by Shelley Charlesworth
Visit Kooth’s website and you’ll read that they are the market leader in online mental health support and advice and the largest mental health platform for 10-25-year-olds in the UK. But what they don’t say is that this also makes them one of the largest sites teaching gender identity theory to children and young people, whose counsellors direct children to other harmful sites such as those promoting breast binding.
Initially, there are no signs of affiliation with the gender cause on the website; no pink and blue flags or allyship statements. But when signing up to use Kooth there’s a compulsory tick box choice of four ‘genders’: male, female, agender, and genderfluid. Whatever reason a child has for joining the platform, from the outset they are being schooled in the neo language of gender.
A major driver of Kooth’s approach to gender identity is their association with the BACP:
“We continue to be a BACP (British Association for Counselling and Psychotherapy) accredited service and indeed are the only nationwide digital mental health service to hold this accolade”.
Some might question whether BACP endorsement is any sort of accolade. BACP’s position of gender identity hardly differs from LGBT activist groups such as Stonewall or Mermaids. BACP was a key player in the contentious addition of gender identity to the Memorandum of Understanding on Conversion Therapy in 2017. This development of the MOU, based on no evidence whatsoever of a problem with ‘anti-trans’ therapy in the UK, has had a chilling effect on therapists wanting to work with gender distressed children. BACP’s evidence to the government’s conversion therapy consultation is written from an ideological, political approach to gender, particularly in relation to children.
Writing for the BACP’s website in 2019 Kooth staff member Charlotte Mindel revealed that:
“In the period 2014–2018, we have seen a 552 per cent increase in the recorded presenting issue of gender identity, accounting proportionately for the increase of users over that time. What this means is that across the population of young people we work with, six times as many are exploring their gender identity in some form”.
Despite the sudden increase, the Kooth platform does not reflect current significant developments in treating gender-related distress, or take into account the closure of GIDS or the finding of the Cass Interim Report. Following the BACP they affirm their users’ identities, in many cases not knowing if they are treating a boy or a girl.
According to Kooth the most used form of therapy on the site is peer to peer-to-peer or self-help. We know social contagion is a major driver spreading gender ideology. What appears to be happening here is that an online platform, which is supposed to offer qualified, evidenced mental health support, has handed over the job to the teenagers.
What is Kooth?
The business started in Stockport in 2004, offering online mental health services to children and young people in conjunction with the Local Authority and Stockport NHS Primary Care Trust. The service spread across the north west and by 2011 their turnover was £1m from contracts with 16 other local authorities and NHS trusts. In 2020 Kooth was floated on the London Stock Exchange and has now expanded into the US. They also offer services for adults and businesses which fall outside the scope of this article.
In their sales pitch to investors they claim the cost of poor mental health in the UK is £118bn. Their biggest UK client is the NHS, which also funds Kooth through another route, SBRI Healthcare, the NHS’s improvement initiative. However, it’s of note that Kooth is not on the list of just four named providers of digital mental health care for children recommended by the National Institute for Health and Care Excellence, NICE.
Data is their thing, despite their first category error in gathering it. Kooth boasts “one of the world’s largest mental health anonymised data sets which we use to help improve product and outcomes for people who utilise our service.”
Today they say:
“In the UK, over 60% of all 10-25 year olds have free access to Kooth, funded by the NHS or their local authority. According to NHS England data for 2021/22, Kooth has now become the largest single access provider for mental health support for under 18s, a testament to the trust and reach that we have achieved in our partnership with the NHS.”
It’s no secret that they’d like their service to reach 100% of this age group.
How does Kooth work?
Kooth works on a Business-to-Business-to-Consumer, B2B2C, model. This allows it to advertise its services as free. If your local authority or Integrated Care System (the replacement for Clinical Commissioning Groups) has signed up to Kooth, you’ll be able to sign up easily and for free. The cost to the LA or ICS will vary but a FOI request revealed that Bedfordshire, Luton and Milton Keynes CCG paid £32,358 for the service for the year 2021 -2022. During the year 939 children and young people accessed the service which the CCG considered value for money. A Kooth commissioned study suggests the annual fee is around £140,000 in an area with a population of 2,160 children and young people.
The service is promoted to the target community by public bodies, GP surgeries, hospitals and many other health agencies. The Tavistock recommends Kooth claiming it “helps to reduce wait times for young people seeking help while removing the stigma associated with accessing help.”
Kooth staff visit schools and youth groups in person to promote the service. It also partners with other online educational resource providers. In this way, online mental health support becomes part of the online curriculum. The offer of free counselling must appeal to cash strapped schools and CAMHS.
The service is anonymised; signing up requires making up a non-identifiable name and putting in your postcode. Once online children can choose from three types of help: website content in the form of articles mainly written by Kooth staff, peer support in chat and forums, and counselling.
However, these three services are not equal, but form a pyramid with the bottom 60% accessing what Kooth calls ‘self-directed therapy,’ which is their own content in the form of articles and community forums. Another 35% may use asynchronous messaging and chat sessions on pre-planned topics. Only the 5% at the top of the pyramid will get structured counselling. Kooth describes it as a “scalable delivery model: 95% get the support they want without the need for 1:1 structured counselling.”
The pyramid diagram features prominently on Kooth’s annual reports and promotional videos. The limited availability of free counselling appears to be built into the system.
The success of the counselling for the 5% who get it, typically 6 to 12 sessions, will depend on a child’s ability to write down their problems because it’s “a text-based chat, similar to WhatsApp, but within Kooth’s own platform.”
The forums and chats are pre-moderated by Kooth prior to publication. They say they are alert to serious mental health presentations and will refer on to other agencies if necessary.
Claims by Kooth about the number of counsellors they employ vary between 225 and 250. But not all of these will have counselling qualifications. At least half are ‘emotional wellness practitioners’ or EWPs in Kooth jargon who can come from non-therapy backgrounds such as teaching or social work. Job requirements and pay for counselling roles mean these jobs are likely to appeal to newly qualified therapists who are not necessarily accredited yet. The shift patterns all require evening and weekend work, unlikely to attract more experienced candidates.
Does Kooth deliver value for money?
Kooth produces a lot of data claiming their model of mental health support works and in doing so saves the NHS money.
“Kooth has a quantifiably positive impact on society whilst also saving healthcare systems money. In 2022, the York Health Economics Consortium published an independent health economics study showing that Kooth delivers £3.14 in cost savings for every £1 spent.”
Three of the six authors were Kooth employees, Kooth funded the report and it’s telling that the report’s conclusions were more tentative than Kooth’s enthusiastic write-up in their annual report.
The York study was only looking at costs; it took it as read that children and young people using the Kooth platform showed measurable improvements in their mental health. This assumption was based on another Kooth funded project undertaken by the London School of Economics’ Care Policy and Evaluation Centre, one of whose five authors is from Kooth’s own research team. Funding by Kooth and use of their own researchers seems to be a pattern.
The LSE study began with 630 CYP Kooth users whose mental health issues were measured by self-reporting. They were re-assessed after just a month, again using self-reporting. However, a majority had dropped out and only 48%, 302, completed the final assessment. The average age of the respondents was 16.7 years.
Some improvements were found across a range of mental health measures. What is interesting and not explored in the research is preponderance of girls taking part, 79% who chose ‘female’ as their gender, compared with 75% over the Kooth platform as a whole. The sex ratio is possibly higher given there was:
“a higher proportion identifying their gender in a different way (9.9% in our sample selected ‘non-binary’ or ‘other’ options while 6.2% selected ‘gender fluid’, ‘agender’ or ‘non-binary’ in Kooth).”
If a further 9.9% taking part were girls, then this is a study of mainly teenage girls (88.9%). However due to the way Kooth gathers data, there’s no way of knowing the exact numbers.
The LSE/Kooth researchers seem uncurious about why this might be, what factors might drive mental health conditions among girls, such as body image, pubertal worries, the ubiquity of porn and sexual harassment. The word ‘girl’ doesn’t appear in the paper, the word ‘female’ just twice.
Who is using Kooth?
Kooth’s own data establishes that this is a platform catering mainly for teenage girls, an inconvenient fact when Kooth markets itself as a universal service. One of the reported benefits of the platform according the LSE study was the sense of purpose the users got from helping others with advice and support, an understandably gendered reason for teenage girls.
In 2020 Kooth reported:
“Amongst young people (11-25 years) who access online mental health support from Kooth in the UK, many have reported issues with their gender identity under lockdown. Gender identity struggles reported in the online support platform have gone up by 74% in March – May of this year compared to the same time in last year. Issues around sexuality are the most prevalent identity based presenting issues, but these young people appear to be increasingly looking for support around gender identity.”
Apart from the above reference we have not been able to find open access research from Kooth on gender identity. So it’s hard to judge what percentage of children are using Kooth to discuss their gender-related distress or gender dysphoria. Nor is it possible to know how many of them are girls. Given that there is an historically unprecedented number of teenage girls identifying as trans, and of these a majority are same sex attracted, are mildly to severely autistic or have other mental health problems, this is a revealing gap on Kooth’s data and research.
Kooth is an unsafe platform
Kooth counsellors direct young girls to sites which promote breast binding. The women’s rights campaigner Kellie-Jay Keen described what happened in a single online chat when she signed up as a teenage girl:
“so I joined. I’m 13, I’m a girl, I think I’m non-binary and I want to bind my breasts and I don’t want my parents to know. So I went into the adult help me chat thing, so some of the people who are paid counsellors, or volunteers, I’m not really sure, but they are the adults looking after. So there was a long sort of ‘Oh I’m sorry to hear you are sad,’ straight away introduced me to a website about binding. Not one fricking word on that website said ‘Don’t,’ not one.”
Many of the peer-to-peer conversations concern binders. This is proof that once they are able to talk to a counsellor, they will not get any form of therapy, but will be directed to harmful sites which will exacerbate their gender issues, not resolve them.
Kooth promotes a political approach to gender-related distress
The most used part of Kooth’s service (60%) is the “self-directed therapy” which refers to the articles written mainly by Kooth employees and the chat forums where young people post their problems and worries.
It’s in the Kooth generated content that the influence of the BACP is most apparent. In April 2022 the BACP reaffirmed their political rather than therapeutic stance on gender identity in a clinical setting:
“We’re fundamentally opposed to any misuse of therapy to try to change a person’s sexual orientation or gender identity, and believe conversion therapy is unethical and potentially harmful. Sexual orientations and gender identities are not mental health disorders. Anyone accessing therapy should be able to do so without fear of judgement or the threat of being pressured to change a fundamental aspect of who they are.”
This approach is echoed in a Kooth article in May 2023 titled supporting words for trans youth:
“Remember, trans youth, you are valid, loved, and supported. Your journey is unique and beautiful, and you have the power to shape a future where all individuals are respected, celebrated, and free to be their authentic selves.”
Another article, Let’s Talk About: Misgendering tells young people that being misgendered can be harassment.
“Sometimes it’s a genuine mistake, but there are also people who do it deliberately because of their incorrect discriminatory beliefs and ideas about the trans community, using misgendering as a tactic for harassment and bullying.”
Teens are led to believe that misgendering may cause them psychic harm.
“Misgendering can have negative consequences for someone’s self-confidence and mental health.”
An article about trans representation in the media goes further:
“Recent research published in the academic journal LGBT Health shows that negative and damaging media coverage of trans and gender nonconforming people was strongly linked to poor mental health in trans people. This included increases in anxiety, depression, psychological distress, and post-traumatic stress disorder (PTSD).”
In Periods and Gender Non-Conformity ‘Ben’ writes in terms of near disgust that:
“Menstruation can be really unpleasant. Not only does it come with a whole variety of symptoms, but there is also still a deeply ingrained cultural stigma against those who menstruate. Unfortunately, if you are someone who falls under the huge umbrella of gender non-conforming (GNC), periods might also be an unwelcome reminder of gender dysphoria. If, for example, you are someone who identifies as non-binary or as a man and has a uterus, you might experience menstruation.”
Thus the mainly female users of Kooth, possibly just starting their periods, have been written out of their unique experience, which they are told is ‘unpleasant.’ The writer elides being gender non-conforming with gender dysphoria which sends a strong message to girls that if they hate their periods they could be ‘trans.’
There is more interaction on the forums where teenagers, 80 to 90% of whom are likely to be girls, discuss mental health issues. Teenage girls especially will self-diagnose and pass on every detail of their latest condition to each other, as they did with tics and Tourette’s during lockdown. It’s a sure-fire way of spreading negative emotions, as girls respond with empathy to the extent that they take on the condition themselves.
Headings for the chats include ‘so im trans’ ‘Trans hairstyle’, ‘what’s the best tape for binding’, ‘Gender issues’, ‘Non binary name’, ‘Medical transitions suck’, ‘Agender or non-binary’,‘Trans struggles’.
In ‘Coming Out As Trans’ a girl asks for help as she doesn’t like being a girl and thinks her parents won’t support her. One responder tells her to ask a teacher to get the school to change her name but make sure they don’t tell her parents.
A girl writing in ‘Trans hairstyle’ says she is a ‘trans male (biologically female)’ and wants a haircut that is more ‘masculine’ but her parents are unlikely to agree.
In the thread ‘so im trans’ a girl states she is ‘transmasc’ and in the future wants to transition socially and medically. But just now she feels horrible because she can’t get a haircut or a binder as her parents are transphobic. She says she has suicidal thoughts. Responders are quick to offer sympathy and tips for binders (buy a sports bra) and how to cajole her parents into getting a haircut. Two of the responders say they are 13. It seems no one is moderating this exchange.
In ‘Anxiety about sexuality’ a 13-yr-old is worried that she is attracted to girls, which she describes as ‘intrusive thoughts and images.’ As yet, no one has suggested she might be a lesbian.
Another girl says she is ‘genderfae’ which she explains is when you are gender fluid but only experience ‘female or nonbinary genders.’ She is wondering how to get a binder.
Another girl writes, under ‘Trans struggles,’ that she had just got over her period, and that she is ‘male, trans MtF’ and it was so painful that she couldn’t wear her binder as her breasts were so sore. She describes herself as male ‘trapped in a woman’s body.’ She still lives with her parents.
Under the heading ‘i think i am transgender’ an older teenage girl says she is uncomfortable with her feminine body. She is confused because she wants to identify as a girl but had thoughts when she was younger that she’d like to be a boy. One responder says she should consider if she’s trans. Another says ‘some of us are born in the wrong body’ and suggests she is gender fluid. There are a lot of tips about pronouns, haircuts and clothes.
These testimonies are hard to read as they contain so much unfiltered, raw anxiety. But it’s clear that the girls have come to the Kooth platform already informed by the neo language of trans activism, ready to label themselves as trans, transmasc, gender fluid, agender, non-binary, asexual, aromantic. They are not describing symptoms but rather picking a self-diagnosis from LGBTQIA+ glossaries. These are then reinforced by the online community they share. They believe the world is hostile to them; Kooth has already told them they’re vulnerable to discrimination and hatred. The contrast with the forum threads on eating disorders could not be more stark. There the teenagers are encouraged to accept their bodies, to reject harmful thoughts and behaviours.
Kooth versus Cass
Kooth cannot claim to be a serious provider of mental health care for its predominantly teenage girl users while not offering an alternative explanation about trans identification. Its content should reflect that there’s been a rapid rise in girls identifying as boys, it should suggest possible reasons for this, and explain the harms of puberty blockers and the irreversible effects of cross-sex hormones and surgeries. It should talk about the growing number of detransitioners. In other words, it needs to stop following a discredited, politicised approach to gender-related distress.
The Cass Review has led the world in resetting gender healthcare for children and young people. It’s resulted in the new draft service specifications for the NHS, putting care for this vulnerable group back into mainstream mental health provision within a safeguarding framework. Kooth, however, has taken a diametrically opposed path which, as the closure of GIDS proved, we know to be unsafe. Surely it’s time the NHS stopped paying outside providers to undermine Cass’s careful, evidenced findings.