Relying purely on face-to-face counselling to address the emotional and mental health needs of young people could potentially put this vulnerable demographic at risk.

With long waiting times and a stigma still attached to accessing counselling, many young people appear on the radar too late, when their issues require Tier 3 intervention and access to Child and Adolescent Mental Health Services (CAMHS).

The online and face-to-face counselling service for young people – www.kooth.com – noted that of the 1,500 young people registered in one region, 89% were not involved with other services.

In severe instances, young people's first involvement with services is when they present at A&E with injuries from self-harm or attempted suicide – a sequence of events that can cost the NHS £425.24 per admission from A&E to discharge.

Early intervention is vital, but the question is, how can this be practically delivered? A blended face-to-face and online approach could certainly be the answer.

This integrated way of working ensures an agile service that is driven by young people and tailored to their preferences; a recent survey revealed that 86% of young people prefer to access help online.

For Cornwall Council, the blended model has reduced waiting times and improved the mental health of young people in the area.

Back in 2012, it became clear that our in-house face-to-face counselling service for young people was not able to cope with demand or react quickly enough to young people's needs.

Cornwall has a very mixed demographic, with pockets of severe deprivation, families affected by domestic violence, substance use and mental health issues, resulting in young people being affected by depression, anxiety and self-harm.

We needed a new approach so we put the counselling service out to tender and quickly recognised the potential of the blended online and face-to-face model.

Cornwall Council commissioned Kooth in February 2012, collaboratively working up a model. To-date, the service has been accessed by over 1,600 young people between 11 and 25-years-old.

There are no referrals or waiting lists for the online service: young people sign up and can speak to a counsellor through ‘live chat', messaging or gain peer support through moderated forums.

The face-to-face counselling service is available to all young people through provision in 15 young people's centres and 13 schools across the county.

Young people can self-refer through the website or be referred by professionals such as youth workers, GPs and school pastoral teams, including other agencies, such as Careers South West.

A blended model that is well integrated with on-the-ground services and can signpost and refer-in ensures young people can be tracked and are not lost between services.

It is apparent that an out-of hours facility is crucial to young people, with 69% of users logging in for counselling in the evenings and at weekends. This is something that we could not have offered face-to-face.

In rural areas it is often hard for young people to get to appointments and transport is another barrier to accessing help. Online therefore offers greater privacy and autonomy, which is key for many young people.

Around 57% of young people's aggregate core scores – one measure of their emotional health – have improved since their involvement with the blended service.

By offering a flexible approach, we are protecting their long-term mental health.
Young people are increasingly accessing both online and face-to-face counselling and dipping in and out of both options, with online vital to provide a rapid response while they are waiting for their face-to-face appointment, then being used again to follow up face-to-face sessions.

Waiting times have been dramatically reduced since 2012.

Mapping needs by community network areas allows us to provide a meaningful service.

We recently secured further funding through the Learning Partnership to extend the service to young people who are NEET (not in education, employment or training) or at risk of becoming NEETs.

If young people aren't coping, they certainly will not stay in education beyond the age of 16.

Building on the lessons we have learned from the blended counselling model, we are now considering extending the scope of our blended approach into other areas of support.

Penni Barker is Cornwall Council's strategic lead for 11+ commissioning