Overview
In the face of stress, deteriorating health, lack of social engagement and other challenges, elderly and middle-aged persons are more susceptible to emotional distress, which affects their mental health and causes higher risk of depression and more serious illness conditions. To address the issue, The Hong Kong Jockey Club Charities Trust initiated and funded the “JC JoyAge” Project.
Through cross-sectoral collaboration, JC JoyAge provides a community-based support network for our older adults to enhance their resilience in facing the challenges of ageing. The service connects District Elderly Community Centres (“DECCs”) and Integrated Community Centres for Mental Wellness (“ICCMWs”) to establish a collaborative and integrated model to render standardised prevention and timely intervention services to those with depression and depressive symptoms according to their level of risk and symptoms severity, etc. From 2024 onwards, JC JoyAge partnered with three District Health Centres / District Health Centre Express to strengthen the provision of mental-health support at the primary care level to a wider age group of people aged 45 or above.
Phase I: 2016-2019
In 2016, The Hong Kong Jockey Club Charities Trust partnered with The University of Hong Kong (“HKU”) and six local non-government organisations (“NGOs”) to pilot the JC JoyAge Project in four districts. The Project developed a collaborative stepped-care service model to align community mental health services with district elderly services, providing early prevention and timely intervention for older adults with depressive symptoms as well as promoting mental health literacy. During this phase, 21 social workers were trained to deliver evidence-based interventions, primarily Cognitive Behavioral Therapy (“CBT”) to these older adults. Additionally, young-olds and retirees who have similar life challenges as the depressed elders, were trained to serve as Peer Supporters to accompany them on the voyage to mental wellness by sharing their personal experience. A quasi-experimental study was conducted and showed that the stepped-care model is both more effective and cost-effective than treatment as compared to traditional services.
Phase II: 2020-2023
From 2020 to 2023, JC JoyAge expanded its service coverage to all 18 districts in Hong Kong, encompassing 47 DECCs and ICCMWs (covering over 70% of service units providing community mental health services and district elderly services). During this phase, JC JoyAge launched a citywide Ambassador programme and a mental health promotion group initiative in five districts. More than 5,900 Ambassadors received the Mental Health First Aid (“MHFA”) training and actively volunteered in their communities to promote mental wellness. By the end of 2023, nearly 870 Ambassadors had completed an additional 80 hours of training to become Peer Supporters. During the COVID-19 pandemic, due to the mandated social distancing measures, JC JoyAge conducted telephone interviews with 13,303 older adults to assess their needs of emotional support and implemented an online intervention to assist vulnerable individuals. In Phase I and II of the Project, more than 16,900 at risk or depressed older adults were served, including nearly 8,500 symptomatic older adults who received intervention. Among those who received interventions, 94% showed a significant reduction in depression, anxiety, and loneliness.
Current Phase: 2024-2027
In view of its successful impact and the evolving mental health needs, JC JoyAge extends its reach from community to primary care settings. In the current phase, alongside existing services, the Project partners with three District Heath Centres (“DHCs”) and District Health Centre Express (“DHCE”) to establish the “Jockey Club JoyAge Hub”, to provide mental health support to a wider group of people aged 45 or above. In addition, the Project collaborates with designated primary care physicians in these districts to provide co-care services for those in need. Through Primary Care Physician Co-Care Service (“PCP Co-Care Service”), social workers work with Primary Care Physicians* to offer a combination of psychological and pharmacological support for individuals with increased mental health needs. This not only provides more holistic mental health support at the primary care level, but also strengthens social-medical collaboration in the community.
Furthermore, a referral mechanism has been established between the Hospital Authority (“HA”) and the Project to support stable and waitlist cases for psychiatric services through our partnering service units at the respective districts. To unleash the potential of Peer Supporters, starting in late 2023, selected Peer Supporters went through additional training to become Emotional Support Assistants, offering low-intensity group intervention for middle-aged and older adults with mild depressive symptoms.
*Primary Care Physicians include General Practitioner (GP) and Family Physician (FM).
Project objectives
Since 2016, JC JoyAge has expanded into territory-wide community mental health services aimed at making a positive impact on various stakeholders within the community:
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Middle-aged and older adults with depressive symptoms and/or suffering from depression |
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Middle-aged and older adults at-risk of depression |
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Professionals and non-professionals, i.e. social workers and Peer Supporters |
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General public |
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Stepped-care Model
JC JoyAge promotes a collaborative stepped-care model for tackling depression in middle-age and older adults, based on the principles of early prevention and timely intervention. Individuals are assessed and triaged according to the standardised intervention protocol and clinical guidelines of the stepped-care service model. Trained social workers and Peer Supporters then provide preventive services and interventions based on each individuals’ risk level, depressive symptom severity and intervention response.
Those at-risk of depression are offered psychoeducation groups (e.g. sleep and pain management) at DECCs or DHCs/DHCE, and are encouraged to join the Ambassador training programme to enhance their mental health literacy. For individuals with mild depressive symptoms, low-intensity psychological intervention is provided at DECCs or DHCs/DHCE. For those with moderate depressive symptoms, high-intensity psychological intervention is provided by DECCs, DHCs/DHCE or ICCMWs. For individuals with moderately severe depressive symptoms, or for those with moderate depressive symptoms who do not respond to initial intervention, high-intensity individual support is available at ICCMWs or DHCs/DHCE.
Starting in 2025, individuals aged 45 or above with moderate to moderately severe depressive symptoms, especially those with persistent or deteriorating depressive symptoms despite receiving JC JoyAge psychological intervention, can be offered both psychological and pharmacological services through the Primary Care Physician Co-Care Serviceat the three Jockey Club JoyAge Hubs. Under this service, eligible service users can receive subsidised services from designated PCPs, including the consultation fee and medication cost (according to the list of shortlisted drugs covered). In parallel, JoyAge social workers will continue to meet with the service users regularly throughout their enrollment in the PCP Co-Care Service.
For individuals who are at the level of mild depression or above, Peer Supporters will be matched and accompany them on the journey to mental wellness throughout the intervention period.
Ambassadors
JC JoyAge Ambassadors programme aims to increase mental health literacy in community and to prevent depression through behavioral activation. It targets individuals 50 years and older (45 years or older for DHCs) with no clinically significant depressive symptoms.
Training
To become a JC JoyAge Ambassador, candidate need to complete a 18-hour classroom training covering Mental Health First Aid for Older Persons and introduction to JC JoyAge and a 6-hour practicum. Upon successful completion of the training required, Ambassadors are expected to provide 36 hours of voluntary services at their affiliated centres over the course of a year. They will engage in various activities, including assisting at street booths, supporting community events, and serving as “e-buddies” to help fellow older adults enhance their technology skills. Additionally, some Ambassadors may receive further training to become Peer Supporters.
Impact
Through participation in the training programme, prospective Ambassadors will engage in productive ageing and meaningful activities, resulting in enhanced self-efficacy, a stronger sense of purpose, and improved quality of life. Moreover, they will be equipped to:
- Provide support individuals at risk of depression in building resilience and coping with life challenges
- Lead community-based participatory activities that promote mental health literacy and awareness, strengthening the capacity of NGOs and service units to support mental wellness in older age
- Share knowledge and skills with families and social networks, improving their mental health literacy and fostering a resilient community network
Peer Supporters
People who share similar life experiences are often the best people to offer support to one another. By sharing personal experiences and resources on mental wellness, they can support peers who are experiencing depressive symptoms. JC JoyAge offers additional training programmes for Ambassadors to become Peer Supporters. Upon completion of the training and practicum, some Peer Supporters may be employed by Project NGO partners, where they offer companionship and emotional support to those suffering from depression by sharing their own personal journeys.
Training
The training is structured to equip participants with the core competencies of Peer Supporters and includes two levels: basic and advanced. This comprehensive training programme, consisting of classroom learning and practicum, is designed to equip participants with the core competencies necessary for effective peer support. Through the training, prospective Peer Supporters will gain a deeper understanding of mental wellness and recovery, enabling them to establish meaningful connections with their peers, inspire hope for recovery, and accompany them on their journey to mental well-being.
Impact
Upon completing the training, Peer Supporters will collaborate with Project social workers and staff to enhance social capital for mental health support in the community. Specifically, they will:
- Reach out to and support peers experiencing depressive symptoms
- Facilitate or lead group interventions for depression
- Share personal experiences, resources, and skills relevant to recovery to their peers
- Assist peers in reconnecting with community resources, building social networks, and enhancing resilience
- Assist peers in setting and attaining physical and mental recovery goals
- Promote mental wellness awareness in families and communities
Selected Peer Supporters who demonstrate strong group leadership skills and a desire to deepen their understanding of mental health will be recruited for an additional 15 hours of training in low-intensity cognitive behavioural therapy (“CBT”). This training will prepare them to become Emotional Support Assistants, offering low-intensity group intervention for middle-aged and older adults with mild depressive symptoms.