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We knew Kooth was making a difference for the hundreds of thousands of service users using it annually, but before now we have not understood the intricate workings of a service that holistically caters for the needs of the whole person, rather than being symptom-led. 

This report delves into the different and powerful mechanisms of change within the service and its role as a safe virtual environment for support. This is a unique and collaborative research project involving researchers, Kooth practitioners and young people, and utilising more than 15 years of data amassed through our therapeutic work with children and young people.

Defining Digital Mental Health for Young People

XenZone: Future Thinking for Mental Health

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Copyright XenZone and University of Manchester 2019

XenZone and The University of Manchester have published groundbreaking new research exploring the rich therapeutic journeys of young people through Kooth, the largest digital mental health service in the UK. 

Key Contributors

Aaron Sefi


Aaron is the Research & Evaluation Director at XenZone - an academic with substantial experience in counselling and Mental Health Research. 

Dr. Terry Hanley

University of Manchester

Dr. Hanley is a senior lecturer at the University of Manchester, a renowned expert in the study of psychology and advisor to masters and doctorate programmes.

Dr. Julie Prescott

University of Bolton

Janet Grauberg



Dr. Lynne Green

With Special Thanks To:

...and the brilliant XenZone Team

Aisha Gordon-Hiles   |   Anne-Marie Yates   |   Charlotte Mindel   |   Cherrelle Gayle   |   Holly Brick   Lex Young   |   Kat Cormack   |   Nelly Gentric

A Positive

Virtual Ecosystem

The Theory of Change for Kooth

Are you better now?

Evidencing a broader, more personalised approach to mental health support

Change is how we understand the world; how we gauge progress. It’s how we feel compared to yesterday. How the economy is faring year on year. How the world is changing, and whether we feel that change is tracking in the right direction. But as important as it is, evaluating change is rarely easy. 

For mental health professionals who understand that change is rarely linear or straightforward, it can seem like an impossible task. 

Anyone who has assessed and monitored progress in mental health care knows that change and improvement are dependent on perspective, expectation and a million other shifting determinants, some of which may be outside our control.

To compound this issue, we are still inclined to measure progress in mental health using a frame developed for assessing physical health outcomes. These are singular and narrowly defined in nature. As a result, when used by mental health practitioners, we see brief, short-term insights around reduction of distress.The big picture is out of reach and therefore impossible to evaluate. A bit like reviewing a restaurant after only half a spoonful of dessert. 

As a backdrop to this, the wider culture around assessment and diagnosis in the world of mental health is, in places, reductive, narrow and prescriptive; people are defined by symptoms and problems. This approach does not reflect human lives with all the complexities therein... (continued)

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The Kooth Theory of Change

An interactive overview