Kooth FAQ

Founded in 2001, Kooth is a pioneer and leader in digital mental healthcare. Our purpose is to build mentally healthier populations, leaving no one behind. We achieve this by providing everyone with safe and effective digital support from their first moment of need.

Today, our services empower 17 million users worldwide to identify, manage, and address a range of emerging, escalating and established mental health and wellbeing challenges.

Never has this support been more needed. According to the Children’s Commissioner, in England alone, nearly one million children and young people were referred to Child and Adolescent Mental Health Services (CAMHS) in 2022-23.

In March 2024, more than a quarter of a million (270,300) of those were still waiting for mental health support. Meanwhile, as outlined by the Centre for Mental Health, NHS Benchmarking Network data shows that in 2023, referrals to adult community mental health services rose by some 11% compared to the previous year.

Working predominantly with NHS and Local Authority partners and embedding our service in local networks, Kooth brings safe, early mental health support directly to those in need, with no costs, no referrals and no waiting lists. In April 2024, the average wait time for a one-to-one session with a practitioner was just 22 minutes.

In the UK, Kooth has two mental health support platforms:

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  Kooth - for children and young people aged 10-25 (note: in some areas the service is commissioned for slightly different age groups)

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  Qwell - for adults

Both services offer free, safe and anonymous access to proven tools and techniques to address areas of concern, including stress, anxiety, sleep, self-esteem, trauma, relationships, and more. Both blend immediate online access to therapeutic resources with experienced mental health practitioners.

Individuals can access:

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  One-to-one live text chat with a professional mental health practitioner

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  Interactive asynchronous messaging with professional mental health practitioners

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  Self-guided tools, including online journals and goal and mood trackers

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  Therapeutic mini activities

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  An extensive library of peer and professionally-created therapeutic articles, podcasts and videos, all reviewed by our clinical team and age-gated to ensure they are appropriate for all our service users

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  Our active community of service users who offer and receive peer support through discussion posts and forums

Note:

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  Every word we publish is reviewed first by our professional team of moderators adhering to strict clinical and age guidelines

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  There is no way for users to directly message each other within the site or to share private messages, or any personal contact information

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  All user-generated content is anonymous.

There are lots of face-to-face services that can provide effective support for people. However, there are some barriers to these services, including their geographical location, waiting lists, and thresholds for accessing them.

We've found that some people prefer to use a service like Kooth or Qwell, which they can access outside of "traditional" hours and from wherever they are. We do not have a waiting list or thresholds for access, so it can also be helpful for people who want timely access to support.

Some people also feel there is some shame and stigma attached with attending face-to-face mental health services, especially if their peers may see them, perhaps at school. Our anonymity can support individuals to access support in a way that remains confidential from those around them.

We often support young people who are finding it difficult to engage with their existing face to face support (teachers, social workers, CAMHS workers etc). Because young people work with Kooth on their terms, it can help them to better engage with the face to face services that are available to them when there are barriers.

The same can be said of support for adults who may find reaching out for help a difficult first step. For this reason, we're often not a substitute for face to face services at all, we're more a service that works alongside, and very much in support of the other help in a person's life.

In addition, people who have additional needs, neurodiversity, or disabilities that make traditional services inaccessible or difficult to navigate, may find Kooth or Qwell a more manageable way to access support.

There is lots of evidence to demonstrate that the therapeutic alliance can be achieved in an online setting as it can be in a face to face setting which is an essential part of delivering effective support through the counselling process.

Our services are designed to be as flexible as possible, so that people can access support when they need it. Kooth.com for children and young people and Qwell.io for adults are available 24/7.

One-to-one sessions with mental health practitioners are available as booked or drop-in sessions from mid-day to 10pm on weekdays and from 6pm to 10pm at weekends.

Our data shows that around 60% of service users access Kooth outside the traditional 9am to 5pm window.

Yes - we hold the UK’s longest standing accreditations for digital mental health services from the British Association for Counselling and Psychotherapy (BACP) for Kooth (for children and young people) and for Qwell (for adults). As such, our practices and systems are periodically and independently audited.

We also earned a score of 90% for Qwell and 86% for Kooth from the UK’s Organisation for the Review of Care and Health Apps (ORCHA), amongst the highest of reviewed digital mental health services.

While we are not in scope for national accreditation with Digital Technology Assessment Criteria (DTAC), ORCHA has supported us through a DTAC assessment and we have certification to demonstrate full compliance in all areas, with a high usability and accessibility score of 92.5%.

In addition, Kooth is ISO 27001 certified.

Usually, Kooth is commissioned for children and young people aged 10-25 and Qwell for people 18 or over. These age brackets may vary depending on the commissioning area. Anyone living in commissioned areas within these age groups can access Kooth whenever they need to.

As a safe, easy-access and anonymous service with a strong inclusivity principle, Kooth is effective in reaching seldom heard groups. Data from our user survey (Dec 2022 - Jan 2023) shows 19% of service users were from ethnic minority backgrounds and that 7.5% identified as non-binary, both significantly higher figures than those accessing traditional services.

Being a flexible digital service, people are free to access help out of hours. In fact, around 60% of service users access Kooth outside the traditional 9am to 5pm window.

Kooth.com and Qwell.io are pre-moderated sites and operate within strict safeguarding and clinical governance guidelines. It is important to note that it is not possible for any user to share personal information with another on Kooth or Qwell.

In addition, any user submission (eg. a comment or post) is reviewed and assessed against our strict clinical and age guidelines by our moderation team which determines whether to publish.

We use a range of clinically robust and evidence-based measures to determine the effectiveness of Kooth. We also invest heavily in research to constantly enhance our services.

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  An external evaluation conducted by academics at the London School of Economics (LSE) followed a cohort of young people over a month to explore changes in mental health and social relationships.They found a notable improvement in psychological distress, a decrease in suicidal ideation a prominent increase in the level of hope and a significant shift towards increased confidence and decreased loneliness.

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  In terms of measures we use in the platform - for children and young people our clinicians use CORE 10 and YP CORE questionnaires and for adults, GAD-7 and PHQ-9 assessments.

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  Goal-based outcomes: Kooth developed a goal-based outcome measure (GBO) to assess the impact of setting and working towards goals on our platform. All service users can create goals on Kooth and Qwell and can track them over time. Over two thirds of Kooth users who set goals achieve them, resulting in a positive and meaningful change in their lives.

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  Kooth has developed the SWAN-OM, an innovative tool and measure for our responsive ‘single session’ work, sometimes referred to as ‘one at a time sessions’. This is for those who want to drop in for a single session rather than a traditional ‘block’ of sessions, and is becoming increasingly popular within mental health care. SWAN-OM data shows that 72% of service users are getting what they want and need through Kooth.

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  Service users also find the community elements - mini activities, forums and other therapeutic resources - useful. A study by LSE showed 75% of young people found our community and peer support beneficial to their mental health.

We use a range of satisfaction measures to ensure we understand and can respond to the experiences of our service user community.

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  Therapeutic content: we ask service users across the full age range to rate the content that they've engaged with in terms of how helpful it was. These peer support measure scores are routinely high; article ratings average out at 4 out of 5.

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  Chat sessions: data from our regular End of Session questionnaire shows over 85% of service users feel ‘heard, understood and respected’ and over 83% say the person helping them was a good fit. 93% of service users on Kooth would recommend it to a friend.

Kooth has developed systems, practices, and expertise over more than 20 years, working in partnership with the NHS, academia, and the mental health ecosystem. This has enabled us to create a safe, person-centred service that provides access to support without stigma, thresholds, or waiting lists.

We embed Kooth into local communities through stakeholder engagement, not only to drive awareness but to ensure that our platform is built with the user’s voice at its heart, and is integrated and embedded within system pathways.

Kooth’s i-RESPOND clinical framework underpins our approach: it is integrative, responsive, evidence-based, safe, person focussed, outcomes driven, non-judgemental and data led.

As part of Kooth’s focus on ensuring its work is safe and evidence-based, we operate a system of improved reporting and root cause analysis. This helps the team to identify earlier on any opportunities for improvement and learning.

To deliver a continuous improvement model, the i-RESPOND framework is fully embedded into our quarterly audit process for each practitioner - offering all practitioners the opportunity for individual professional development, delivering important learnings for the wider clinical team, and identifying areas of focus for training programmes as well as an enhanced offering for clinical supervision and support.

Our approach aligns with the Thrive Framework developed by the Anna Freud Centre, and adopted by the NHS, introduced to provide a shift away from a linear and tiered service model to a more fluid one, where children and young people can access the right level of intervention at the right time without having to wait or repeat their story.

While most services tend to operate in one or two of the THRIVE quadrants, the Kooth model enables access at all four levels, some simultaneously, depending on need.

We work with a range of presenting clinical issues and all interventions are based on the available evidence base, including (but not limited to) CBT-informed practice and person-centred counselling.

Yes. We offer access to booked or ‘drop-in’ support as needed. There are no thresholds to meet and no need for a GP referral. The sessions are conducted through live text via the platform.

We deliver therapeutic intervention through single sessions as well as through the more traditional 6-12 sessions.

Our population health model is designed to intervene before issues escalate. We offer three distinct pathways:

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  Self-guided psycho-educational tools and resources

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  Safe and moderated peer communities and support

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  ‘Text chat’ with a mental health practitioner

These pathways align with our commitment to empower and educate individuals in understanding and navigating their mental health challenges.

We hold the UK’s longest standing accreditation for our digital mental health services from the British Association for Counselling and Psychotherapy (BACP).

A crucial component of Kooth’s success is that we build our services with young people based on what they want - not what the system says they should have. We have rich data gathered over more than 20 years which supports our Theory of Change and we have built our pathways around this.

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  Today, just under 40% of people who use Kooth engage with a practitioner to get the support they need through messaging and/or a booked or ‘drop in’ chat.

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  Around 60% find the help they need through the community, therapeutic content, and self-therapy activities we provide, such as the ability to set and track goals. For people solely engaging with our therapeutic content and community, 75% find it beneficial to their mental health. Of those that set and track goals, 74% achieve their life and therapy goals.

Kooth delivers a range of integrated tools and therapies. We provide choice and diversity to enable people to access mental health support that best meets their needs. We are the only digital mental health provider to offer one-to-one professional counselling in addition to therapeutic self-help activities and peer-to-peer support.

No. People cannot directly engage with each other, add friends, post likes and comments, or directly message others as they would on a gaming platform or social media site.

By not asking for an individual's name, address and/or other details, we are eliminating common barriers associated with stigma or fear, which can stop people from finding help.

Anonymity brings more people to our service and means we can provide early, preventative help to more people: it helps us to safeguard people who may not otherwise seek help or engage with mental health support.

Our data shows that 97% of our community value Kooth’s anonymity.

We are only too aware of the serious impacts when help is not sought or is unavailable. The likelihood of issues escalating or becoming entrenched increases, leading to greater need for acute or crisis support.

We are primarily commissioned by the NHS and Local Authorities across England, Scotland and Wales. We are also commissioned directly by organisations, such the Royal Agricultural Benevolent Institution (RABI).

We employ ethical AI to help our mental health practitioners review service users’ online journal entries for possible safeguarding concerns. This enables the team to reach out to service users in a timely way and to offer appropriate support. It is important to note that service users can only view their own personal journal entries, not those of others.

All professional support is delivered by trained mental health practitioners; Kooth does not use AI within counselling or elsewhere on the platform.

Content on Kooth’s site is pre-moderated, which means nothing is published until it has been through a thorough review process by our dedicated moderation team. The moderation team screens all submitted content, such as articles and comments, for both safeguarding issues and appropriateness, ensuring it is in line with our clinical guidelines. This 'pre-moderated' approach means we offer a safe place for all those coming to us for support.

We do not support any particular agenda. We simply promise to help people from all walks of life get the mental health and wellbeing support they need.

Many people coming to us want to explore numerous aspects of their life that impact their mental health. This can include particularly sensitive topics around gender expression/identity, sexuality, culture, race, and faith. Our role is to support them on their personal mental health and wellbeing journey.

This approach aligns with the Cass report’s central theme, that all young people in distress should have the same access to psychological support.

For more information on how our model is aligned with the Cass report guidance, see our explainer for more information.

Yes, Kooth supports individuals with a range of issues including those who present with suicidal thoughts, self harm and eating disorders. We do not diagnose, nor do we provide any medical advice, however, our teams are well trained and experienced in providing general mental health and wellbeing support in line with relevant evidence-based and best practice guidelines.

If a more specialist intervention is required (eg. family therapy to support an individual with Anorexia Nervosa), then we would refer to a local specialist service or signpost individuals as appropriate and depending on the level of personal information we have.

Some individuals may be anxious about accessing specialist interventions. Our work might be to help reassure them about what to expect and encourage them to talk to a parent or trusted adult, all while continuing to provide emotional support and appropriate evidence-based interventions so they do not feel alone and to prevent further deterioration.

Similarly, while we are not a crisis service and would always signpost to 24/7 crisis services, such as Samaritans or Shout, individuals do present at Kooth with suicidal thoughts or intent as well as with self-harming behaviours. Our team is not only highly experienced in assessing risk, they also know how to manage risk in the moment and how to help individuals minimise future risks.

We have a number of tools within our platform which offer support, alongside a fully moderated peer community which vulnerable individuals can find extremely helpful. All content is carefully moderated based on appropriate guidance (eg from BEAT and Samaritans) to protect all who use Kooth.

Our work to reduce healthcare inequalities (in line with the NHS’s Core20PLUS5 approach) has resulted in an above average uptake of Kooth from marginalised groups.

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  20% of service users are Black, Asian, and minority ethnic backgrounds, compared to 14% of the UK population

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  14% identify as LGBTQIA+

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  We see 1.5x more use from males vs traditional services. To this end, we do provide resources on a diverse range of topics at Kooth, in line with areas of concern and prevalence for young people

The short answer is yes. The Online Safety Act (OSA) is a new law designed to protect children and adults online. A fundamental intention of this law is to safeguard against potentially very harmful types of internet content, for example illegal pornography and trolling. As Kooth (our service for children and young people) and Qwell (our service for adults) are both pre-moderated by a team of trained professionals, we know no such unsafe content is published.

In November 2023, Ofcom released its consultation on proposed regulations for the OSA requirements for protection people from illegal harms online.

Our overall assessment found that Kooth’s existing moderation processes were sufficient to mitigate the risks, although we have added to current safety measures to reduce the likelihood of harm and will regularly review this.

In May 2024, Ofcom released a consultation on proposed regulations for protecting children from harms online, including effective age assurance requirements. Kooth’s OSA Working Group is now undertaking an assessment of our alignment with the proposed regulations.

Ofcom is not due to start releasing the final regulations until later in 2024, at which point the OSA Working Group will review risk assessments and measures to ensure Kooth remains in line with best practice and compliant with the OSA.

Yes. We have rigorous policies and procedures to ensure our users’ safety and privacy, which includes age-gating content.

Our processes are in alignment with the rules set out in the preliminary Online Safety Act to ensure content on our platform is appropriate, and our users are kept safe.

There are aspects relating to particularly sensitive and risk-related topics which we would never publish for any age group, such as details or methods of self harm and unhelpful content relating to eating disorders including details of purging and/or bingeing, recognised to be potential triggering to others who may be vulnerable to this.

Our age rating framework is informed by a variety of evidence sources, including from DfE Guidance, NHS Digital Manual, NSPCC’s sexual development and behaviour in children, Government Online Safety Guidance, and a number of specialist mental health sources for particular topics, eg. BEAT, Mindand the Samaritans.

Our age ratings on Kooth are:

10-11

12-13

14-17

18+

Content on Kooth’s site is pre-moderated, which means all user-generated content is subject to a thorough review process by our dedicated moderation team. The team screens all submitted content for both safeguarding issues and appropriateness, ensuring the material is in line with our clinical guidelines.

Only after careful examination and approval is the content published to the site and, therefore, visible to other users. If content submitted by a service user gives us cause for concern, our safeguarding team is alerted and the user is offered appropriate support.

All user-generated content is anonymous. Users cannot chat directly with each other on the site. They cannot share private messages, or any personal contact information.

Children, young people and adults in commissioned areas can register with Kooth or Qwell to access free and safe support if their age falls within the bracket agreed with the commissioner. For Kooth, this is usually between the ages of 10 and 25.

We have rigorous policies and procedures to ensure our users’ safety and privacy; pre-moderation is central to the service, ensuring safety. As such, it is not possible for any user to share personal information with another. Any user submission (eg. a comment, post or journal entry) is reviewed and assessed against our strict clinical and age rating guidelines by our moderation team before it is published to the site.

While anyone who engages with Kooth professionals will receive the same clinically informed and supportive response, users improperly engaging with Kooth professionals take time and resources away from young people we’re committed to helping through our platform.

The creation of fictitious accounts with malicious and/or potentially harmful intent is taken seriously and in some cases may lead to police involvement.

All our counsellors have a relevant professional qualification in counselling or psychotherapy to at least level 4 or the equivalent recognised by the BACP, UKCP, NCPS, or COSCA.

Our emotional wellbeing practitioners are a multidisciplinary team of experienced mental health professionals who have a qualification in a relevant field (eg. social work, mental health nursing, psychology).

All our practitioners have an enhanced DBS check. They are supported and supervised by an experienced team of qualified clinical specialists, and their work is governed and audited internally through an industry standard best practice. In addition, practitioners are supported on shift by experienced shift managers, as well as clinical 'on call' staff to advise and support.

All staff across the organisation complete safeguarding training. Roles and safeguarding training requirements are aligned to the NHS Intercollegiate competency documents for Adults Safeguarding and Safeguarding Children and Young People.

Those specifically in service delivery and clinical roles complete Level 2 for adult safeguarding and Level 3 for child safeguarding; these are one day learning modules. This training ensures that all staff and contractors are adequately trained to recognise a safeguarding issue, understand their responsibilities and to take appropriate steps. A further module is completed in Prevent (radicalisation and extremism).

Additionally, all support teams and clinical teams complete an online digital safeguarding module that focuses on identifying and managing safeguarding issues within Kooth’s digital context in line with our safeguarding procedure. Our further training incorporates suicide prevention, domestic abuse, Mental Capacity Act and Deprivation of Liberty standards, Modern Slavery, FGM and whistleblowing.

The Clinical and Safeguarding teams are led by experienced professionals, trained to level 4 or 5 safeguarding (level 5 is the highest possible level).

As user safety is our top priority, we have designed our services to ensure clinical safeguards are in place at every turn. Safety and clinical quality underpin our three main service pathways:

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  Self-guided support. Self-led journeys include therapeutic content and tools. All content is evidence-based and clinically reviewed, meaning that a Kooth-trained team member has reviewed it to ensure it is clinically safe and appropriate for different age groups.

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  Peer-support: While peer support allows young people to benefit from the lived experience and support of their peers, this should not be confused with social media. Kooth is not and never will be a social media platform. We have rigorous policies and procedures to ensure user safety. Any user submission (eg. a comment or post) is reviewed by our clinical team before it is published to the site to make sure it is both safe and supportive. User-generated content is anonymous, and users cannot chat directly with each other or share personal contact information. There is no way that people can talk privately on our site.

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  Professional support: This is offered through our messaging and chat functions in a single-session model or a structured pathway. All interventions are based on the available evidence base, including (but not limited to) CBT-informed practice and person-centred counselling.

When someone presents to us with risk, practitioners will de-escalate risk by creating a safety plan with that individual, ensuring they have coping techniques and know where to go for crisis support. The safety plan is then saved to that person's profile and can be updated and revisited when appropriate.

Kooth complies with statutory safeguarding frameworks and best practice. We conduct annual organisational audits to ensure our safeguarding arrangements are fully in line with the requirements of safeguarding legislation within each nation we operate.

For safeguarding children, this predominantly includes: Children Act, 1989 (2004), Social Services and Wellbeing (Wales) Act 2014, Children (Scotland) Act, 1995, The Children (NI) Order 1995. In addition, the statutory guidance within each nation also underpins our arrangements, notably Working together to Safeguard Children 2023, Wales Working Together to Safeguard People 2022, National Guidance for Child Protection in Scotland 2021 and Co-operating to Safeguard Children and Young People in NI 2017.

For safeguarding adults, we comply with the Care Act 2014 and associated Care and Support Statutory Guidance and The Adult Support and Protection (Scotland) Act 2007 and associated statutory guidance.

Additional assurance of our safeguarding arrangements is routinely conducted internally and externally against NHS England’s Safeguarding Assurance and Accountability Framework and the NHS Scotland’s Public Protection Accountability and Assurance Framework.

Kooth as a platform and service has over 20 years of evidence and more than 50 independent peer-reviewed publications that investigate and examine its therapeutic value and effectiveness.

Kooth values independent and impartial research, as well as investing in a specialist internal team that conducts research and evaluations. Kooth’s chronology of research and evidence demonstrates effective impacts on the individual and population level.

A notable evaluation conducted by The London School of Economics independently assessed Kooth’s effectiveness. The findings revealed that after just one month, students demonstrated significant improvements, including reduced psychological distress, significant decreases in suicidal ideation and self-harm, increased confidence, decreased loneliness, and heightened levels of hope (full article here).

Kooth has additional evidence to demonstrate the helpfulness of the peer-to-peer community and its effectiveness in helping youth with their wellbeing, with 74.6% of users indicating that they found community forum posts helpful (Banwell, et al., 2022).

Goal-based outcomes on Kooth show meaningful change (Jacob et al., 2020), with over two thirds of young people who engage with goals achieving their life and therapy aims.

Kooth has developed novel and innovative measures (SWAN-OM and POCEM) to enable quantifiable assessment of its service. Over our 20 years of operation, we have found that ‘responsive chat’ ‘in the moment’ is highly valued and effective for youth, (Roberts et al., 2023). As a result, our delivery model is designed to support this, with ‘drop in’ chats available to those looking for timely support.

By developing a new outcome measure for single sessions (SWAN-OM), and validating it independently with highly respected international research partners CORC (Child Outcomes Research Consortium) and Anna Freud (De Ossorno Garcia, et al., 2023), we can evidence that 72% of users achieve their wants and needs. This is an impressive outcome in an environment where typically 50% is considered a good level of efficacy.

For more detailed information and evidence of Kooth's effectiveness and commitment to research, see our Research Chronology.

Our staff are extensively trained and supported to identify and assess safeguarding concerns in relation to risk to self, risk from others and risk to others. Specifically, in relation to risk to self, it is standard practice in our service to make routine enquiries into suicide and self-harm risk in every user session.

When someone presents to us with risk, practitioners will de-escalate risk by creating a safety plan with that individual, ensuring they have coping techniques and know where to go for crisis support. The safety plan is then saved to that person's profile and can be updated and revisited when appropriate.

Our safeguarding threshold for escalating concerns is met when there are indicators of or potential indicators of imminent risk to self, significant harm as defined for children in Working Together to Safeguard Children Statutory Guidance 2023 and for adults in relation to ‘adults at risk’ within Care and Support Statutory Guidance 2022 and accumulation of low level concerns.

Additionally, staff are required to record and escalate any concerns that relate to a serious crime or allegations against professionals or volunteers to a team manager, with oversight from our safeguarding team, to ensure the appropriate authorities are reported to.

In line with our safeguarding procedures and safeguarding training, where safeguarding risk is identified, staff will immediately escalate to a manager (level 4 trained) to discuss and agree the concern, the threshold of risk/harm and the required safeguarding actions. Managers are trained and supported by Kooth’s specialist safeguarding team to act as duty safeguarding leads on shift. They have the authority within policy and procedure to make decisions and take all necessary safeguarding actions (or oversee that they are carried out), including referrals to external agencies.

All staff have access to a duty safeguarding officer from Kooth’s specialist safeguarding team to provide advice and guidance on thresholds and required actions.

Parents and caregivers play an indispensable role in supporting their child’s mental health and wellbeing. It's our ongoing practice to advocate for children and young people to engage with trusted adults in their lives.

That being said, the Kooth platform was built with and for children and young people so is safe to use; all content is age gated and clinically reviewed for safety and appropriateness. Our safeguarding standards are exceptionally high and our services are accredited by the British Association of Counselling and Psychotherapy (BACP).

We know from talking to many thousands of children and young people that it doesn’t always feel possible to share their feelings with adults, even if they are their parents or carers. For those who feel they have no-one to talk to, services like Kooth can be a lifeline, often offering support to enable them to work up to sharing their worries with a trusted adult.

Please be assured that we would encourage individuals to speak to their support network about what they were experiencing, and that if we are able to, we will ensure that key figures such as parents/caregivers are aware of those difficulties.

One of the things we also consider and assess, is whether somebody has the mental capacity and understanding to consent to counselling. This is something that they have the right to consent to, if they have the capacity to do so, without their parents or caregivers being informed. If someone does not have the capacity to consent to counselling, we would adjust the way in which we work with them, offering more of a "key work" style support.

Kooth is an anonymous service, but there are questions we do ask at registration, such as a person’s age and location. Information on data sharing, why we ask for information at registration, use of cookies and the personal data we hold is outlined here.