Abstract
OBJECTIVE: The study evaluated the effectiveness of headwind service, an online, clinician-led mental health advisory platform, in engaging individuals with moderate to severe psychological distress. It also compared distress reduction achieved through headwind with natural recovery in a community cohort, providing a benchmark for evaluating active interventions. DESIGN SETTING AND PARTICIPANTS: The study analysed data from 13 527 people across three cohorts: headwind users (n=3559), participants in a territory-wide youth mental health (YMH) programme (n=6734) and a community youth cohort (n=3234). Data were collected between April 2019 and December 2024 in Hong Kong. INTERVENTION: headwind offers single 30 min informal mental health advisory sessions through Zoom or telephone, led by psychiatrists and clinical psychologists. Designed for accessibility and anonymity, the service provides practical advice without establishing a formal doctor-patient relationship. MAIN OUTCOMES AND MEASURES: Distress levels were measured using the Kessler Psychological Distress Scale (K6) at baseline and follow-up. Primary outcomes included engagement of individuals with moderate to severe levels of mental distress, reductions in K6 scores and shifts in distress severity categories. Secondary outcomes examined demographic subgroup differences and comparisons with natural recovery in the community cohort. RESULTS: At baseline, headwind users reported higher baseline distress levels (mean K6 score: 13.11) than YMH (7.88) and community (7.27) cohorts (p<0.001). Following a single session, headwind participants experienced a substantial reduction in distress (large effect size: 0.74), with the largest improvements observed in individuals with severe distress. Reductions were consistent across age and gender subgroups. headwind users showed significantly greater distress reductions than the naturalistic recovery observed in the propensity score-matched community cohort (p=0.008). CONCLUSIONS: The headwind service effectively engages young people experiencing moderate to severe mental distress, delivering immediate and significant reductions in distress levels. Its low-barrier design, characterised by anonymity, timely access to professionals and an informal, user-friendly structure, effectively addresses systemic challenges in traditional mental healthcare, making it a scalable, accessible and impactful complement to existing mental healthcare systems.