Q&A: How one company aims to be at the forefront of digital mental health care

XenZone is a provider of digital mental health services in the UK and has been providing online mental health support to young people since before the advent of social media. Its youth-focused platform, Kooth, is available in over 100 CCGs. For 18 years, XenZone has helped children, young people and adults by connecting them with clinicians in safe, supportive online communities. Now its using data and artificial intelligence to create new models in preventative, early-response mental healthcare.

Zoe Blake, CEO, XenZone

Web content editor Ian Bolland caught up with Zoe Blake, CEO of XenZone, who talks about her belief in technology as an agent for positive change, and how she intends to stay at the forefront of delivering the digital mental health services people need.

How does the online platform compare to dealing with people’s mental health face-to-face?

Very favourably. Through our friends and family test we know 95% of service users would recommend us, and 86% say they prefer online counselling to face to face.

While we offer video counselling in our adult services, the vast majority of our counselling sessions are text based. This has a unique benefit called the ‘disinhibition effect’, where young people particularly find it easier to share their deepest thoughts and experiences when there is no eye contact or indeed no one looking at them. This is also true for issues around shame and self-blame.

While there are obviously some therapeutic approaches that cannot be delivered online – for example, theraplay – our online mental health workers are trained in a range of approaches, including Cognitive Behavioural Therapy (CBT), Dialectical Behavioural Therapy (DBT), humanistic and psychodynamic psychotherapy.  As with traditional services, sessions are time-bound to around an hour, and we use assessment and outcome measures widely used in the offline world.

For our workers, the experience of delivering support is enhanced through real-time access to supervision. This compares to a traditional setting where a therapist would finish a session and often have to wait for the next scheduled supervision slot before having the opportunity to reflect on what they heard in session. It means our online workers feel well held and supported in what they do.

How has XenZone kept pace with the changes in technology when offering its services?

Our CTO joined us with a wealth of experience and a rich network of peers. He often dips into this network, as well as attending conferences and networking events. As we grow, each new team member who joins brings with them new insights and understanding. As an organisation we see the value in investing in ongoing training and development across all teams. We are currently recruiting a technology thought-leader onto our advisory board.  We’re particularly interested in using AI to realise the potential of our database, which holds over 15 million mental health-related activities, including real-time natural language scripts and associated assessments.

Has working with the NHS become easier to provide services like Kooth/Qwell as the health service moves increasingly to a more digital setting?

Most often we work directly with the commissioners within CCGs of the NHS. In the early days our commissioners had to be visionaries, often being the lone champion of digital within their internal networks. Today, we are in over 100 CCGs (out of 195). That footprint is testament to the impact of our service and also of the increased appetite within the NHS for digital services.

XenZone has a variety of services under its umbrella that seems to target different people? Can you explain your thinking behind that rather than, for example, offering one particular service for all?

Kooth is our platform for children and young people up to the age of 25, whereas Qwell is our platform for those over 25. Both offer a range of support, including psychoeducational content, peer discussion groups, messaging and counselling (chat) with our therapists. While the features and functionality are mirrored in each platform, the content is specific to the age groups each serve. This is the most appropriate way to deliver support and to keep all our service users safe. We are also testing self-directed content within a native app environment. There are some unique benefits to this, such as the ability to push content (which can help with programme adherence), and also bringing in data for phenotyping, thereby enabling us to build up a fuller picture of the cognitive, behavioural, and personality patterns that may typify various disorders and conditions.

What kind of technology is used by Kooth?

Kooth is a modern web application. We use a PaaS cloud to run our custom built applications. These applications are built with a range of up-to-date web programming languages and platforms, including JavaScript, TypeScript, React and PostgreSQL. We also use an open source chat server running XMPP to operate very low-latency chat for our counselling and messaging so that counsellors are able to respond virtually in real time to our users. Kooth generates a lot of data. We manage this using cloud infrastructure, including serverless technology. To get further insight, we use open source machine learning platforms including TensorFlow and spaCy.

Are there any future plans for XenZone’s services we should know about?

We’ve been at the forefront of digital mental health services for 15 years now, and it’s a position we intend to keep. Ultimately, our purpose is to help everyone find their way to better mental health. Starting with children and young people (CYP) was a strategic choice on two fronts – firstly, because CYP are digital natives comfortable with using technology in innovative ways, and secondly, because by addressing the large and growing mental health need in CYP, by default we impact adult mental health – 75% of all adult mental ill health starts before the age of 25.

As our service users have grown up, we have moved into adult mental health with Qwell.  There is much more we can do to help meet the care deficit in non-acute mental health services using technology. Currently, we are working with NHS partners to create a new digital service around the treatment of eating disorders and services for parents; we have already launched an internal AI-driven tool to sit alongside our clinical team with more to follow; and finally, we have been incubating a project in the area of peer support and evaluation, which will be rolled out in the coming months. These are our mid-term plans, our roadmap for the future centres around helping more people access high-quality support and treatment at the earliest opportunity.

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