Enhancing Mental Health Services in Residential Care Homes for the Elderly in Hong Kong: The Experience of the Mental Health Programme in Australia ()
1. Introduction
The well-being of the elderly encompasses more than just having a place to live; it also involves their mental health. In Hong Kong, most government-funded residential care homes focus on care and attention. Social workers and welfare workers often oversee the mental health aspect of the programme. However, there are far fewer social workers than healthcare workers. With so much administrative work to deal with, do they have time to take care of the mental health of the elderly?
The Social Welfare Department (2024) released the report of the consultancy study on “Skill and Qualification Requirements of Residential Care Home (RCH) Staff providing Health and Rehabilitation Services in Hong Kong”. According to the Social Welfare Department (SWD) report from September 2024, there are currently 817 residential care homes for the elderly (RCHEs) in Hong Kong, providing over 77,000 places, as well as 344 residential care homes for the disabled (RCHDs), providing over 19,000 places. The entire residential care sector employs over 44,000 people. On average, there are around 30 staff members in each residential care home, including colleagues of various ranks and disciplines such as registered nurses, enrolled nurses, health workers, care workers, social workers and therapists. While elderly health care is naturally the main concern of the homes, who is responsible for the residents’ mental health?
Manpower resources are generally considered to be salaried staff. However, given the current manpower arrangement in Hong Kong, there is a shortage of social workers and nursing staff. The Australian experience enables us to consider alternative ways of utilising community resources, particularly in collaboration with universities.
2. Objectives
1) To explore the possibility of applying the Australian Mental Health Programme in Hong Kong. How can the Australian Mental Health Programme be adapted to address the unique mental health challenges faced by the residential care service in Hong Kong, considering cultural, social, and economic factors?
2) To discuss the strategies and barriers to implement the Australian Mental Health Programme in Hong Kong. What strategies are necessary to adapt the Australian Mental Health Programme to meet the specific needs and challenges faced by the Hong Kong population? What are the primary barriers to implementing the Australian Mental Health Programme in Hong Kong, and how can these barriers be addressed?
3) To explore ways to enhance students’ practical experience in mental health settings for older people.
3. Background
At the beginning of this article, it was stated that the ageing of the population is an issue that needs to be faced globally. Hong Kong will be no exception. Over the past 50 years, the number of older adults aged 65 and over has climbed from 180,000 in 1971 to 1.45 million in 2021, and the proportion of the total population has increased from 4.5% to 19.6% (Census and Statistics Department, 2021). The number of older adults will increase from 1.45 million in 2021 to 2.74 million in 2046. The corresponding proportion of the population is projected to increase from 20.5 per cent to 36.0 per cent, meaning that more than one in three people in Hong Kong will be elderly (Census and Statistics Department, 2023). Therefore, it is necessary to face the problem of the elderly and think about how to deal with the problem of an ageing population. We have always believed that the ageing population is not a problem, the question is how to provide a quality life for the elderly. These issues require the collaboration of different stakeholders in the community.
4. Literature Review
4.1. Mental Health of Elderly
Kan, Zhang, Bai and Peng (2025) was conducted a study in the last 2025, and the results showed that it highlights the growing research interest in suicide among older adults, particularly in relation to depression and the identification, treatment and prevention of suicide risk. The findings highlight the need for targeted prevention strategies and further research in this important area of public health.
According to the study was conducted by The University of Hong Kong (2022), one in 10 older adults had symptoms of depression or anxiety, and the rate of depression was twice as high among caregivers with cognitive impairment. Those with visual impairment, anxiety and loneliness were more likely to have suicidal thoughts. Survey also reveals over a third of older adults in Hong Kong suffered from emotional distress in the fifth wave of COVID-19. Therefore, we need to pay attention to the relationship between the mental health of older people and suicide rates after pandemic.
Study suggests that the loneliness experienced by older adults increases the likelihood of suicide. There are three main factors including personal, society and Chinese culture that suggest that older adults living in institutions are at greater risk.
For the individual, people who have to move to a new environment, away from familiar people and things, will experience adjustment problems. Feelings of loneliness and anxiety are normal.
For the society, there are still some negative perceptions of RCHEs in society, and sending the older adults to RCHEs may be seen as ungrateful. This social stigma makes the elderly feel ashamed and lonely. Therefore, the older adults is reluctant to be institutionalised. In addition, the quality of service in many residential care homes has been severely compromised by regulatory problems in the past. This has reinforced the community perception that institutionalisation is a way of waiting for death.
For the Chinese culture, traditionally, Chinese culture emphasises the importance of the family. Chinese people usually regard the family as the centre of their lives, and family members are very close to each other, especially in respecting and caring for the older adults. Filial piety is a fundamental value of Chinese culture, emphasising respect and care for parents and the elderly, and this concept is deeply embedded in people’s daily lives. Therefore, older adults usually expect to live with their family members and may feel abandoned and lonelier if they are sent to residential care homes. Elderly people living in RCHEs feel abandoned by their families. Would they be willing to receive counselling? This is another issue that requires attention. The mental health of the elderly is, of course, affected by various factors, including health, family relationships, personality and home environment. However, figures show that problems with the mental health of the elderly are becoming increasingly serious.
According to the Survey on the Mental Health of Children, Youth and the Elderly in Hong Kong conducted by the Chinese University of Hong Kong in 2023, 70% of people living in residential care homes for the elderly (RCHEs) suffer from dementia, and the survey found that the cognitive and mental health status of people with higher mobility or willingness to participate in activities was better.
According to the figures of the Labour and Welfare Bureau in 2021, the proportion of elderly living in residential care homes for the elderly (RCHEs) in Hong Kong is one of the highest in the world. There are about 1.45 million older adults aged 65 or above, and the number of those residing in RCHEs is about 59 000, which accounts for about 4.1% of the population aged 65 or above. This figure is increasing with the ageing of the population.
A survey was conducted by C&SD in July-August 2024 to collect the profile of persons residing in Private Elderly Homes (PEH). As of 1 July 2024, there were 40,600 people living in PEH on the list maintained by the Social Welfare Department.
In summary, the above figures show that the ageing of the population and the mental health of older adults in residential care homes is a cause for concern. It is therefore worth exploring how we can make older adults living in RCHEs feel cared for and valued by the community.
4.2. An experience from Australia
The global population is aging at an unprecedented rate. Like other countries, Australia is experiencing a rapid increase in the number of older persons. By 2031, nearly a quarter of the population is projected to be over 65. Australia and Hong Kong have different cultural backgrounds. However, they are both facing the same problem of an ageing population.
4.3. Aging population in Australia
According to demographic projections, the proportion of people aged over 60 increased from 9.2% in 1990 to 11.7% in 2013, and is expected to rise further to 21.7% by 2050 (Kendig et al., 2016). In Australia, the number of individuals over 65 living in permanent residential aged care increased by 3.1% in the past five years (AIHW, 2024). This demographic shift is accompanied by an increase in age-related health challenges, particularly in mental health. Residential aged care facilities (RACFs) report high levels of psychological distress among residents, especially in the form of major depressive disorder and depressive symptoms. Seitz, Purandare, and Conn (2010) found that the prevalence of major depressive disorder in RACFs ranges from 5% - 25%, while depressive symptoms affect between 14% - 82% of residents. A recent study (Hughes et al., 2024) found that around 3 in 5 residents take antidepressants. As such, there is an urgent need for mental health interventions that specifically target older people in residential care settings. Therefore, older adults, particularly those living in residential care can have difficulties accessing services to help maintain or improve emotional wellbeing.
Stakeholders from different communities are looking forward to helping this group of vulnerable older people in residential care. The stakeholder with the most resources is the University. This is a good opportunity to integrate education and service provision, as many universities have relevant professional programmes in helping people, such as social work, counselling or psychology, and these students also need practical opportunities.
5. The Scheme of the Mental Health Program in Australia
Wellbeing Clinic for Older Adults
The Wellbeing Clinic for Older Adults is a free and confidential advice and support service for older adults living in residential care which established by Swinburne University of Technology, Australia.
The clinic provides counselling and befriending services. Counselling services are provided face-to-face or via telehealth by postgraduate students of psychology, counselling or social work. The clinic also provides training in late life mental health practice and conducts research into the psychology of ageing.
The main components of the programme are as follows1:
1) Counselling and support services
This approach emphasises the importance of involving family members, carers and academic staff, and the importance of a strong therapeutic relationship between therapist and client.
Telehealth counselling
In response to COVID-19, the Wellbeing Clinic for Older Adults is offering a free telehealth service to provide ongoing emotional support during this challenging period.
Face-to-face counselling
The programme provides counselling services to older adults living in residential aged care facilities in Melbourne, Victoria. A key focus of our counselling is finding creative ways to work with older adults, their families and carers to help them cope with life transitions, loss and grief, physical health problems and mental health issues. A range of interventions are used, including cognitive behavioural therapy, reminiscence therapy and solution focused therapy.
Group programmes
The clinic offers group treatment and support, including reminiscence groups and carer support.
2) Education and training
The clinic offers training programmes for practitioners working with older adults, aged care staff, aged care volunteers, students and researchers. Members of the public, older adults and families are welcome to attend our training programmes.
Student placements
Swinburne’s Wellbeing Clinic for Older Adults is the largest university-based training clinic in psychological approaches and counselling for older adults. We train students from tertiary institutions across Australia.
Webinars on ageing
Presented by experts in health and ageing, the webinars cover a wide range of topics related to working with older adults, such as cognitive impairment, life-stage transitions, emotional experiences in later life, and psychosocial approaches for aged care residents and their families. Webinars are free and open to the public.
Workshops
The Clinic runs workshops for aged care workers and practitioners working with older adults. These workshops provide tools and practical strategies to improve the care of older adults living in residential and community settings.
3) Volunteering
Volunteering is a means to provide companionship and social interaction to aged care residents. Students and community members have the opportunity to provide befriending and digital storytelling services to older adults living in care homes.
In summary, The Wellbeing Clinic for Older People offers both in-person and online mental health services to elderly residents in RACFs across Australia. This program not only provides mental health support for older adults but also serves as a training platform for postgraduate students in psychology, counselling, and social work. The two focuses of the program—education and service delivery—positions it as a promising model for addressing mental health concerns in aged care. Among its various services, the Face-to-Face Counselling program stands out for its direct engagement with elderly clients, allowing for more personalized and impactful therapeutic interventions.
The Face-to-Face Counselling service is conducted by registered psychologists, postgraduate counselling students, or social work interns under the supervision of experienced professionals. The aim of this service is to listen to the concerns of aged care residents, their family members, relatives or friends of an aged care resident, then provide emotional support, and improve their overall psychological well-being. The counselling process typically involves 7 - 10 sessions over several months, interventions such as Cognitive Behavioural Therapy (CBT) are employed. CBT is a widely recognized therapeutic approach that helps clients identify, challenge, and modify unhelpful thought patterns and behaviours (Better Health Channel, 2022). In this context, CBT assists older adults in managing feelings of loneliness, isolation, and depression by equipping them with coping mechanisms and strategies for emotional regulation. There will be no discussion here of whether CBT is an effective intervention model. There are some very good practices in the above-mentioned programmes of Swinburne University of Technology Australia that we should learn from and see if they can be implemented in Hong Kong universities.
This is a good opportunity for us to consider how elderly services and institutions in Hong Kong can work together. The Press Releases from The Government of the Hong Kong Special Administrative Region (2024) reported that Minister of Education Dr Choi Yuk-lin continued her visit to Australia in March. She visited local universities in Perth to learn about the development of higher education in Australia. For this reason, Hong Kong has been active and attentive to the development and strategies of different countries in the field of education, in the hope that the development and strategies of different countries can be utilised to enhance the quality of education in Hong Kong. It is therefore worthwhile for Hong Kong to learn from the operation of higher education in other countries.
6. Current collaboration on Mental Health Programme
between Institutions and Welfare Sectors in Hong Kong
The ageing of the population and the mental health of older adults has always been a concern for the community, and a number of studies have been carried out by social care organisations and higher education institutions to provide appropriate services in light of these situations. As previously announced by the University of Hong Kong and the Hong Kong Jockey Club’s co-operation scheme: JC JoyAge: Jockey Club Holistic Support Project for Elderly Mental Wellness (JC JoyAge), which covers older adults in four pilot areas, enhancing their resiliency to facing the challenges of ageing. In the past, higher education institutions also collaborated with various social welfare organisations to promote and optimise their services. The HKJC Centre for Suicide Research and Prevention (CSRP) of the University of Hong Kong (HKU) held a press conference today (29 June) under the theme “Connected for Life”. The event also saw the launch of the “Help a Friend” booklet, which aims to provide guidance and support to those in emotional distress. The CSRP, Facebook and other partner organisations hope to use the opportunity to empower the public to act as Good Samaritans, caring for vulnerable people in society and encouraging members of the community to stay connected to prevent suicide.
In 2020, a collaborative HKU study on different approaches to psychiatric rehabilitation, led by Professor Samson Tse, Professor of Mental Health in the Department of Social Work and Social Administration, found that the Strengths Model Case Management (SMCM) implemented in some Integrated Community Centres for Mental Wellness (ICCMWs) in Hong Kong helps people with mental health problems aged 18 to 59 make better progress towards their goals, and helps those aged 60 and over make better progress in terms of personal recovery and hope, compared to traditional approaches to psychiatric rehabilitation.
The Education University of Hong Kong (EdUHK) and Edge Development Centre2, a Hong Kong social enterprise, have co-organised the “Mind and Study Matter” project to improve young people’s mental health. It is an award-winning project of “Mind Matters—A Hackathon for Social Impact”, organised by Asian Charity Services, and sponsored by HSBC Private Banking in 2021.
In 2023, Hong Kong Polytechnic University (PolyU) has been awarded funding for five projects under Phase 2 of the Mental Health Initiatives Funding Scheme3 (the Funding Scheme), coordinated by the Advisory Committee on Mental Health. The projects will develop innovative social service programmes to support the mental wellbeing of people in the community.
We can see that Hong Kong’s higher education institutions are willing to work together with various community organisations to help the underprivileged and to improve the quality of the services they provide. But there is something special about the Australian experience on the scheme of The Wellbeing Clinic for Older Adults. The two key concepts of the scheme are education and service delivery. In the Australian scheme, postgraduate students in the helping professions can be motivated to participate in the programme. Attempts are made to analyse the benefits from the perspective of students, institutions, older adults living at residential home and care homes. They mobilised a number of postgraduate students from the department of Counselling, Social Work and Psychology to volunteer in this community residential care programme. They have volunteered to participate in this community residential counselling programme. On the one hand, it will give them more opportunities to apply their knowledge and on the other hand, there will be more manpower to support the mental health problems of the older adults in the residential care homes.
Participating as volunteers in elderly residential care services offers numerous benefits for helping profession students including enhance practical skill, social responsibility, career development and personal growth.
At current, different higher education institutions in Hong Kong offer taught postgraduate programmes in psychology, counselling and social work. The following Table 1 shows the programmes offered by each institution.
Table 1. Insititutions in Hong Kong offer taught post-graduate programmes in psychology, counsleing and social work.
College |
Taught Postgraduate Programmes |
|
Psychology |
Counselling |
Social Work |
University of Hong Kong |
|
* |
* |
The Chinese University of Hong Kong |
|
|
* |
The Hong Kong Polytechnic University |
|
* |
* |
City University of Hong Kong |
|
* |
* |
Hong Kong Baptist University |
|
* |
* |
Hong Kong Shue Yan University |
|
* |
* |
Lingnan University |
|
|
|
The Education University of Hong Kong |
|
|
|
*practicum offers.
As these disciplines are helping professions and require practical training, apart from some formal work placement arrangements, we can also refer to the Australian scheme where students can take part in some community service projects on a voluntary basis. College can also have different achievements such as increasing student participation in elderly residential service volunteering benefits colleges by enhancing educational relevance, fostering community ties, improving student outcomes, and promoting a positive institutional image.
Statistics show that the mental health problems of older adults in residential care are becoming more serious, so this programme can also advocate for the provision of services to address their mental health problems.
For residential, eencouraging social workers and counseling students to participate more as volunteers in elderly homes offers numerous benefits to residential Home.
In order to enhancing the effectives of the scheme, Bhar et al. (2015) and Bhar et al. (2021) suggested to work collaboratively within the resident’s whole network such as family members, residential staff and community. Furthermore, expanding the Person-centred Care Model to include family members and staff working with residents enhances the sense of partnership in resident care for both family members and residents themselves (Hutchinson et al., 2017). We believe that, with the commitment of staff and family members, the outcome will be more effective. Due to the family-oriented nature of Hong Kong society, the involvement of family members can help to reduce the elderly’s resistance to counselling.
In terms of the overall program (The Wellbeing Clinic for Older People), it is well-positioned to contribute to this body of knowledge through continued evaluation of its services. By tracking client outcomes, training quality, and therapeutic effectiveness, the clinic can provide valuable data on how counselling-based interventions work in real-world aged care contexts. Additionally, the educational component of the program ensures that future professionals in the field are well trained with necessary skills to support the mental health needs of older adults. This programme provides us a deeper understanding of the effectiveness and feasibility of different mental health interventions in residential aged care facilities.
However, the Scheme also requires special attention to ensure the quality of the student trainees. Koder, Bhar, Jayaram, Silver, Linossier, & Kelly (2024) conducted a review paper on supervisors need to be aware of when working with students in clinical space. Specifically, for this scheme, the Bhar S, et al point out that there are a number of things that supervisors need to be aware of when supervising students in residential care homes. There are specific ethical issues involved when working in residential aged care, and supervisors should be able to identify and respond to these promptly and supportively. Furthermore, the following should also be considered when implementing the Scheme: confidentiality, multiple relationships, consent, privacy and duty of care.
7. Conclusion
As the global and national aging population continues to rise, so too does the urgency of addressing mental health challenges among older adults in residential care. Counselling-based intervention offers a well-supported, flexible, and effective approach to improving psychological well-being in this demographic. While foreign experience is beneficial, it is also important to consider the local cultural context. This includes concepts such as family care, filial piety, and the monitoring of the quality of student counselling. Overall, the model of The Wellbeing Clinic for Older People is vital in both delivering needed services and advancing the field through practical research and professional training, and that their provided services are effective in helping RACFs resident mental health. We also understand that different cultures can have different effects, but this is a good start for us to work together to contribute to the mental health of our elderly residents.
NOTES
1https://www.swinburne.edu.au/research/centres-groups-clinics/wellbeing-clinic/.
2The Education University of Hong Kong (EdUHK) and Edge Development Centre, a Hong Kong social enterprise, have co-organised the “Mind and Study Matter” project to improve young people’s mental health. It is an award-winning project of “Mind Matters—A Hackathon for Social Impact”, organised by Asian Charity Services, and sponsored by HSBC Private Banking. https://www.eduhk.hk/en/features/eduhk-edge-development-centre-mind-and-study-matter-project-promotes-mental-well-being.
3https://www.polyu.edu.hk/media/media-releases/2023/0220_five-polyu-projects-supported-by-phase-2-of-mental-health-initiatives-funding-scheme/#:~:text=The%20five%20awarded%20projects%20devise%20sustainable%20solutions%20to,carers%20of%20AD%2FHD%20children%2C%20and%20persons%20with%20disabilities.