Collaborative community mental health and aged care services with peer support to prevent late-life depression: study protocol for a non-randomised controlled trial.

BACKGROUND: Late-life depression is common, modifiable, yet under-treated. Service silos and human resources shortage contribute to insufficient prevention and intervention. We describe an implementation research protocol of collaborative stepped care and peer support model that integrates community mental health and aged care services to address service fragmentation, using productive ageing and recovery principles to involve older people as peer supporters to address human resource issue. METHODS/DESIGN: This is a non-randomised controlled trial examining the effectiveness and cost-effectiveness of the "Jockey Club Holistic Support Project for Elderly Mental Wellness" (JC JoyAge) model versus care as usual (CAU) in community aged care and community mental health service units in 12 months. Older people aged 60 years and over with mild to moderate depressive symptoms or risk factors for developing depression will be included. JoyAge service users will receive group-based activities and psychoeducation, low-intensity psychotherapy, or high-intensity psychotherapy according to the stepped care protocol in addition to usual community mental health or aged care, with support from an older peer supporter. The primary clinical outcome, depressive symptoms, and secondary outcomes, self-harm risk, anxiety symptoms, and loneliness, will be measured with the Patient Health Questionnaire-9 (PHQ-9), Self-Harm Inventory, Generalized Anxiety Disorder 7-item scale (GAD-7), and UCLA Loneliness 3-item scale (UCLA-3) respectively. Cost-effectiveness analysis will assess health-related quality of life using the EQ-5D-5L and service utilisation using the Client Service Receipt Inventory (CSRI). We use multilevel linear mixed models to compare outcomes change between groups and calculate the incremental cost-effectiveness ratio in terms of quality-adjusted life years. DISCUSSION: This study will provide evidence about outcomes for older persons with mental health needs receiving collaborative stepped care service without silos and with trained young-old volunteers to support engagement, treatment, and transitions. Cost-effectiveness findings from this study will inform resource allocation in this under-treated population. TRIAL REGISTRATION: ClinicalTrials.gov NCT03593889. Registered on 20 July 2018.

Mental health service user participation in Chinese culture: a model of independence or interdependence?

BACKGROUND: Current models of user participation in mental health services were developed within Western culture and thus may not be applicable to Chinese communities. AIMS: To present a new model of user participation, which emerged from research within a Chinese community, for understanding the processes of and factors influencing user participation in a non-Western culture. METHOD: Multiple qualitative methods, including focus groups, individual in-depth interviews, and photovoice, were applied within the framework of constructivist grounded theory and collaborative research. RESULTS: Diverging from conceptualizations of user participation with emphasis on civil rights and the individual as a central agent, participants in the study highlighted the interpersonal dynamics between service users and different players affecting the participation intensity and outcomes. They valued a reciprocal relationship with their caregivers in making treatment decisions, cooperated with staff to observe power hierarchies and social harmony, identified the importance of peer support in enabling service engagement and delivery, and emphasized professional facilitation in advancing involvement at the policy level. CONCLUSIONS: User participation in Chinese culture embeds dynamic interdependence. The proposed model adds this new dimension to the existing frameworks and calls for attention to the complex local ecology and cultural consistency in realizing user participation.