Mental health and well-being are defined here as a general state of being content with life and not feeling depressed or anxious about current circumstances. They occur when someone perceives respect for their individuality, emotional comfort, and a capacity for social achievements that contribute to the realization and fulfillment of self-worth (Mu, 2004b). Research has demonstrated that 85% of older adults in China have mental health problems at different levels, with 23.09% of adults aged 60 or older suffering from severe mental disorders (Wu et al., 2019). It is especially true for older adults with disabilities, older adults who have lost their only child, empty nesters, and older adults living in poverty, who often have greater mental health needs.

A survey of more than 500 older adults in Nanjing, China, found that their major mental health needs included respect from society and behavioral significance, receiving due attention from family and society, receiving objective comments on their hard work and contributions to society, social role transformation, and continual pursuit of social significance behind their individual actions (Liu, 2004). Some scholars summarized the mental health needs of older adults as need for emotional communication, interpersonal interaction, culture and entertainment, knowledge and education, political participation, and self-actualization (Geng & Feng, 2009; Ming, 2000; Zhou, 2007). Need for self-respect, hope, and family love were also emphasized as mental health needs (Mu, 2004b). Among these, emotional needs, need for social interaction, and need for meaning were seen as a common focus of mental health needs among older adults.

In the early 1980s, European welfare states began to adopt policies and programs designed to respond to population aging. They developed systems that addressed the basic housing, personal care service, and mental health needs of older people (Zhou, 2005). However, mental health needs have only recently been directly addressed in social policies in China, whereas policies and programs addressing housing and personal care needs have been in place since the 1990s. We reviewed a wide range of legislation documents concerning mental health and services, and Table 1 summarizes recent major policies relevant to the provision of mental health services to older adults. The first major policy was the Law of the People’s Republic of China on Protection of the Rights and Interests of the Elderly, issued in August 1996 (No. 8 National Congress of China, 1996). Article 11 of this law stipulates that families assume the duties of offering financial and psychological support and caregiving services to older adults. However, in the ensuing years, mental health issues affecting older adults have not yet drawn attention from families and society. Since 2004, scholars have started studying the mental health issues of older adults and developed the core concepts of mental support, which emphasizes emotional support and stress release received from relatives or close friends (Fang, 2009; Zuo & Gao, 2004); psychological sustenance, which emphasizes intergenerational support (Mu, 2004a; Shao, 2006); and mental health and well-being (Chen, 2014). Compared to the first two concepts, mental health and well-being requires greater variety in terms of scope of services, types of providers, and channels of service provision.

Social policies implemented between 2005 and 2012 have addressed the material needs of beneficiaries including older adults living in the community, but they have not specifically addressed mental health and well-being concerns. These policies include the reform of Basic Old Age Insurance for Urban Employees (a compulsory pension program for employees of enterprises; in Chinese pinyin: Chengzhen Zhigong Jiben Yanglao Baoxian); a pilot of Basic Old Age Insurance for Urban Residents (a voluntary pension program for urban residents aged 16 or older who are not formally employed or in formal education; in Chinese pinyin: Chengzhen Jumin Jiben Yanglao Baoxian); and policies regarding the commercialization of long-term care services for older adults.

The Law of the People’s Republic of China on Protection of the Rights and Interests of the Elderly, amended in July 2013, is regarded as a legal effort to cope with population aging in China (No. 11 National Congress of China, 2013). It highlights the mental health concerns of older people. Article 17 was added to the 2013 version, stipulating that “family members should pay heed to the mental health and well-being needs of the elderly and should not ignore or neglect them. The supporters (mainly children) who live separately from the elderly should often visit and extend greetings to the elderly. All employers should protect supporters’ rights to visit the elderly parents according to the related regulations.” Chinese citizens have interpreted this regulation as a legal requirement for children to visit their parents often. In practice, this regulation is more of a social mandate describing an expectation than a strictly enforced law in the absence of mechanisms to ensure or promote compliance. Both the 2013 and 1996 version of the Law of the People’s Republic of China on Protection of the Rights and Interests of the Elderly seek to transfer the obligation of mental support of older adults onto the family. The 2013 version also extended this responsibility to the social services sector. Local governments have aimed to set up and improve the social service system for older adults that is currently based on families and communities, known as Article 36. Further examining this law, Article 37 elaborates that local governments at all levels and related departments should take measures to encourage and support professional service agencies and other organizations, as well as individuals, to provide necessary services including caregiving, emergency assistance, medical care, mental support, and psychological consultations to older adults. Article 38 in the 2013 version acknowledges the Chinese traditions of mutual support among neighbors, including provide mental health comfort to older adults in the community. This article also encourages professional agencies and volunteers to provide various services to vulnerable older adults, including psychological counseling if needed. In addition, “participation in social development,” which was added to the 2013 version of the law, enhances opportunities for older adults by guaranteeing their right to take part in economic, political, cultural and social life; ensuring opportunities for learning among older adults are included in the lifelong education and community education system; and outlining how colleges for older adults, as part of lifelong education in the community, should help broaden their knowledge, maintain their health, nurture their sentiment, enrich their life, and assist them with successfully blending into society (Article 67 and Article 72). Although there are no explicit instructions regarding mental health and well-being in these articles, the content is relevant to these topics among older adults in society. The definition of mental health and well-being includes not only a desire to receive care from children, but also the desire to socialize with neighbors and participate in social activities. This was addressed in Article 17, which is about mental health care from children, and Articles 38, 67, and 72, which demonstrate how policy can promote socialization with neighbors and participation in social activities.

Despite these legal provisions in the 2013 version of the law, the mental health issue has not been addressed in subsequent policies on security and services for older adults issued by the State Council, National Health and Family Planning Commission, Ministry of Civil Affairs, National Development and Reform Commission, Ministry of Finance, or Ministry of Human Resources and Social Security. For example, the Notice on Government Purchasing of Old Age Services issued in August 2014 states that the government should purchase services for older adults regarding caregiving, rehabilitative treatment, and staff training (Ministry of Finance, 2014). The notice indicates that “door-to-door services should be provided to the elderly who are qualified for government subsidies. These services include helping them with feeding, showering, cleaning, emergency assistance, medical care and nursing care” (Ministry of Finance, 2014). This notice does not practically cover mental health and well-being and only mentions “old age rehabilitative and entertainment activities” in the context of basic activities of daily living that may be separate from mental health needs. Soon thereafter, the National Development and Reform Commission (2014) issued its Notice on Speeding up the Project of Health and Old Age Services in September 2014, and the National Health and Family Planning Commission (2015) issued an Announcement of Integrating Medical Care with Old Age Services in November 2015. These two documents can be deemed guiding policies in the development of the Healthy Ageing Project in China, but there is a visible absence of relevant content on mental health. The sole provision relevant to mental health can be found in the section on “encouraging the non-government sectors to set up agencies that combine medical care with old age security services” in the Announcement of Integrating Medical Care with Old Age Services. This section supports the establishment of enterprises that focus on the needs of older adults in terms of preventive and curative health care and rehabilitative care, caregiving and mental health support, and products and relevant services for these needs among older adults.

The Central Government-Funded Local Program for Severe Mental Disorder Management and Treatment, also known as Project 686, was launched in December 2004 to integrate management and treatment in hospital and community settings. This integration marked the beginning of mental health prevention and treatment at the community level, expanding mental health prevention and treatment beyond specialized hospitals. This model combines prevention and treatment and is a sustainable and meaningful measure for any population group (Ma et al., 2011).

According to Chapter III of the Regulations of Shanghai Municipality on Mental Health (Ministry of Finance, 2014), a chapter centering on mental health promotion and mental disorder prevention, responsible parties that implement measures to prevent mental illness and disorder in different sectors include mental health professionals, community health service organizations, residents’ committees, villagers’ committees, the Ministry of Education, schools, and enterprises. The enactment of this regulation demonstrates an increased awareness of mental illness prevention in China. It focused more on wellness, which goes beyond satisfying mental health needs, instead focusing on helping older adults prevent mental health problems and protect their mental health (Ma et al., 2011).

In summary, mental health services in China have received increased attention and gone through several big reformations. Even today, the model of combining prevention and treatment and integrating hospital and community resources is still suitable and effective, yet it runs short of mental illness prevention regulations and ordinances specific to older adults. Given the rapid growth of China’s aging population, more thorough and in-depth research on older adults’ mental health needs is seriously needed.

Regarding relevant policy on mental health in the community, this research took Shanghai as an example, assessing the needs of different groups of older adults to provide inspiration and enlightenment to service and policy leaders to guide relevant regulations and policies conducive to older adults’ mental health services.

According to agentivity theory (Wang, 1994), proposed as part of the Marxist philosophy, agentivity refers to how an agent treats the relationship between people and the material world (nature, society, and humans), consisting of agent spirit, competence, and value (Dong, 1992). Agent spirit can be interpreted as recognizing one’s overall situation in terms of the physical, psychological, and competence-related status quo, and a person with agentivity exercises their rights to fulfill the meaning of life and value (Barrio et al., 2008; He, 2005).

We assumed different agents would come up with their own values and perceptions of older adults’ mental health needs. A theoretical framework based on agentivity theory was adopted to analyze the predicament, causes, and possible solutions of the mental health and well-being challenges in urban Chinese communities.