With the growing demand for mental health services, improving the quality and effectiveness of psychological services has become an important goal in both clinical research and routine practice. Formal Feedback (FF), also referred to as routine outcome monitoring (ROM), involves the systematic collection of client-reported outcome data to monitor treatment progress and inform clinical decision-making. Existing international and Chinese studies suggest that FF can improve treatment outcomes and reduce client dropout. Although FF has been integrated into routine mental health service systems in several Western countries, its clinical use in China remains limited and has not yet become routine practice. To address this implementation gap, this review examines how FF can be effectively integrated into the Chinese mental health service system.

Guided by implementation science, this narrative review examined representative international models of FF implementation and synthesized empirical evidence from China regarding its clinical effectiveness, current patterns of use, implementation barriers, and cultural adaptation. By comparing FF practices across countries and service systems, the review identified several recurring conditions that appear critical for successful implementation, including supportive policies and institutional mechanisms, an appropriate clinical positioning of FF, adequate technological and organizational infrastructure, and sustained professional training and support. On this basis, the review further considered the facilitators and barriers specific to the Chinese context and proposed a set of localized implementation strategies to support the integration of FF into routine psychological services in China.

The review suggests that sustained FF implementation depends on policy and institutional support, a clear clinical positioning of FF as a tool for improving treatment outcomes rather than evaluating therapist performance, infrastructure compatible with clinical workflows, and sufficient professional resources, including training, supervision, and technical support. In China, implementation barriers operate across four interrelated levels. At the individual level, therapists and clients may have insufficient understanding of FF and concerns about its use. At the organizational level, clear implementation standards, operational procedures, and supporting systems remain inadequate. At the infrastructural level, localized measurement tools and digital feedback platforms are still underdeveloped. At the cultural level, face concerns, professional authority, and hierarchical relationships may inhibit honest feedback and collaborative use of feedback results.

These findings indicate that FF has practical value for improving the quality of psychological services. However, its implementation in China should be adapted to local barriers and available service resources rather than direct replication of Western models. Coordinated strategies across individual, organizational, infrastructural, and cultural levels may support its development as a feasible and sustainable component of routine psychological service delivery in China.

In practical terms, the localization of FF in China requires action across multiple levels. At the individual level, training and supervision should strengthen therapists' understanding of FF, their ability to interpret feedback data, and their competence in responding constructively to negative feedback, while also promoting clients' sustained engagement and willingness to provide honest feedback. At the organizational level, stable implementation procedures, supervision mechanisms, and resource support should be established to foster an organizational climate that supports feedback use. At the infrastructural level, brief, reliable, and culturally appropriate measurement tools, along with feedback platforms embedded in clinical workflows, should be developed. At the cultural level, feedback should be introduced and discussed in culturally responsive ways to mitigate face concerns and authority-related barriers, thereby promoting honest and sustained feedback collaboration in clinical practice.