Research Partners | 

Kooth’s Theory of Change

Researching how Kooth provides a positive virtual ecosystem for both young people and adults to thrive within. 

We know that Kooth makes a positive difference in people’s mental health, but as a relatively new context delivering therapy, we need to understand how and why these services work and exactly what the true benefits are to Kooth service users. 

The Theory of Change (ToC) sets the structure to truly start answering these questions. This is groundbreaking. We are at the forefront of identifying the evidence based on what people actually want and need from digital mental health services.

Foreword: Tim Barker

Chief Executive Officer of Kooth Plc

COVID-19 has had a devastating impact on people’s mental health across the globe. Reduced social connections, job losses and insecurity as well as financial worries are just a few of the ways the pandemic has negatively impacted our mental wellbeing. Mental health services that were already underfunded and overstretched are now needed more than ever. Increased adoption of digital health technology, such as apps and teletherapy, can help ensure that people who are suffering from mental health conditions are able to access the support they need in a timely manner. 

Provided by the NHS, Kooth plc offers safe spaces, available to all, for people to access personalised mental health support anonymously for free.

We have served as an early intervention and prevention service for mental health problems since 2004. Today, we are a thriving community where adults can receive peer to peer support via community forums, can have immediate access to free one to one counselling sessions with our trained and accredited therapists, and can read and contribute to self-help articles. 

The Theory of Change (ToC) is a ground-breaking movement towards defining the effectiveness of online therapeutic safe spaces for adults. Through ToC, Kooth can start to articulate how we make a difference to individuals and to the system. It is a unique report that details the therapeutic journey of adults using Kooth and seeks to determine the most helpful mechanisms for change. 

Kooth’s services work and make a real and positive difference in people, but as a new context delivering therapy, Kooth is investing to really understand how and why these services work and exactly what the true benefits are to Kooth service users. The ToC, developed in collaboration with New Philanthropy Capital, allows us to start answering these questions, so we can build a framework for our services that is evidence-based and collects the right information in relation to the change and difference that we are set to make in our users.

Tim Barker
CEO, Kooth Plc

Foreword: Dan Corry

Chief Executive Officer of New Philanthropy Capital (NPC) 

New Philanthropy Capital (NPC) is a charity, a think tank and a consultancy whose mission is to help the whole social sector to create as much impact as possible. By doing this, we help the sector to have the maximum possible benefit for the people it serves. We believe passionately in the potential for data and evidence to help organisations understand the difference they are making and to improve their services. Good theories of change are a key component of this journey because they help organisations to: gain a clear understanding of what they are aiming for; think carefully about how they will achieve these aims; and set themselves up for effective evaluation. Since we published our first guide to theory of change in 2012, we have been really pleased with how much the approach has become an established method across the social sector.


It has brought much needed clarity to the sector’s efforts to support people in need. It has been great to work with Kooth Plc over the last six months and to help them develop a theory of change for their adult mental health service. As Tim says, mental health is a serious problem across the UK, and an issue that is being exacerbated by the stresses of Covid-19 and ongoing pressures on the NHS. We urgently need new ideas and new ways for people to access the help they need. My team has worked closely with colleagues from Kooth to understand the different ways people use the Kooth adults service and how it seems to help those struggling with their mental health. We have been particularly impressed by the concept of a ‘digital ecosystem’, in which people can interact in ways and at times that suit them best, and by the potential for digital tools 

like Kooth’s to reach people who may be ignored by conventional services. We commend Kooth Plc for publishing this report on their new theory of change, which should help to raise awareness of their services and of digital mental health services generally. By describing the underlying thinking behind their model, Kooth are also inviting others to reflect on the value of this kind of service, which can only help to improve the quality and impact of these services in the long run. The next stage for Kooth is to test this theory against the evidence it collects and we really look forward to seeing how the service develops in support those who need help with their mental health.

Dan Corry
CEO, New Philanthropy Capital


Contributers & Authors

Kooth has worked with some of the top academics and mental health researchers in the UK to provide an indepth, robust framework for the Theory of Change.

“Are you better now?”

How Kooth is 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. …continued on 

Special Thanks

Our Theory of Change wouldn’t have been possible without the help of our brilliant team at Kooth. In particular, we’d like to thank:

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

  • Nelly Gentric
  • Emily Booth
  • Barbara Piranty
  • Kate Elliot
  • Emily Rothwell
  • Dr Hannah Wilson
  • Rosa Sefi
  • Lesley Ballard
  • Julia Cornell
  • Joanna Jamieson
  • Olivia Eyimofe Race
  • Rachael Pickett
  • Georgia Sugarman
  • Magdelena Wielopolska


  • Chris Smith
  • Sam Tyler
  • Leyla Gurr
  • Cristina Gascon Garcia
  • Alex Miller
  • Annie Meharg
  • Natalia Sloam