, some findings are contradictory, such as the emphasis on MHETs as both counselors and assistants to homeroom teachers, which may sometimes create practical conflicts. Certain proposed roles, like serving as role models for psychological well-being, may appear outdated or impractical in the modern educational context. Moreover, the prescribed roles often fail to align with the evolving realities of contemporary school mental health, leaving MHETs struggling to balance their diverse responsibilities effectively.\u003c/p\u003e \u003cp\u003eRole ambiguity and conflict is also prevailing among school counselors, resulting in non-counseling duties that detract them from concentrating on counseling duties and cause heightened stress, higher burnout and reduced job performance (Astramovich et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Liberman, 2004). The introduction of comprehensive school counseling programs like the ASCA National Model provides school counselors with well-defined structures to guide their counseling activities with students (Dahir, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2004\u003c/span\u003e; Dollarhide \u0026amp; Saginak, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). For instance, the ASCA National Model divides counselor responsibilities into quadrants: foundation, management, delivery, and accountability, and recommends that 80% or more of a school counselor\u0026rsquo;s time be spent directly related to the delivery of services to students (ASCA, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). These structured frameworks significantly mitigate role ambiguity and conflict by offering clear guidelines on the scope of school counselors\u0026rsquo; responsibilities and prioritizing activities directly related to student support. This clarity empowers counselors to advocate for their role within the school system, ensuring their time and expertise are utilized effectively (Havlik et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Research shows that school counselors in schools implementing the ASCA model experience improved job satisfaction, reduced burnout, and enhanced counseling outcomes for students (Dahir, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2004\u003c/span\u003e; Gysbers \u0026amp; Stanley, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). However, directly adopting the ASCA model in China may not be feasible due to differences in role expectations, cultural factors, and resource constraints.\u003c/p\u003e \u003cp\u003eInstead, China can gain valuable insights from the ASCA model while recognizing the need to adapt it to local contexts. Unlike the United States, where a unified framework exists, China currently lacks an official, standardized prescription for the roles of MHETs. Given the pivotal importance of educational policies in shaping practices within the Chinese education system, role expectations outlined in policy documents provide a crucial foundation for understanding and guiding the work of MHETs.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e1.4 This study\u003c/h2\u003e \u003cp\u003eTo address the role ambiguity and conflict among Chinese MHETs, we aim to clarify and synthesize their roles as prescribed in Chinese national policies. By anchoring the analysis in official frameworks, we seek to provide a more systematic understanding of MHET responsibilities and roles, bridging the gap between theoretical propositions and practical implementation. This policy-based approach will offer clearer role definitions and actionable recommendations, ensuring MHETs\u0026rsquo; contributions align with national goals and the evolving needs of modern education. Additionally, clarifications at the policy level can help build consensus among MHETs, students, parents, and other stakeholders, creating a more supportive environment for MHETs\u0026rsquo; professional development. This study also contributes to a deeper understanding of the unique roles and responsibilities of Chinese MHETs within the global context, promoting international collaboration in school counseling and advancing the development of school mental health professionals worldwide.\u003c/p\u003e \u003cp\u003eIn this study, we plan to address following research questions:\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eResearch Question 1\u003c/strong\u003e \u003cp\u003eWhat specific responsibilities are delineated for MHETs in current Chinese mental health education policies?\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eResearch Question 2\u003c/strong\u003e \u003cp\u003eWhat roles are outlined for MHETs in current Chinese mental health education policies?\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"2. Method","content":"\u003cp\u003eIn this study, we utilized a content analysis approach (Krippendorff, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) to code the prescribed responsibilities and roles of Chinese MHETs outlined in Chinese educational policy documents. Content analysis is a commonly used method for systematically analyzing textual materials to uncover patterns and themes (Bowen, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). By classifying words in texts into content categories, researchers can gain a condensed yet comprehensive description of a phenomenon and conduct further analysis (Elo \u0026amp;Kyng\u0026auml;s, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2008\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Data collection and inclusion criteria\u003c/h2\u003e \u003cp\u003eTo find relevant policy documents, we used \u0026ldquo;student mental health\u0026rdquo;, \u0026ldquo;mental health education\u0026rdquo; and \u0026ldquo;mental health education teachers\u0026rdquo; as keywords respectively to search on the websites of the State Council, the Ministry of Education, and the National Health Commission of the People\u0026rsquo;s Rebuplic of China. These governmental bodies are primary authorities overseeing mental health education in China, with their websites serving as primary platforms for disseminating relevant policy documents, as noted in previous research (Yu \u0026amp; Ju, \u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePolicy documents included in the study were limited to those published between January 1, 2012 and December 1, 2024. The year 2012 was chosen as a starting point due to the issuance of the \u003cem\u003eGuidelines for Mental Health Education in Primary and Secondary Schools (Revised in 2012)\u003c/em\u003e, a pivotal policy document guiding mental health education development over the past decade (Yu \u0026amp; Ju, \u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Dong \u0026amp; Yu, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Additionally, China\u0026rsquo;s mental health education policies underwent significant development around 2012, characterized by a transition towards diversified and legally institutionalized frameworks (Wang et al., \u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Yu \u0026amp; Ju, \u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Therefore, analyzing policies enacted after 2012 can offer deeper insights into the current state of Chinese mental health education and the roles of MHETs.\u003c/p\u003e \u003cp\u003eFurthermore, included policy documents should meet the following criteria:\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003e1) They must be regulatory policies; policy interpretations, news reports, and conference announcements were excluded.\u003c/h3\u003e\n\u003cp\u003e2) They must pertain to primary and secondary education; policies focused solely on higher education were excluded.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eThe screening and inclusion process followed the PRISMA guideline framework (Moher et al., \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e2010\u003c/span\u003e) to ensure a systematic and transparent selection of relevant policies. Initially, a keyword search yielded 2,265 policy documents. During the first stage, we excluded 2,002 documents that were either non-regulatory policies or unrelated to mental health education in primary and secondary schools. Next, we conducted a detailed review of the remaining policies and excluded 235 documents that did not contain content explicitly related to the responsibilities or roles of MHETs. This step left 28 policies for inclusion. To ensure no relevant documents were overlooked, we manually checked the results and identified one additional policy issued by the Ministry of Education in May 2024, which was subsequently included. This brought the final total to 29 policies, as depicted in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFigure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e Screening and inclusion process following PRISMA guideline\u003c/p\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Data analysis and inter-coder reliability\u003c/h2\u003e \u003cp\u003eThe coding process adhered to the framework proposed by Elo and Kyng\u0026auml;s (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2008\u003c/span\u003e), involving three phases: preparation, organization, and reporting. During the preparation phase, we thoroughly reviewed the policy documents to familiarize ourselves with the data and identify the analysis unit, which was determined to be sentence. In the organization process, we first documented 148 text segments related to MHET responsibilities as initial codes. Building on this, we grouped these codes to form categories, resulting in seven sub-categories pertaining to MHET responsibilities. We further consolidated closely related responsibilities, ultimately synthesizing them into five main categories that represent the primary roles of MHETs.\u003c/p\u003e \u003cp\u003eThroughout the coding process, we encountered challenges due to the nuanced nature of Chinese policy discourse. Some sentences within the policies lacked explicit subjects, or only addressed responsibilities of schools, without clearly specifying whether these responsibilities fell under the duties of MHETs or other teachers. To address this ambiguity, we employed two strategies:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eGiven that MHETs are the direct implementers of school mental health education (Deng et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), we assumed that responsibilities assigned to schools in the policies necessitated the involvement of MHETs. Consequently, we coded all responsibilities articulated with \u0026ldquo;school\u0026rdquo; as the subject.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eFor unresolved responsibilities, we sought consultation with a MHET with approximately ten years of experience working in a secondary school in China.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eTo ensure reliability, the coding process was conducted by two graduate students majoring in education, both of whom had experience in content analysis. Inter-coder reliability was calculated according to the guidelines set by O\u0026rsquo;Connor and Helene (2020). Both coders participated in two training sessions to improve coding consistency. In the first session, the coders independently coded five sample documents and then discussed any discrepancies or challenges that arose. This process resulted in a 90.8% inter-coder agreement, which exceeds the commonly accepted threshold for qualitative research (Krippendorff, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). In the second session, the coders revisited the discrepancies identified in the initial coding, addressed problematic areas, and clarified any questions with their supervising tutor. The remaining documents were then evenly distributed between the two coders. Each coder independently analyzed their assigned documents, ensuring consistent application of the agreed-upon coding criteria.\u003c/p\u003e \u003cp\u003eWhile efforts were made to ensure reliability, we acknowledge potential sources of bias, such as differences in how coders interpreted the nuanced language of the policies or the contextual differences between documents. Additionally, one of the researchers, who is also the supervising tutor of the coding, has an academic and professional background in psychology in the United States and may have interpreted Chinese policies through the framework of American school counselors\u0026rsquo; roles and responsibilities. To mitigate this potential bias, the coding responsibility was assigned to the other researcher, who did not have this specific background, and a collaborator. Moreover, regular communication and clarification were maintained throughout the coding process to ensure consistency and accuracy.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results and discussion","content":"\u003cp\u003eThe names of included policy documents, issuing institutions, and publication years are listed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBasic information of included policies\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYear\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIssued by\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePolicies\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZ1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSC\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eOpinions on Further Promoting the Balanced Development of Compulsory Education\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZ2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eOpinions on Standardizing the Layout Adjustment of Rural Compulsory Education Schools\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZ3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMOE\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eNotice on Issuing Guidelines for Mental Health Education in Primary and Secondary Schools (Revised in 2012)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZ4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNHC\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eGuidelines for Mental Health Education in School\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZ5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMOE et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eOpinions on Strengthening Care and Education for Left-behind Children in Rural Areas during the Compulsory Education Stage\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZ6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMOE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eNotice on Issuing Guidelines for Implementing the Spirit of the 18th National Congress of the Communist Party of China in Moral Education Courses in Secondary Vocational Schools\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZ7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMOE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eNotice on Issuing Guidelines for Moral Education in Secondary Vocational Schools (Revised in 2014)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZ8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMOE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eOpinions on Further Strengthening Moral Education in primary and secondary Schools to Cultivate and Practice the Socialist Core Values\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZ9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eNotice on Issuing National Plan for Child Development in Poverty-Stricken Areas (2014\u0026ndash;2020)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZ10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMOE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eNotice on Implementing the Initiative for Establishing Model Schools for Mental Health Education in Primary and Secondary Schools\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZ11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMOE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eNotice on Issuing Guidelines for the Construction of Counseling Rooms in Primary and Secondary Schools\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZ12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eOpinions on Strengthening Care and Protection for Left-Behind Children in Rural Areas\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZ13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eNotice on Conducting Special Intervention of School Bullying\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZ14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMOE et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eGuidelines on Preventing Bullying and Violence in Primary and Secondary Schools\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZ15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eNotice on Issuing National Education Development Plan (2016\u0026ndash;2020)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZ16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eYouth Development Plan (2016\u0026ndash;2025)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZ17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNHC et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eOpinions on Strengthening Mental Health Services\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZ18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMOE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eNotice on Issuing Guidelines for Moral Education in Primary and Secondary Schools\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZ19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNHC et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eNotice on Issuing the Pilot Work Plan for the National Social Mental Health Service System Construction\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZ20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNHC et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eNotice on Issuing Healthy China - Action Plan for Children and Adolescents\u0026rsquo; Mental Health (2019\u0026ndash;2022)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZ21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMOE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eNotice on Issuing Action Plan for Preventing Bullying in Primary and Secondary Schools\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZ22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMOE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eNotice on Strengthening Student Mental Health Administration\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZ23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMOE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eRegulations on the Protection of Juveniles in Schools\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZ24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eGuidelines on Children Development (2021\u0026ndash;2030)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZ25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMOE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eNotice on Issuing National Compulsory Education Quality Monitoring Plan (Revised in 2021)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZ26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMOE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eNotice on Launching the Work for Promoting High-Quality and Balanced Compulsory Education at the County Level\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZ27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMOE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eAction Plan for the Prevention and Treatment of Prominent Psychological Problems Among Students during COVID-19 Pandemic\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZ28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMOE et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eNotice on Issuing Action Plan for Comprehensive Strengthening and Improvement of Student Mental Health in the New Era (2023\u0026ndash;2025)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZ29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMOE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eNotice on Launching the First National Student Mental Health Promotion and Education Month\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003csup\u003e1\u003c/sup\u003e SC\u0026thinsp;=\u0026thinsp;State Council of the PRC \u003csup\u003e2\u003c/sup\u003e MOE\u0026thinsp;=\u0026thinsp;Ministry of Education of the PRC \u003csup\u003e3\u003c/sup\u003e NHC\u0026thinsp;=\u0026thinsp;National Health Commission of the PRC\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAfter data coding and analysis, we identified a total of 148 codes related to the responsibilities of MHETs. From these, we coded seven main responsibilities and five primary roles of Chinese MHETs. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e demonstrates the frequency of MHETs\u0026rsquo; primary roles and respective responsibilities. \u0026ldquo;Frequency\u0026rdquo; refers to the number of occurrences of each responsibility across all included policies, while \u0026ldquo;Number of policies mentioning this responsibility\u0026rdquo; indicates the number of policies mention the particular responsibility.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRoles, responsibilities of MHETs and the frequency across included policies\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRoles\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eResponsibilities\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNumbers of policies mentioning the responsibility\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInstructor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTeach courses in mental health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGuide\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOffer developmental guidance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMonitor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAssess and record student mental health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCounselor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProvide counseling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eCollaborator\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCollaborator I: Support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCollaborator II: Liaison\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCollaborator III: Emergency response coordinator\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFigure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e illustrates the distribution of MHETs\u0026rsquo; roles across different student groups. Based on the varying degrees of students\u0026rsquo; psychological problems, we categorized the student groups into three levels: all students, students with general psychological problems, and students with sever psychological problems, and use three concentric circles to visually reflect their hierarchical and inclusive relationship. Notably, the term \u0026ldquo;psychological problems\u0026rdquo; is adopted because it is a direct translation of the wording used in the original policy text. Our classification method is similar to the one used in the U.S. Multi-Tiered System of Supports (MTSS) (ASCA, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Stoiber \u0026amp; Gettinger, 2015). In our model, the roles of MHETs at each level can be further divided into two categories: direct roles and indirect roles. The direct roles are located on the left side of each circle, including Instructor, Guide, Monitor, and Counselor. These roles require direct interaction with students, providing face-to-face services such as education, guidance and counseling. The indirect role, Collaborator, is located on the right side of each circle, and is divided into Supporter, Liaison and Emergency Response Coordinator, with each corresponding to the respective student group. This role emphasizes the interaction and collaboration between MHETs and parties outside the student group, aiming to create a supportive environment conducive to student mental health through multi-party cooperation.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFigure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e Multiple roles of MHET across different student groups\u003c/p\u003e \u003cp\u003eAs shown above, the primary roles of MHETs outlined in included policies are Instructor, Guide, Counselor, Monitor, and Collaborator. The following sections will delve into a more detailed description of each role, exploring their specific responsibilities and the extent to which they are addressed in relevant policies.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Instructor: Teach courses in mental health\u003c/h2\u003e \u003cp\u003eInstructor is one of the most important and unique roles of Chinese MHETs. The corresponding responsibility, \u0026ldquo;Teach courses in mental health,\u0026rdquo; has 38 codes, accounting for 25.7% of the total number of codes, making it the most frequently mentioned responsibility. Among the 29 policies, 17 mention this role, with the first reference appearing in Z3 (2012). This role refers to educators responsible for teaching mental health courses in schools, whose primary task is to impart mental health knowledge to students through curriculum design and delivery.\u003c/p\u003e \u003cp\u003eCourse instruction serves as the primary avenue for conducting mental health education in primary and secondary schools. MHETs should \u0026ldquo;base their instruction on the local or school curriculum systems\u0026rdquo; (Z3, 2012). Generally, each class should \u0026ldquo;have one mental health lesson every two weeks\u0026rdquo; (Z10, 2014). The core curriculum content encompasses basic mental health knowledge and methods, such as \u0026ldquo;emotional regulation, interpersonal communication, learning to learn, life and growth\u0026rdquo; (Z27, 2022). Meanwhile, MHETs are expected to tailor the curriculum to suit different age groups and school types. For instance, primary school curricula may focus on \u0026ldquo;self-awareness and sexuality\u0026rdquo;, while secondary school curricula extend to \u0026ldquo;character and personality, career planning, emotion regulation and adolescent mental health, etc\u0026rdquo;. And vocational schools should emphasize \u0026ldquo;psychological qualities related to career development\u0026rdquo; (Z4, 2012). In cases of significant events, such as campus bullying, or under special circumstances like COVID-19 pandemic, MHETs are required to adapt their teaching to address students\u0026rsquo; unique needs. For example, Z27 (2022) stipulates that during the pandemic, MHETs should:\u003c/p\u003e \u003cp\u003e \u003cem\u003eUse a variety of methods to spread knowledge and skills related to pandemic prevention, helping students learn to cope rationally with the setbacks and difficulties caused by the pandemic, and avoid excessive worry or panic.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eAdditionally, MHETs should adopt diverse pedagogical methods and emphasize experiential learning and the application of knowledge when delivering courses (Z3, 2012). They can also leverage community resources including public cultural institutions, mental health service centers, and youth centers to organize various practical activities (Z3, 2012; Z18, 2017). To enhance the quality of mental health education, MHET is also encouraged to actively engage in research activities. This includes attending research conferences or workshops, receiving expert supervision (Z3, 2012), and conducting educational research on the mental health of children and adolescents (Z3, 2012; Z10, 2014; Z11, 2015; Z20, 2019).\u003c/p\u003e \u003cp\u003eThe role of Instructor holds particular significance for Chinese MHETs. Unlike school counselors in the United States, Chinese MHETs are mandated to place greater emphasis on teaching mental health courses. In 2017, the MOE introduced mental health education in the Teacher Qualification Examinations for primary, middle, high schools, and secondary vocational schools, which required MHETs to obtain the Mental Health Education Teacher Qualification Certificate before assuming their positions (MOE, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). The emphasis on delivering courses significantly differs from the training focus and primary responsibilities of school counselors. For instance, in the United States, the main duties of middle school and high school counselors do not include instruction though courses (Trolley, \u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). According to the 2024 Council for Accreditation of Counseling and Related Education Programs (CACREP) Standard, key areas of foundational counselor preparation curriculum do not encompass curriculum design and delivery. Additionally, the topic of school counseling curriculum and lesson plan development is mentioned only once in this document (p.24). In contrast, a textual analysis of mental health education policies across 31 provinces in China reveals that \u0026ldquo;curriculum development\u0026rdquo; is a central keyword in Chinese policies (Tan \u0026amp; Peng, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Furthermore, mental health education courses are recommended to be based on direct experiences and emphasize student participation and reflection (Yu \u0026amp; Hou, \u003cspan citationid=\"CR93\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Yu, \u003cspan citationid=\"CR92\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), thereby imposing unique requirements on MHETs\u0026rsquo; pedagogical skills. Current challenges in course design and implementation include unclear course objectives, insufficient class hours, lack of standardized and high-quality teaching materials, monotonous teaching methods, and low teacher quality (Lin et al, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Zhang \u0026amp; Wang, \u003cspan citationid=\"CR100\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Guide: Offer developmental guidance\u003c/h2\u003e \u003cp\u003eGuide is one of the core roles of Chinese MHETs, reflecting its proactive and central position in implementing mental health education. As Guides, MHETs are expected to offer developmental guidance to all students. This responsibility is mentioned in 15 policies, with the earliest appearance in Z3. The related codes amount to 24, accounting for 16.2% of the total codes.\u003c/p\u003e \u003cp\u003eMHETs play a proactive role in supporting students\u0026rsquo; psychological well-being, addressing their needs promptly to prevent psychological problems. This proactive approach aligns with the principle of positive psychology that emphasizes the prevention of mental illnesses through fostering positive psychological qualities (Bian et al., 2018; Meng, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). As Guide, MHETs\u0026rsquo; primary responsibilities include providing developmental guidance in areas such as \u0026ldquo;academics, daily life, interpersonal relationships, and career development\u0026rdquo; (Z7, 2014; Z22, 2021). As outlined in Z7:\u003c/p\u003e \u003cp\u003e \u003cem\u003e[MHETs should] provide guidance or assistance to address potential psychological problems students may encounter in areas such as academics, daily life, and career development, strengthen care and support to cultivate students\u0026rsquo; positive psychological qualities and promote their overall mental and physical well-being.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eWhen providing guidance, MHETs should prioritize a combined approach of universal student care with tailored supports for specific student groups, involving economically-disadvantaged students, children from single-parent or migrant households, left-behind rural children, students with learning difficulties, and victims of school bullying (Z5, 2013; Z9, 2014; Z18, 2017; Z20, 2019; Z24, 2021; Z29, 2024). When possible, they may also offer developmental guidance to students\u0026rsquo; family members and school staff, such as supporting third-year high school students and their parents facing academic pressure (Z20, 2019).\u003c/p\u003e \u003cp\u003eIn addition to preventing psychological problems, another key goal of MHETs as Guide is to foster a school environment conducive to students\u0026rsquo; mental health. To achieve this, they can adopt various approaches, such as organizing student psychology clubs (Z4, 2012; Z10, 2014), conducting mental health promotion activities (Z4, 2012; Z17, 2017; Z29, 2024), and carrying out themed mental health education activities (Z10, 2014; Z29, 2024). For example, Z10 (2014) states:\u003c/p\u003e \u003cp\u003e \u003cem\u003eEach semester, diverse mental health education activities should be organized though mental health education months, student psychology clubs, school bulletin boards or broadcasts, television, and online platforms, creating a positive atmosphere for mental health education.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThe most prominent characteristic of Guide is its proactive and preventative approach. Both MHETs and school counselors emphasize a proactive stance in their work. For example, within the MTSS framework, programs provided for students who are in the general education population (Tier 1), such as social-emotional learning (SEL) programs, reflect a preventative nature of school counseling (Stoiber \u0026amp; Gettinger, 2015). Similarly, in other multi-tiered school counseling systems in the United States, such as Response to Intervention (RTI), school counselors are also required to serve in a proactive and accountable manner (Ockerman et al., \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Their interactions with students primarily take place in classrooms, large groups, small groups, and individual settings, using direct engagement to influence students\u0026rsquo; attitudes and behaviors (ASCA, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Berg et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). In China, while the MHET-to-student ratio is comparatively lower, efforts are being made to enhance proactive mental health education in schools despite existing challenges. A 2024 survey of 422 primary and secondary schools in Shanghai showed that approximately 64% of schools were staffed with only one full-time MHET, who is confronted with common challenges include heavy non-counseling burdens and limited contact with students (Wang et al., \u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). However, China has been actively addressing these issues by improving policy support and gradually enhancing the allocation of MHETs. MHETs have also leveraged broader platforms such as mental health promotion activities and mental health months to deliver school-wide mental health education.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Monitor: Assess and record student mental health\u003c/h2\u003e \u003cp\u003eAnother key role of MHETs targeting all students is Monitor. As Monitor, MHETs are required to conduct and record student mental health assessment regularly. This responsibility is mentioned in nine policies, first appearing in Z3 in 2012. There are 20 relevant codes, accounting for 13.5% of the total codes.\u003c/p\u003e \u003cp\u003eRegular mental health monitoring is crucial for safeguarding students\u0026rsquo; psychological well-being. MHETs are responsible for assessing mental health status of all students and, when possible, teachers as well (Z11, 2015; Z19, 2018; Z23, 2021; Z28, 2023). These assessments help identify potential mental health issues and facilitate targeted interventions (Z11, 2015). Additionally, the analysis of assessment results serves as a foundation for effective prevention and management of mental health crises (Z21, 2021). MHETs are expected to conduct at least one assessment per year for students in upper primary, junior high, senior high, and secondary vocational schools (Z28, 2023).\u003c/p\u003e \u003cp\u003eIn conducting assessments, MHETs must adhere to ethical guidelines, exercise caution when using testing scales, and refrain from coercing students into undergoing assessments. The use of any instruments that could potentially harm students\u0026rsquo; mental well-being is strictly prohibited (Z3, 2012). Additionally, MHETs are responsible for ensuring the security and confidentiality of assessment data (Z27, 2022; Z28, 2023). Besides external evaluation, MHETs can also encourage students to engage in self-assessments using common psychological scales for children and adolescents (Z27, 2022). When analyzing data, a comprehensive approach should be taken, considering factors such as academic performance, social interactions, and family dynamics (Z27, 2022).\u003c/p\u003e \u003cp\u003eAfter completing assessments, MHETs are required to systematically document results to establish \u0026ldquo;student mental health profile\u0026rdquo; for each student. This profile should include basic personal information of students, assessment results, and intervention plans. According to Z27 (2022):\u003c/p\u003e \u003cp\u003e \u003cem\u003eStudent mental health profiles and a list of major psychological problems should be established. For each student with severe psychological issues, [MHETs should] maintain a targeted profile to ensure thorough and precise mental health support.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eOur analysis indicates that the role of Monitor has received increasing policy attention in recent years, particularly in the wake of the COVID-19 pandemic. Notably, Z27 (2022), introduced as a key initiative to address students\u0026rsquo; psychological problems during the pandemic, explicitly positioned mental health assessment as a core component of its objectives. In the post-pandemic era, policies such as Z28 (2023) have further institutionalized mental health assessment practices by promoting the normalization and standardization of psychological monitoring, along with the widespread adoption of student mental health profiles.\u003c/p\u003e \u003cp\u003eThe role of Monitor receives special attention in China, since understanding the mental health status of students and identifying potential psychological problems are fundamental to improving students\u0026rsquo; psychological well-being (Xiong et al., \u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). While school counselors in countries such as the United States also conduct assessments, their scope extends beyond social-emotional development to encompass academic progress and career planning. For instance, ASCA National Model designates \u0026ldquo;Appraisal and Advisement\u0026rdquo; as one of three key direct student services of school counselors, requiring them to \u0026ldquo;analyze and evaluate students\u0026rsquo; abilities, interests, skills, and academic achievements\u0026rdquo;, and \u0026ldquo;provide recommendations [...] to support future decision-making\u0026rdquo; (ASCA, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2019\u003c/span\u003e, p. 148). This responsibility emphasizes helping students gain insight into their interests and strengths, plan their academic and career paths, and access relevant resources (Levy \u0026amp; Lemberger-Truelove, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). On the contrary, in China, the primary concern of conducting psychological assessments is to understand students\u0026rsquo; psychological status, identify underlying mental health issues, and provide a basis for improving related counseling and teaching practices (Xiong et al., \u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Furthermore, school counselors typically conduct assessments on an individual or small-group basis, rather than organizing assessments for all students, whereas Chinese policies emphasize comprehensive, school-wide assessments. Despite its importance, psychological monitoring in China still faces several challenges, including mismatches between psychological assessment tools and students\u0026rsquo; real-life experiences, inconsistency and lack of scientific rigor in assessment result analysis, and heavy workloads for MHETs (Ye, \u003cspan citationid=\"CR90\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Zhang et al., \u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Scholars have been exploring the use of artificial intelligence and Internet-based technologies to facilitate the implementation of psychological assessments (Gao et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Jiang et al., 2021).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Counselor: Provide counseling\u003c/h2\u003e \u003cp\u003eWhen students encounter psychological or developmental problems, MHETs should promptly intervene, taking on the role of Counselor. Out of the 29 reviewed policies, 12 reference this role, with the earliest mention found in Z1. This role is associated with 20 codes, making up 13.5% of the total.\u003c/p\u003e \u003cp\u003eAs Counselor, MHETs are responsible for applying professional counseling knowledge and skills to provide scientifically effective counseling for students in need (Z3, 2012). All students are entitled to counseling services provided by MHETs. However, unlike the role of Guide, which is featured by the proactive and preventative nature, the role of Counselor highlights corrective interventions after identifying psychological problems. In this capacity, MHETs support students experiencing psychological issues through individual or group counseling (Z10, 2014; Z11, 2015). For instance, Z11 (2015) prescribes:\u003c/p\u003e \u003cp\u003e \u003cem\u003e[MHETs should] provide individual and group counseling to help students address and resolve psychological and behavioral issues related to learning, life, self-awareness, emotional adjustment, interpersonal relationships, and further education or employment.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eIn China, the primary setting for providing counseling is the school counseling room, which must be open for at least 10 hours per week for individual or group counseling (Z10, 2014). During counseling sessions, MHETs are required to maintain comprehensive records, including analyses, intervention plans, and evaluations of counseling outcomes (Z10, 2014). Similar to school counselors, MHETs do not provide long-term therapy. If a student\u0026rsquo;s psychological issues require specialized clinical intervention, MHETs should facilitate referrals to external professionals (Z11, 2015).\u003c/p\u003e \u003cp\u003eAs Counselor, MHETs\u0026rsquo; primary responsibility is to intervene when students show signs of psychological problems. However, unlike school counselors, MHETs must navigate the dual roles of both Counselor and Instructor, and often need to balance counseling duties with responsibilities in moral education. Given that Chinese policies place great emphasis on the teaching duties of MHETs, they may carry authoritative attitudes from the classroom into counseling sessions, which can undermine the sense of equality and inclusivity essential for effective psychological support (Yang, \u003cspan citationid=\"CR89\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). Additionally, in China, mental health education is considered an integral part of moral education (Z3, 2012). As Counselor, MHETs are expected to integrate moral education values into their practice (Yu \u0026amp; Jin, \u003cspan citationid=\"CR94\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). However, research suggests that disciplinary approaches in counseling may reduce its effectiveness and hinder the development of a trusting counselor-student relationship (Liu \u0026amp; Gu, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2004\u003c/span\u003e; Liu \u0026amp; Xue, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Yang, \u003cspan citationid=\"CR89\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). Additionally, excessive moral education responsibilities may increase MHETs\u0026rsquo; workload. The ASCA (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) explicitly states that \u0026ldquo;performing disciplinary actions\u0026rdquo; is an inappropriate duty for school counselors, as it interferes with their ability to address students\u0026rsquo; psychological needs (p. 130). However, Chinese MHETs are often expected to take on moral education or even homeroom teacher duties in practice (Zhang et al., \u003cspan citationid=\"CR98\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Furthermore, many school mental health offices are supervised by the moral education department (Peng et al., \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), which may intensify conflicts between their counseling duties and administrative or disciplinary expectations.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e3.5 Collaborator\u003c/h2\u003e \u003cp\u003eCollaborator is an important role of MHETs in coordinating internal and external resources to enhance student mental health. As collaborator, MHETs engage with a diverse array of collaborators, including guardians, school staff, and medical institutions. Overall, this role is mentioned in 14 policies, with the first reference in Z1. The associated coding count is 46, accounting for 31.1% of the total coding count.\u003c/p\u003e \u003cdiv id=\"Sec16\" class=\"Section3\"\u003e \u003ch2\u003e\u003cb\u003e3.5.1 Collaborator I\u003c/b\u003e\u003cem\u003e\u0026mdash;\u003c/em\u003e\u003cb\u003eSupporter: Provide supportive resources\u003c/b\u003e\u003c/h2\u003e \u003cp\u003eTo promote psychological well-being of all students, MHET empowers key stakeholders, guardians and school staff, by equipping them with supportive resources. Studies show that parent-child relationships and the school environment are crucial micro-system variables influencing adolescent mental health (Elgar et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Chapman et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Yu et al., \u003cspan citationid=\"CR96\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Accordingly, MHETs, as professionals in school mental health education, are expected to offer supportive resources to enhancing these stakeholders\u0026rsquo; ability to address students\u0026rsquo; psychological needs and effectively manage related challenges.\u003c/p\u003e \u003cp\u003eSupportive resources include mental health training, guidance on addressing psychological issues, and written materials on student mental health (Z3, 2012; Z10, 2014; Z20, 2019; Z27, 2022; Z28, 2023; Z29, 2024). For example, Z20 (2019) mandates that MHETs should \u0026ldquo;organize at least one annual mental health training session for parents during parent-teacher meetings\u0026rdquo;.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section3\"\u003e \u003ch2\u003e\u003cb\u003e3.5.2 Collaborator II\u003c/b\u003e\u003cem\u003e\u0026mdash;\u003c/em\u003e\u003cb\u003eLiaison: Promote communication about student mental health\u003c/b\u003e\u003c/h2\u003e \u003cp\u003eWhen students exhibit mental health or developmental problems, MHETs are required to promptly inform guardians and homeroom teachers. This responsibility not only aligns with the \u003cem\u003eMental Health Law of the People\u0026rsquo;s Republic of China\u003c/em\u003e (SC, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), but also helps coordinate family and school resources to address psychological concerns effectively (Z22, 2022; Z27, 2023). If students have been diagnosed with psychological disorders, MHETs should also inform guardians of the intervention plan (Z23, 2021).\u003c/p\u003e \u003cp\u003eIn the United States, confidentiality is recognized as a foundational principle in counseling practice (American Counseling Association, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). In the Chinese context, this principle is explicitly outlined in both the professional ethical guidelines for counselors (Chinese Psychological Society, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) and the \u003cem\u003eMental Health Law of the People\u0026rsquo;s Republic of China\u003c/em\u003e (SC, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). However, adolescents\u0026rsquo; limited developmental capacity to accurately assess risks, articulate their experiences, or care for themselves may hinder their ability to disclose potential harmful situations (Ren et al., \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). In such cases, the \u003cem\u003eLaw of the People\u0026rsquo;s Republic of China on the Protection of Minors\u003c/em\u003e mandates that MHETs report any suspected threats to a minor\u0026rsquo;s physical or psychological well-being to the appropriate authorities without delay (SC, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). In alignment with this legal framework, our reviewed policies further stipulate that if a student exhibits behavior harmful to themselves or others, MHETs should override confidentiality and inform both the homeroom teacher and guardians promptly (Z11, 2015; Z22, 2021; Z23, 2021).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section3\"\u003e \u003ch2\u003e\u003cb\u003e3.5.3 Collaborator III\u003c/b\u003e\u003cem\u003e\u0026mdash;\u003c/em\u003e\u003cb\u003eEmergency Response Coordinator: Facilitate referral and crisis management\u003c/b\u003e\u003c/h2\u003e \u003cp\u003eWhen students\u0026rsquo; mental health problems are assesed at high risk, MHETs are responsible for promptly referring them to professional mental health institutions (Z3, 2012; Z10, 2014; Z11, 2015; Z20, 2019). Due to the limited medical resources available in schools and the often insufficient expertise of MHETs to address complex psychological problems, referrals are essential to ensure that students receive the appropriate treatment (Yang, \u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Additionally, timely referrals help make better use of external resources and promote the integration of education and healthcare (Zhang, \u003cspan citationid=\"CR99\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). During the referral process, MHETs are required to maintain detailed records, assist parents with the referral, and collaborate with professional institutions. For instance, Z11 (2015) mandates:\u003c/p\u003e \u003cp\u003e \u003cem\u003eFor students with serious mental disorders, or when other referral needs are identified, they should be promptly referred to the relevant medical institutions. The referral process must be thoroughly documented, and a tracking and feedback system should be established.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eWhen a student\u0026rsquo;s mental health issues lead to crisis, MHETs need to cooperate with school staff to manage the situation effectively. Reviewed policies primarily address crises such as bullying (Z14, 2016), student self-harm or harm to others (Z11, 2015; Z27, 2022), and major emergencies triggered by natural disasters, accidents, or public health events (Z28, 2023). In the crisis intervention process, MHETs work alongside school administrators, homeroom teachers, and medical staff (Z27, 2022), with moral education directors and grade team leaders also playing important roles (Cao, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Lin et al, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). MHETs are primarily responsible for providing short-term interventions and supporting long-term recovery (Z3, 2012; Z11, 2015; Z14, 2016; Z27, 2022; Z28, 2023).\u003c/p\u003e \u003cp\u003eCollaborator is also a central role of school counselors, reflected in various responsibilities such as serving on school/district committees, organizing parent workshops, and taking on leadership roles in crisis response (ASCA, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). A key similarity between school counselors and Chinese MHETs in collaboration is their shared focus on providing supportive resources and emphasizing timely communication with relevant parties, in order to foster a conducive environment for student mental health. However, there are notable differences in the collaborative practices. Unlike the systematic and institutionalized structures in the United States, such as school counseling advisory councils (ASCA, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), Chinese schools have yet to establish similar permanent committees dedicated to student mental health. In some cases, schools do not even have a specialized mental health department (Peng et al., \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Zhang et al., \u003cspan citationid=\"CR101\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). While school counselors in the United States are typically expected to assume leadership roles during crises (ASCA, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2016\u003c/span\u003e), Chinese MHETs often play a supportive role in such situations. During crises, parents are most commonly perceived as the primary agent of intervention, followed by key school personnel such as homeroom teachers and school administrators, and then MHETs or psychologists (Gao et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). The organization and leadership of crisis intervention teams in Chinese schools are typically handled by administrators, such as principals or vice principals (Cao, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Pang, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e2009\u003c/span\u003e), with MHETs mainly providing support rather than leadership (Cao et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Cui \u0026amp; Xie, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Their responsibilities include crisis detection, short-term intervention, timely reporting, and referral assistance (Cao et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Ju et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Additionally, due to their involvement in moral education and subject teaching, MHETs often face challenges in fully dedicating themselves to mental health services (Peng et al., \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Zhang et al., \u003cspan citationid=\"CR101\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). This dual role, coupled with their marginalization within school structures, may limit their ability to effectively initiate or guide mental health initiatives (Feng et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003e3.6 The trend of roles\u003c/h2\u003e \u003cp\u003eFigure\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e The trend of MHETs\u0026rsquo; roles in mental health education policies (2012\u0026ndash;2024)\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e presents the changes in the coding frequencies associated with different roles of MHETs. As illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, the frequency of most roles is notably high in 2012 and 2014. This corresponds with the publication of the \u003cem\u003eGuidelines for Mental Health Education in Primary and Secondary Schools (Revised in 2012)\u003c/em\u003e, a milestone policy that clearly defined the basic principles, objectives, tasks, main content, approaches, methods, and implementation for mental health education in Chinese primary and secondary schools (Yu, \u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). In 2014, multiple policies related to mental health education were issued, including \u003cem\u003eImplementing the Initiative for Establishing Model Schools for Mental Health Education in Primary and Secondary Schools\u003c/em\u003e, which has greatly promoted the deepening of mental health education across primary and secondary schools (Yu, \u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMost roles experience a significant decrease around 2015 and 2019. However, there is a general upward trend for all roles during 2020\u0026ndash;2021. This likely occurred because during the COVID-19 pandemic, delayed school openings led to increasing academic pressure and family conflicts, which negatively affected the mental health of children and adolescents (Cheng \u0026amp; Liu, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). As a result, the government increased its focus on mental health in schools and issued documents such as \u003cem\u003eStrengthening Student Mental Health Administration\u003c/em\u003e and \u003cem\u003eAction Plan for Comprehensive Strengthening and Improvement of Student Mental Health in the New Era (2023\u0026ndash;2025)\u003c/em\u003e to standardize mental health education in primary and secondary schools. During this period, the roles of Instructor, Monitor, and Collaborator increased significantly, indicating that recent policies have emphasized the importance of mental health curriculum, mental health monitoring, and collaborative efforts between schools, families, and communities in mental health education.\u003c/p\u003e \u003c/div\u003e"},{"header":"4. Conclusion and implications","content":"\u003cp\u003eBy synthesizing the roles and responsibilities of Chinese MHETs as prescribed in national policies from 2012 to 2024, this study provides several significant findings. Firstly, national policies outline Chinese MHETs five primary roles: Instructor, Guide, Monitor, Counselor, and Collaborator. The emphasis on each role varies depending on the specific needs of the student groups they serve. Secondly, policy emphasis has long been placed on delivering mental health courses, providing developmental guidance, and conducting counseling. However, psychological monitoring and home-school-community collaboration have emerged as focal points in recent policies. Thirdly, compared to school counselors in Western countries, Chinese MHETs are expected to place greater emphasis on classroom instruction and school-wide psychological assessment. Moreover, they are expected to undertake supportive rather than leading roles in collaborative efforts.\u003c/p\u003e \u003cp\u003eOur study provides valuable insights for MHETs, students, schools, parents and other stakeholders by offering a clearer understanding of MHETs\u0026rsquo; roles and responsibilities. This clarity can help mitigate role ambiguity among MHETs, reduce misunderstandings, and promote more effective collaboration in mental health education. Furthermore, this study reveals that some policy statements lack definite subjects, which may result in misinterpretation of MHET roles and practical challenges. Although we attempted to address this issue by referring to relevant literature and consulting front-line MHETs, gaps remain in the clarity and precision of policy language. Additionally, while we have outlined a framework of MHET roles, certain responsibilities, such as the effective utilization of psychological assessment results, are still insufficiently defined in current policies. To address these gaps, we recommend that policymakers develop more specific guidelines, alongside clearer and more precise policy language. Additionally, we encourage further empirical research to deepen the understanding of MHET roles, identify specific challenges in their implementation, and help refine policy frameworks.\u003c/p\u003e \u003cp\u003eFinally, our research suggests that existing MHET education and in-service training programs may not fully align with the roles and responsibilities outlined in current policies. For example, while the roles of Instructor, Monitor, and Collaborator are increasingly emphasized, current pre-service and in-service programs are not sufficiently developed to meet these policy requirements. Therefore, we recommend that these programs be more closely integrated with policy priorities, particularly in areas such as classroom instruction, psychological assessments, and home-school-community collaboration. Furthermore, society should provide greater support through resources and professional development opportunities to help MHETs continuously enhance their skills and adapt to the evolving demands of mental health education.\u003c/p\u003e"},{"header":"5. Limitations and future directions","content":"\u003cp\u003eThis study has several limitations that must be taken into account when interpreting the results. Firstly, our analysis is confined to policies issued after 2012, which may exclude earlier documents that shaped the current mental health education landscape and limit the exploration of policy evolution over a longer historical trajectory. Moreover, the implementation and establishment of mental health education policies vary across different Chinese provinces. Analyzing and comparing these provincial policies would be valuable for gaining a comprehensive understanding of the current state of MHETs.\u003c/p\u003e \u003cp\u003eWhile we briefly compared MHETs with school counselors in the United States, which have presented certain unique aspects of Chinese MHETs, these comparisons were not comprehensive enough to fully capture the differences between these two professions across educational systems. Besides, given the variance in socio-cultural contexts, some of these comparisons may introduce some biases. We hope that future research will more thoroughly explore the similarities and differences between MHETs and their counterparts in Western countries, which would deepen our understanding of school mental health in diverse contexts and contribute to the global development of school mental health professionals.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eCompeting interest\u003c/h2\u003e \u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eDeclaration\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eH.L. and X.C. drafted the main manuscript text. X.C. searched and included the policy documents used for analysis. X.C. and N.T. conducted the policy coding, under the supervision of H.L. All authors reviewed the manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData is provided within the supplementary information files.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAllen VL, Vliert E (eds) (1984) Role transitions: Explorations and explanations, vol 23. Springer Science \u0026amp; Business Media, New York\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerican Counseling Association (2014) ACA Code of Ethics. Author, Washington, DC, VA\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eASCA (2016) ASCA Ethical Standards for School Counselors. 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Chin Stud 3(01):8\u0026ndash;11. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4236/chnstd.2014.31003\u003c/span\u003e\u003cspan address=\"10.4236/chnstd.2014.31003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"humanities-and-social-sciences-communications","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"palcomms","sideBox":"Learn more about [Humanities \u0026 Social Sciences Communications](http://www.nature.com/palcomms/)","snPcode":"41599","submissionUrl":"https://submission.springernature.com/new-submission/41599/3","title":"Humanities and Social Sciences Communications","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-6870592/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6870592/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIn China, Mental Health Education Teachers (MHETs) are the primary agents responsible for implementing school-based mental health education, yet growing policy attention has intensified ambiguity and conflict regarding their roles. Although previous studies have explored these role-related challenges, most rely on personal experiences and lack alignment with current policy frameworks. We thereby investigated the roles prescribed to MHETs in national mental health education policies through a content analysis of 29 policy documents issued between 2012 and 2024. Findings reveal five core roles: Instructor, Guide, Monitor, Counselor, and Collaborator. The emphasis on each role varies according to the psychological needs of three student groups: all students, students with general psychological problems, and students with severe psychological problems. While policy has long prioritized instruction, guidance, and counseling, recent documents increasingly highlight psychological monitoring and home\u0026ndash;school\u0026ndash;community collaboration. We have also made comparisons with school counselors in Western countries, which provide additional context for understanding the unique aspects of the MHET roles in China. These findings help clarify MHET responsibilities, mitigate role ambiguity and conflict, and promote more effective mental health education practices. The study also calls for more comprehensive policy frameworks that articulate the roles and responsibilities of MHETs, as well as enhanced pre-service and in-service training to support their professional development.\u003c/p\u003e","manuscriptTitle":"The roles of mental health education teachers (MHETs) in China: A content analysis of policy documents","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-18 18:45:29","doi":"10.21203/rs.3.rs-6870592/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-28T08:10:41+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-20T11:11:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"202174602781685403610452719283033454978","date":"2026-01-12T12:50:56+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-12T01:19:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"122581937161798734902766343669486748958","date":"2026-01-03T12:25:22+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-30T07:21:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"97674104464347986987740099204416458009","date":"2025-12-30T06:54:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"123265615048373386710204738121549479248","date":"2025-12-27T16:53:22+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-12T15:38:01+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-07-11T15:27:37+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-07T12:06:27+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-06T17:29:39+00:00","index":"","fulltext":""},{"type":"submitted","content":"Humanities and Social Sciences Communications","date":"2025-06-11T10:02:33+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"humanities-and-social-sciences-communications","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"palcomms","sideBox":"Learn more about [Humanities \u0026 Social Sciences Communications](http://www.nature.com/palcomms/)","snPcode":"41599","submissionUrl":"https://submission.springernature.com/new-submission/41599/3","title":"Humanities and Social Sciences Communications","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"ca941c52-d424-4d53-a22d-c65a03a6770b","owner":[],"postedDate":"December 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[{"id":59604264,"name":"Social science/Education"},{"id":59604265,"name":"Social science/Psychology"}],"tags":[],"updatedAt":"2026-05-17T08:54:22+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-18 18:45:29","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6870592","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6870592","identity":"rs-6870592","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}