Impact & Efficacy
How do we make a difference?
TalkLife undertakes regular impact assessment within our communities including dynamic surveying asking respondents a range of questions regarding their help seeking behaviour and their current wellbeing across a series of standardised measures.
Key measures include where users are choosing to go for support and the impact using TalkLife has had on their individual, relational and societal wellbeing. TalkLife has a very active and responsive relationship with its users, and regularly checks out how it is supporting them.
Key performance indicators include how TalkLife enables and empowers users to seek help when needed, how they function, and how positive they feel about many aspects of their lives and futures. They are based on standardised well-being measures including WEMWBS and NEF.
These performance indicators allow us to track any quality improvements or other developments.
Since using TalkLife:
78% find it easier to ask for help
77% say their relationships have improved
65% feel more positive about the future
72% feel more understood
68% feel more able to cope
The Evidence Behind Peer support as an intervention:
Student mental health presents a particular challenge to the NHS and Universities today. Not only are students in greater need, they are placing unprecedented demands on overstretched services. Students are also highly mobile, moving between home and University at such regular intervals, it can be hard to establish who has a duty of care. The case for a digital health solution, that is impactful, accessible 24/7, optimised for the smartphone, wherever you are, could not be stronger.
Recent research from the US social innovation lab, Hopelab, has suggested that young people make use of digital health opportunities, notably peer support, in support of their mental health. Seeking support from health peers occurred in 39% of all 14-22 year olds, and 91% said it was ‘at least somewhat helpful’, with 20% saying it was ‘very helpful’. When it came to depression: (53%) of teens and young adults said they have tried to find people online with similar health concerns – nearly twice the rate of those who are not depressed (27%).
So, if young people are going online to connect with health peers, can we understand how it is helpful, and is there evidence that it can make a difference?
Research from 20 years ago suggested that online peer support had a positive impact on mental health. Focusing on college students, Shaw and Gant (2002) examined the effect of chat room discussions between psychology students on depression, loneliness, self-esteem and social support. Findings revealed that the use of the chat room significantly reduced depressive symptoms, loneliness and increased self-esteem and social support. Similarly, Morgan and Cotton (2003) looked at the relationship between internet activities and depressive symptoms in first year university students and found that the use of chat rooms was associated with reduced depressive symptoms.
So, if the support is valuable, how is it effective? And what needs to be in place to facilitate support?
Research from The Dartmouth Institute for Health Policy and Clinical Practice on ‘The future of mental health care’ in 2016 gives some pointers as to the mechanisms of effective support. The authors concluded that those with mental health problems were helped in peer support environments through a reduction of stigma (through personal empowerment and the promotion of hope), by being helped to be more active about their health (better self-care), and through support in accessing help. “By learning from peers online, these individuals may gain insight about important health care decisions, which could promote mental health care seeking behaviours.” Peer support only flourishes when online risks are also attended to. The authors note “risks may include exposure to misleading information, facing hostile or derogatory comments from others, or feeling more uncertain about one’s health condition.” Moderation that identifies and manages risks sensitively is key.
Whilst the authors conclude that more research is needed, they remain impressed that there is a powerful opportunity to foster ‘mutual support between peers, help promote treatment engagement and reach a wider demographic’.
Whilst there is scope for better research, there are repeated messages from the research available that peer support helps with depressive symptoms. “A meta-analysis of peer support interventions for depression found evidence that peer support leads to improvements in depressive symptoms relative to usual care. A systematic review of Internet support groups for a wide variety of health conditions also found positive effects for depressive symptoms”.
There is a further piece of research that is helpful in considering how peer support can help. Paul Hodgkin and Ben Metz interviewed those working with online health communities to map and explore this new field. They found that when users were identifiable, they were far less likely to post about health concerns, with only 3 and 5% posting compared with the 10% who would post on non-health issues. Users were more likely to read content than create it. Users expressed a desire for anonymity which they felt could help them interact with others, privately.
Anonymity could help someone share something for the first time. But that could mean the disclosure of suicidal thoughts or other risks? It becomes apparent that when someone is able to take the step of sharing something that disturbs and distresses them, it is vital that they are not left to wait too long for some acknowledgement or signposting to greater support. Reducing obstacles to disclosure creates a need for a higher level of responsiveness.
There is further research that suggests clinical expertise should inform both support and any moderation, and the combination of this with class-leading e-safety measures and is a further aspect of positive peer support.
So, in drawing upon the research evidence available, and the insights of good user design and social media, it is now possible to create a peer support network that is tailored to the needs of students and their Universities.
The specification includes:
•A mobile optimised service, with a user experience familiar to those who use messaging apps.
•A culture of support from ‘health peers’.
•‘Safety by design’ safeguarding.
•Sophisticated machine learning to identify, support and escalate anyone at risk in seconds.
•Trained volunteers who enhance the peer support.
•Personalised recommendations of the support available at the user’s University.
•Liaison with Student Support Services for those needing more support.
•24/7 support whether you are at home or University, over the lifetime of your course; no brief measures.
•An advisory board on global mental health experts to advise on strategy
•A world class research programme to continuously improve the support available.
TalkLife Randomised Control Trial (2018-2020)
Cornell University, USA
This study will generate the highest quality research evidence, through a randomised trial, and consists of two phases. The first phase is a study of how users with a history of self-harm engage with and make use of the opportunities for support on TalkLife. The second phase involves both a short-term and longer term follow-up, to assess the influence of different types of support (peer support, psychological therapy) in improving the ability to tolerate distress and reduce the urge to self-harm.
Initial findings suggest that many users make very positive use of listening to others discuss their difficulties, and that TalkLife is a safe space to acknowledge negative feelings. When they do reach out for help, based on a research sample, there are very few cases of unsupportive feedback (<1%).
One interesting detail is that many of the requests for support are indirect, highlighting the need to help users feel they deserve and should seek support more directly. It is encouraging that our well-being survey indicates that currently 78% of users feel TalkLife helps them to seek help. Our goal is to improve upon this.
What our users say
This app has helped me through the toughest parts of my life. Times I felt alone and like I had nobody. I know I can log in and say what’s bothering me without fear of being judged. It's like a big family that helps and genuinely cares about everyone
Right now I am studying for my final exams for this term of University. I am graduating college early, I am involved in a fraternity on campus, I have a 3.42 cumulative grade point average out of 4.0 points, this term I am thinking that I will have a 3.75/4.0, and I am now on anti-depressants and anti-anxiety medication; this is mainly from the support of this app. Thank you!!!!
This community gives me a place to write what's going through my head, and try to make sense of it. People are always there to lend their thoughts and support and give you someone to talk to if you need it. It’s helped me through the toughest parts of my life.
This app has helped me through some very tough times and also allowed me to be there for others going through similar difficulties. I think it's safe to say that it has literally saved my life as well as countless others.
Finally, people I can talk to. Thank you so much for giving me this outlet.