People with mental health needs are often reluctant to seek help due to inaccessibility to service and also stigmatization, especially in Chinese societies. However, professional effort to identify the high-risk people is inadequate. In this paper the authors described a five-year community-based outreaching project, which aimed at identifying the high-risk groups in seven deprived and low-income communities territory wide and linking them up with mental health and social services. We assessed the project outcome by analysing the data (total number = 2181 participants) gathered on-site using the 20-item Centre for Epidemiological Studies Depression Scale (CES-D). The results of our analysis have shown that the project had successfully identified the high-risk groups (20.6%), with the following profile: the unemployed, housewife, the widowed and divorced and people with low education. They were referred to different services. The results of the post-intervention have indicated improved mental well-being of the participants who had received the services referred (n = 43). Our positive experience has confirmed the need of social workers to take an active role to reach out the unreachable, rather than be passive waiting them to come in.