A survey by the Chinese Psychology Society published by state media last week found that of 18,000 people tested for anxiety related to the coronavirus outbreak, 42.6% registered a positive response
Hundreds of 24-hour mental health support telephone hotlines have sprung up in China in recent weeks as millions of people fret about catching the coronavirus - and try to avoid infection by staying at home.
Medical professionals welcomed the launch of several official services in a country where mental health remains a relatively taboo subject, but cautioned that unofficial talk lines could do more harm than good.
"There are a lot of hotlines out there staffed by a lot of volunteers but it just doesn't make sense because there's not many that can be well-trained," said Cui Erjing, a Seattle-based volunteer for one of the hotlines, who is originally from China's Southern Guangdong province.
"It can be really traumatising to ask for support but not get the right responses."
A survey by the Chinese Psychology Society published by state media last week found that of 18,000 people tested for anxiety related to the coronavirus outbreak, 42.6% registered a positive response. Of 5,000 people evaluated for post traumatic stress disorder (PTSD), 21.5% had obvious symptoms.
The hashtag #howtodealwithfeelingveryanxiousathome has been trending on social media platform Weibo, with more than 170 million views, as misinformation about the spread of the disease and travel bans feed public worries.
The hotlines are part of the government's "first level response" for dealing with the psychological impact of major health emergencies, a strategy that was first deployed following the 2008 Sichuan earthquake, a disaster in which 87,150 people were killed or listed as missing.
The National Health Commission said more than 300 hotlines had launched across the country to provide mental health advice related to coronavirus, with support from university psychology departments, counseling services and NGOs.
They have been inundated by callers in a country which has just 2.2 psychiatrists available for every 100,000 people, according to WHO data, five times fewer than in the United States.
A national hotline run by Beijing Normal University was overwhelmed when it went live at the end of January, said Cheng Qi, a Shanghai-based psychologist.
While the number of calls has dropped as other lines opens, the content has become more challenging, Cheng said, noting one caller with chronic depression who had reported suicidal thoughts triggered by the barrage of bad news.
"It's not the virus [that caused it], but the virus is stimulating it," she said.
Xu Wang, a psychotherapist at Tsinghua University, which is working with the official Beijing city hotline, said a major challenge was working out which callers showed real symptoms of the virus and which were instead suffering from anxiety.
"Callers often have somatic issues, and might say, 'I can't eat well, can't sleep well, and I want to know if it's a virus infection,'" he said.
A volunteer group of more than 400 therapists called 'Yong Xin Kang Yi', which roughly translates to 'Use Heart to Fight the Virus', focuses on helping overworked medical staff in Wuhan, the epicenter of the virus.
"They leave messages saying they're exhausted, that they're scared," Cui said. "The doctors don't know if they're going to get infected or if their co-workers or going to get infected, and they don't know how bad it's spreading."
Medical researchers from Peking University included telephone and internet counseling for healthcare staff, patients, and the public among six key strategies for coping with mental stress over the coronavirus outbreak.
"We believe that including mental health care in the national public health emergency system will empower China and the world during the campaign to contain and eradicate
2019-nCoV," the researchers said in a paper published in The Lancet medical journal last week.
The government recently issued guidance for the hotlines, saying they should be free, confidential, staffed by volunteers with relevant professional backgrounds and supervised by experienced by experts.
Still, concerns remain about enforcement.
"There are many individually initiated helplines and it's difficult to gain consistent support and supervision," said Sami Wong, a Beijing-based psychotherapist.
Tsinghua University's Xu said the very nature of the hotlines added to the challenges, preventing volunteers from gaining much-needed face-to-face experience with people suffering mental health issues.
Wong worried that untrained volunteers could easily put their foot in their mouth. A seemingly innocuous "I can understand how you feel" can cause vulnerable people to clam up, she said: "PTSD training is not something you can learn overnight."