The Status Quo of Nonprofits Providing Children Mental Health Services in Mainland China: A Resource Dependency Perspective

Background and Purpose: Approximately 230 million children were enrolled in Chinese education settings, ranging from pre-school to high school (UNICEF, 2018). Among those children aged 6–16, an estimated 17.5% experienced some kind of mental health issue, from attention-deficit and disruptive disorders to anxiety, depression, and substance use (Li et al., 2021). Nonprofit organizations responding to these mental health needs have not yet been studied for how they function as NGOs.

This study fills this research gap through a comprehensive screening of all nonprofit mental health organizations serving children 6–16 in mainland China. Applying resource dependency theory, this study examined their rationale for maintaining the status quo or adopting new strategies to accelerate development, as well as showing the comparative analysis of foundations and social service organizations (SSOs).

Methods: Through a careful screening of the China Foundation Center, 26 nonprofit mental health organizations were identified through strict inclusion and exclusion criteria. We collected the organizational data in two ways. First, the basic characteristic data of the 26 organizations were exacted from their official websites, annual reports, and work statements submitted to the government. The information encompassed organization type, funding source, registered capital, organizational ratings, annual revenue and expenditure, number of full-time employees, service domain, and percentage of manpower expenditure. Second, 26 semi-structured interviews with organization leaders or program directors from the screened nonprofits were conducted to obtain a comprehensive and deep understanding of the status quo of their organization and program and how they mobilize resources to sustain and expand their programs. All interviews were transcribed verbatim and coded thematically using Nvivo qualitative software.

Findings: This study uncovered that the development of nonprofits providing children mental health services is limited in its number, size, manpower, finance, service domain, as well as organizational effectiveness. In addition, foundations, mainly operating foundations that implement programs by themselves, generally perform better in those dimensions compared to SSOs. Barriers and challenges (e.g., the small number and size of registered organizations; small amount of initial fund; limited-service domain) resulting from their high level of reliance on certain resources were explored and examined through resource dependency theory. This study also revealed the dilemma of program evaluation when balancing external stakeholders and internal organizational needs and capacities and identified a few survival strategies that those organizations took to mitigate the control from external forces.

Conclusion and Implications: The development of nonprofit mental health organizations targeting children is still in its early stage due to their reliance on external resources, predetermining their service domain, program implementation, and program evaluation. This study serves as the very first research on child mental health NGOs in China and sheds light on how those organizations leverage resources to magnify their impacts under external and internal forces. Policy level recommendations are also made to support this group of organizations to survive and thrive.