Mental health level two warning

The second-level mental health early warning is the intermediate level in the psychological crisis hierarchical prevention and control system. It is set for groups that have shown clear emotional, behavioral, and cognitive abnormalities but have not yet reached the clinical diagnostic standards for mental disorders. The core function is to block the deterioration of the problem through early identification and early intervention, and avoid the development of severe psychological problems that require clinical treatment.

I have been in a university psychological center for 5 years, and my experience with this classification is very intuitive. Two weeks after the entrance exam for freshmen last fall, a counselor from the School of Computer Science came over with a student’s attendance record and said that a sophomore girl had not gone to morning classes for 17 days in a row. Her roommate reported that she often lay staring at the ceiling all day long and only ate rice balls from the convenience store downstairs. She weighed almost 10 pounds. She had previously scored high on the depression dimension of the SCL-90 scale. She went to the city’s Jingwei Center for a diagnosis. She had not reached the clinical standard for moderate depression and was a typical secondary warning target.

At that time, the counselors in our center almost quarreled over how to intervene. A young consultant with a CBT orientation said that in this situation, she had to first grasp her core irrational beliefs - she was defeated by the ACM competition and was 0.2 points short of qualifications for graduate school after preparing for half a year. She felt that "all my hard work for so long was in vain, and I will definitely not be able to accomplish anything in the future." If she gets rid of this idea first, her emotions will be reduced by half. But the old consultant who does psychoanalysis directly waved her hand and objected, saying that you should stop thinking about it. Her parents have asked her to take the first place in the exam since she was a child. She didn't dare to tell her family about her failure this time. She has been holding it in for two months. Let her cry enough first and express her dissatisfaction with her parents that she dare not say. Otherwise, she won't listen no matter how much you say. The teacher in charge of campus public health did not get involved in our school dispute at all. He only cared about whether the early warning sentinel could be set up on the dormitory director's floor. After all, by the time the counselor found out, many people had been carrying it for almost a month. It was discovered two weeks earlier that the difficulty of intervention could be reduced by half.

It’s interesting to say that there was a newly graduated novice counselor who took a Level 2 alert case for the first time. She followed the CBT process and asked her, “Do you think the idea that ‘I can’t do anything’ is true? Is there any evidence that you can actually get things done? ”As soon as she finished speaking, the girl stood up and left, crying as she walked and saying, "You don't understand how difficult it is for me, so you talk about these big principles." Later, it took us almost three weeks, asking the dormitory director to bring her some hot milk tea brewed by our center every week, without asking anything, before we slowly made her willing to come back and talk. You see, no genre is as practical as having empathy first.

In the domestic psychological early warning systems of universities, middle schools, primary schools, and enterprises, the proportion of the second-level early warning groups is between 2% and 4%. According to the 2024 survey data of the Chinese Mental Health Association, if no intervention is done for this group of people, about 11.7% will develop moderate or above psychological disorders that meet clinical diagnosis standards within 6 months. With standardized intervention, this proportion can be reduced to 1.2%, which is 10 times faster.

However, the biggest controversy now about the second-level early warning is not actually the intervention technology, but the deployment method. Many schools and companies require real-name screening when conducting psychological screenings, and they also need to be linked to student status and personnel files. The euphemistic name is "convenient tracking and intervention." But in fact, most people dare not fill in the real situation at all, for fear of being labeled as having "psychological problems," which will affect public examinations, job hunting, and scholarship evaluations. There was a hot topic last year. A certain university required students with Level 2 alerts to have their parents sign an informed consent form, otherwise they would not be allowed to live on campus. As a result, one student was just anxious about the postgraduate entrance examination, but his parents scolded him, "I spent so much money for you to study, and you are causing me psychological problems." Instead, he collapsed and dropped out of school. Many places are now piloting anonymous screening, such as several universities in Shanghai. During the screening, they do not fill in their names and student numbers, but only leave their contact information. When making appointments, consultants will only say "we randomly selected some students for interviews" and will not reveal that they were screened. Privacy protection is good. , the screening accuracy can be more than 40% higher, but the responsibility of schools under this model is much greater. After all, if something goes wrong, if parents ask "Why didn't you tell us before?" there is no way to explain it. Both models now have their own supporters, and there has been no conclusion after years of quarreling.

In fact, if you use an analogy, you will understand. The mental health early warning system is similar to our usual physical examination. The first-level early warning is the annual routine physical examination. If there is any problem, there should be no food or drink.； The second level warning is to detect a small nodule on the lung, which has not yet reached the level of cancer. No surgery or medication is required, but you must review it regularly and avoid staying up late and not smoking, otherwise it will develop into a serious illness one day. ； At level 3 or 4, there are already pathological changes, and you need to go to the hospital for treatment immediately. Many people misunderstand the level 2 warning and think it is equivalent to "mental illness". In fact, it is not at all. Just like nodules are not cancer, most people can return to normal after adjustments.

After working for so many years, my biggest feeling is that the Level 2 warning is never a cold grading standard, nor is it a tool used by schools and companies to blame others. To put it bluntly, it is just to extend a hand to those who are stuck at the bottom of their emotions, but can still give a hand. Scale scores, attendance records, and roommate feedback are all just for reference. The most important thing is that you are willing to stop and ask that child who has been avoiding people recently if he has encountered any difficulties recently. If you want to say it, I'm here to listen.