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Case Studies - NHS Live What is is an online counselling service that provides vulnerable young people, between the ages of 11 and 25, with advice and support for emotional or mental health problems. offers users a free, confidential, safe and anonymous way to access help. 

The problem

Young people are one of the most vulnerable groups in society and typically find it difficult to access face-to-face counselling or support for their problems. In the UK, around one in ten young people are diagnosed with a mental health issue and feelings of isolation or unhappiness make it more difficult for them to get the support they need. These people are more likely to self-harm, turn to alcohol or drugs, become victims of or commit crime, and suffer from suicidal feelings.

The solution was developed to offer PCTs, local authorities and GPs the resource and expertise to engage with young people in a way that best suits them and provide help to those most at risk. The free service includes:

  • drop in chats with counsellors 
  • booked 1:1 chats with a counsellor
  • themed message forums
  • a secure email service
  • a variety of self help feature
  • an on line magazine

10,000 young people visit Kooth every year, with the vast majority recommended by friends or school staff. Young people know and trust the service.

Who was involved?

In collaboration with neighbouring PCTs in the North West, the Kooth team consulted local high schools to ask young people whether they would use an online counselling service and what they would like to see from a service designed for them, ie would they need to register, what would it look like etc.

The service links up with Child and Adolescent Mental Health Services (CAMHS) and a wide range of PCTs and local authorities.


Although Kooth provides online counselling, it also links in to a range of local pathways including schools and other youth services. is clinically governed and follows ethical guidelines to provide a stepped service – run in the same way as face to face counselling – where young people can get online support regardless of the severity of their mental health.

The service offers three levels:

• Level one offers drop-in support for young people with ordinary adolescent issues – friendships, relationships, problems at home, transitions from primary to secondary school, into further education, training or work, leaving home, care or moving from child to adult services.  This is offered via a chat or messaging system to help the user get things off their chest on an ad hoc basis.

• Level two provides structured weekly counselling – usually 12 sessions with a counsellor, with chat and messaging available in between. Adolescents in particular are unable to retain thoughts and feelings in the same way as adults can, and need a more flexible process.  Extra sessions can be provided if needed.

• Level three is offered for more complex cases, for example individuals accessing the website independently who report suicidal feelings.  Young people at this level may be in residential units, working with CAMHS or a dedicate psychiatrist or accessing tier three NHS mental health services.  Counsellors insist on knowing the name and having contact details from these young people.  This enables us to provide an appropriate level of support and/or offer seamless referral to other services.

Elaine Bousfield, Director at Xenzone Limited, says: ‘Many counsellors are not trained in mental health specifically. Our counsellors are trained in mental health and will provide cognitive behavioural therapy and person centred counselling, as well as a variety of other approaches. They are also supported with line management, fortnightly team meetings, professional development opportunities and independent supervision.

Kooth counsellors refer in to NHS mental health services and CAMHS when it’s appropriate to do so and, similarly, CAMHS will refer young people to Kooth if face to face work isn’t proving beneficial. We keep a foot in the real world as well as being a virtual service.’

Investing in services and support for young people can ease feelings of isolation and depression, reducing hospital attendances as a result of self harm, alcohol and drug abuse, and other criminal activities. Not only does this save money for the NHS, it also impacts on education, social care and the criminal justice system.

Next steps is available to commissioners to buy as a ready-made online counselling service for children and young people operated by a robust clinically managed therapy and support team.  For more information please see our website or call Elaine Blousfield on 0845 330 7090.

Key Learning Points can only be available to young people who live in areas where the service has been commissioned.  Young people who live outside these areas cannot use the service.

More information

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