An interview with XenZone founder Elaine Bousfield

Elaine Bousfield, a former therapist, is the founder of XenZone, an organisation that aims to remove barriers and increase access to mental health support through technological innovation. In 2004, XenZone established the UK's first online counselling and mental health resource service for children and young people, Kooth. Following the success of Kooth, Qwell was launched to offer this service to adults. Most recently, XenZone has adapted its service for students – Kooth Student is currently offered to students at the University of West England as part of a seven-month pilot.

For more information on XenZone and Kooth Student, see the website.

Why was Kooth developed?

I established XenZone in 2001 when I was working as a therapist in a Manchester-based mental health charity. I wanted to find a way of reaching those who needed mental health support but, for a variety of reasons, did not feel able to speak out. A particular issue that I observed during this time was that few men and boys were coming forward to seek help for mental health issues. Research conducted by the Samaritans at that time suggested that the accessibility and anonymity of online support would especially appeal to this group.

The Kooth service is aimed at 11-25-year olds and currently covers 37% of the UK. It is free at the point of use, and those accessing the service can speak to a trained therapist online until 10pm, seven days a week. Kooth counsellors treat the sessions as they would a face-to-face meeting, bringing cases to supervision and taking part in regular clinical team meetings. meeting. Users can also make use of self-help materials and take part in group chats in a monitored forum.

What is the average age of a Kooth user, and what are some of the common reasons for logging on to the service?

Looking at 2016-17 data, Kooth users are typically 13-15 years of age, but we have users up to the age of 25 regularly logging on. We launched Kooth Student in September last year and have a pilot running at the University of the West of England, which is already proving popular with students.

Taking Kooth as a whole, between October and December 2017, the top ten issues in order of prominence were: anxiety/stress, friendships, depression, self-worth, confidence, family relationships, self-harm, loneliness, boyfriend/girlfriend issues and bullying. When young people log on, they can speak to trained, professional counsellors who will help them in a variety of ways, such as exploring their emotions, setting personal goals, utilising self-help tools, working ​on emotional regulation (particularly those who are managing feelings of anxiety), minimising self-harm, and building self-confidence.

In addition to speaking with a counsellor, what other support services can users access through Kooth?

There are also interactive, live forums on the site; these run on three evenings a week and are monitored by trained members of staff. Users can read comments or submit their own, and these are checked by the moderators before publication for triggering language or themes. Over the last year, 17,000 people have taken part in the forum. Our articles, which offer advice and support on a wide range of issues, had over 133,000 views in the same period. ​

What other barriers do you feel exist when it comes to seeking help for a mental health issue?

A November 2017 study which analysed Kooth user demographics found that black and ethnic minority groups are less likely to access traditional mental health services; individuals in these groups may not as culturally comfortable receiving face-to-face support which is why there has been a higher than expected uptake online.

Young people also worry about their parents finding out if they are feeling a certain way, or need to access support. This is why the anonymity of Kooth is so important and helps increase accessibility.

Kooth users are also still predominantly female, but we do hold focus groups with young men to try and understand the sort of issues they are facing and encourage them to speak to someone if they are struggling. We visit schools and run online focus groups to try and reach as many different people as possible, and to reduce the stigma attached to mental health issues. One of our Kooth counsellors, Jo Jamieson, has also written a very insightful piece on the impact of gender difference when it comes to presenting issues and seeking help, which I would highly recommend reading.

How was Kooth adapted for students?

Around 60% of site content is produced by users (with the rest developed by Kooth), which means students can tell their own story and offer peer support. Students can also take part in live peer support sessions across three evenings a week. We looked at the content that would be most relevant for university students and pushed this to the forefront of the site. Structurally, it offers the same content as Kooth but includes dedicated support around specific issues such as dealing with exam pressure. Of course, students can also speak to trained counsellors online.

Some local councils already pay for the service so anyone living in that area up to the age of 25 (including students) can access Kooth. In this instance, students are often signposted from their university’s website, and they can sign up via their university email address. This information is then deleted from the site, no details are held, so sign-ups are entirely anonymous.

You are currently piloting Kooth Student at the University of West England. What sort of data will you collect?

We are very interested in the impact on waiting lists for counselling services, which is a big issue across the HE sector. We also want to track the impact on the number of students being referred to external health services; the aim is to get to young people earlier and prevent a problem from escalating into a serious issue.

As part of the Kooth Student package, we provide quarterly reports to the university on usage data and outcome data. This shows what sort of issues are coming up, and why students are being referred to the service. We also liaise with the NHS and lead for student welfare in this work.

Kooth Student is separate to UWE wellbeing services; what information (if any) is shared?

Kooth will not share any information without the student’s permission. If a Kooth counsellor is concerned about a student, they will encourage the student to disclose this to their university. If the student needs extra support, and is willing to talk to their university, a joined-up approach is preferable and Kooth Student will work with wellbeing services to develop a plan of action, but only if the student consents.

There are many reports of university mental health services struggling to cope with demand. How can Kooth Student help?

Students can be a vulnerable group for a number of reasons, and of course supporting them in large numbers costs a lot of money. But universities have a duty of care to all of their students and must have a mental health strategy in place if they are to meet demand appropriately. Kooth Student fits in alongside other university wellbeing services by offering a pathway into the various available services; we can work with universities and local health services to help ensure that need is met. The online, digital and anonymous aspect to Kooth Student is also appealing to young people; it provides an immediate, confidential space where they get help with any issues they are experiencing. Early intervention is key to preventing a problem from escalating. A bit of support and education really can be a lifeline for some people.

Indicator 4.1.1 of ProtectED's Student Wellbeing and Mental Health Instrument requires member universities to have provisions in place to allow students access to 24/7 mental health support.