Prevention approach: digital peer support as a public health support intervention

Adjacent to London and home to around 1.2 million people, Hertfordshire is a diverse county with an expanding population and economy. Hertfordshire County Council’s Public Health team focus on measures to improve the public’s understanding about public health issues and prevent poor or ill health.

The work commissioned by Public Health is vast and varied – including immunisation drives, sexual health services, health improvement initiatives, health protection advice, awareness raising, information and behaviour change campaigns, and mental health support services. The council’s focus on mental health and suicide prevention likewise covers a broad range of grant-funded preventative programmes to promote, for example physical activity, mindfulness, social connection, and mental health first aid training.

“What we do acts as one element of the wider system to support a whole pathway. We support the front end so we can help people to not get worse, if they have low to moderate mental health issues such as depression and anxiety.”

Dr Manawar Jan-Khan PhD, Health Improvement Lead Mental Health & Suicide Prevention, Hertfordshire County Council

Mental health issues are, of course, a population-level consideration with at least 1 in 4 people affected by serious mental health issues in their lifetime. Dr Jan-Khan, Hertfordshire County Council’s Mental Health and Suicide Prevention Health Improvement Lead tells a similar story to many public health officials across the UK – that COVID lockdowns, compounded by a tough cost of living crisis has created a long tail of challenges which are now impacting the wider health system.

Offering choice, access and a safety net

Following a successful 12-month pilot initially aimed at supporting those on waiting lists and mental health service referrals, Hertfordshire County Council re-commissioned Togetherall to provide wider population level mental health support across the county. A survey sent to members who registered during the pilot to evaluate effectiveness showed that:

• Over 70% of respondents who said they had used Togetherall, experienced an improvement in their well-being.
• 68% of members say Togetherall is their only formal support for Mental Health
• 7 in 10 registered members recently experienced feelings of depression and 35% had thoughts about ending their life.
• 37% of members received private support from one of Togetherall’s online professionals (Wall Guides)
• 78% said they found the site helpful.
• An average of 123 minutes time spent on the platform per member

Togetherall’s 24/7 access and ability to cater to different needs were key considerations for Hertfordshire County Council at the outset of the partnership.

“Depression and anxiety doesn’t start at 9am and stop at 10pm. So, we’ve got to have responses that meet the needs of our local communities,” says Dr Jan-Khan. 72% of Hertfordshire residents who signed up to the site logged in outside of traditional service hours of 9-5pm Monday to Friday.

Choice lies at the heart of Hertfordshire County Council’s decision to commission Togetherall. The platform facilitates peer-to-peer interaction, allowing individuals to receive and provide advice and comfort while fostering a sense of belonging, validation, and empathy. The ease of access and anonymity provided by Togetherall ensures that individuals can seek help at their own pace, regardless of the time of day.

“By offering Togetherall to our residents, it offers choice. It’s what we call self-managed care. So, they can access it when they want, where they want, and any time they want. We see that as a safety net, particularly when people might be in crisis, and they cannot access local services at the time of day.”
Dr Manawar Jan-Khan PhD

Fitting into the system

Offering more choice means diversifying the range of tools and interventions available in the wider system. Hertfordshire County Council works collaboratively with the existing health structure to bolster ecosystems of support available to the population.

“It’s about having a conversation with the wider system, and working together to see where each element fits,” says Dr Jan-Khan.

As part of primary or secondary care, if an individual has been seen by a service, and they need some backup at weekends or in the evenings, then they can use Togetherall as an additional digital support tool service.

Hertfordshire County Council is also attempting to serve and support individuals who remain untouched or unsupported by existing systems at both ends of the continuum of care needs – from prevention to crisis. To meet a prevention agenda, Togetherall helps Hertfordshire residents who may be feeling slightly anxious log on and get support from peers, they can enrol onto a course or get advice to help them in the moment. When it comes to people in crisis and not being in touch with the system, Togetherall also plays a role.

“We know there are people who die by suicide, who are unknown to mental health services. They don’t go to the GP, don’t go to the NHS and they’re suffering silence. And if we can provide something that gives them confidence and is anonymous, then I think that’s so important to help them. We still have stigma, although many people talk about it now.

“Part of our work is to reduce that stigma but also give people the opportunity to get support that’s going to help them and give them confidence in the system.

“In combination, Togetherall has helped to improve the reach of the system, to aid previously unsupported demographics and improve experiences for those engaged in the formal system of care.

“I think that’s really crucial for people, because it is, in many ways, trying to find a wraparound service for the individual, for when they need it,” says Dr Jan-Khan.

People supporting people

While Hertfordshire County Council’s Public Health team takes a population-wide approach to the partnerships it funds, it is the individual users and their stories that matter.

“I recently attended an event where someone spoke about their experience of using the [Togetherall] community many years ago,” says Dr Jan-Khan. “Someone had messaged her and asked if she was okay. It was an amazing story and she said, it was really, really excellent, the way it felt that someone cared about her.”

“I think that’s the important element: that you feel like someone’s looking out for you, caring for you, is interested in you, wants to help you, and is there for you, when you want them to be there for you.”

For Dr Jan-Khan, Togetherall offers something complementary and different to the existing system and to digital telehealth services.

“People can spend as little or as much time as they like on the platform. I think having ownership and control is important. Particularly if you’ve got a mental health issue; that you feel you are in control, you feel you are supported is really important.

“I think Togetherall does it in a way that’s more innovative, more creative with the creative art feature. Innovation like that makes it fun and inclusive for people.

“And to know that there’s a Wall Guide [Togetherall’s trained mental health professionals] behind there who’s going to intervene when someone’s distressed, I think it’s just so, so important.”

Visit www.hertfordshire.gov.uk/healthinherts to find out more about Hertfordshire County Council’s Public Health team and the mental health support offered in the county.

Contact Togetherall today to learn more about integrating digital peer support into your preventative, early intervention or complimentary strategies at place or system level.