The unspoken pandemic: how our mental health services could be redesigned

Posted on: 30 July 2021 by Professor Philippa Hunter-Jones, Chloe Spence, and Dr Rachel Spence in July Posts

Mental health services have been severely challenged and disrupted during Covid-19. In this blog, Professor Philippa Hunter-Jones, Chloe Spence and Dr Rachel Spence from our Management School, discuss the lessons learned from their ‘Let’s Keep Talking’ Project, and how the pandemic has presented an opportunity to improve responses to mental health needs enhanced by adaptions to service design.

When a crisis hits, along with it comes service disruption and an unexpected opportunity to look at things differently. The disruption to mental health services caused by Covid-19 has had exactly this effect prompting one organisation, The Psychological Therapies Unit (PTU) in Liverpool, to re-vision a way of delivering their services to a nation experiencing new patterns of anxiety, depression, trauma and loneliness exacerbated by lockdowns, a fear of the unknown and bereavement. Their answer was to supplement their existing services with a new telephone service, ‘Let’s Keep Talking’, designed with the intention of being responsive, agile and inclusive. With estimates suggesting that there might be 10 million people (almost 20% of the population) in England likely to require new or additional mental health support as a direct consequence of the crisis (O’Shea, 2020), better understanding whether the ‘Let’s Keep Talking’ model has something to offer both now, and in the future, is important to consider.


The PTU commissioned our services at the University of Liverpool to evaluate the contribution of the new service delivery model. We collected stories from clients and volunteers involved in service delivery exploring the design principles underpinning the service, whether the service worked, in what ways and considered also the question of scalability. A number of decisions were built in to the service design in order to achieve inclusivity. For instance, individuals are able to refer themselves into the service by calling a phone number or emailing an address shared with relevant organisations and via social media. It is entirely free and open to anyone in need. There are no long waiting lists and no assessment process to determine eligibility. Clients are also not limited on the number of calls they can receive. Call length is dependent on their individual needs and preferences, though these are generally limited to a maximum of around 30 minutes. Calls are with the same therapist, unless otherwise requested. It is delivered by a combination of professional therapists and trained volunteers utilising a solution-focused practice approach.

The service attracted a range of clients with different experiences who identified a number of benefits from subsequently engaging with the service. Four overriding themes were particularly dominant: accessibility and immediacy; collaboration and flexibility; the mitigation of isolation; and trust. Interestingly, these themes were also applicable to volunteers’ experiences too. Mitigation of isolation one key outcome, especially in the lockdown context, was important to both clients and volunteers. Volunteers viewed their involvement in the service as detracting from the negative effects of lockdown. This was an unanticipated positive side effect of engaging with the project. Both clients and volunteers often viewed the calls as something to rely on, ameliorating negative emotions and giving some structure to their lives.



It was, however, the other three themes that really set the service apart from competitors in the eyes of clients and volunteers. Several clients described a feeling of surprise at how quickly they heard back from the service which they described as crucial in ensuring that issues were dealt with as and when needed. The flexibility of the service model meant that clients were also not pressured to continue with calls or with the same frequency of calls when this was no longer appropriate for them. Clients had the opportunity to mutually decide with the volunteer the pace in which the service is engaged with. Also appreciated was the ongoing relationship between client and a particular volunteer. This relationship enabled trust and is a distinct feature of the service when compared to similar providers, the Samaritans for instance, where each phone call is received by a different volunteer.

Is the service scalable? Many might argue no when dealing with large referral numbers. However, actually this would be mis-leading. What this evaluation does show is that applying the design principles adopted in this study has enabled a fast response to mental distress which is scalable. A simple conversation from the outset of need with a provider has offered reassurance that help is out there. That people are not forgotten. In so doing levels of distress are more effectively supported, and at a time when they are likely to be particularly heightened. Yes, a fuller intervention may prove to be necessary, and yes, this might take time, but the fast response and immediacy of effective intervention might make all the difference. With waiting lists of 50 weeks for an initial assessment of mental health support not uncommon more generally, and mental health staff burnout a growing concern, now more than ever is the moment to look carefully at tweaking service design. Effort put in to the very early stages of need, as this study illustrates, can make a considerable difference.


The full evaluation of this service can be found via the following link:

Discover more

Explore the wide range of Covid-19 research work going on at the University of Liverpool.



Dr Philippa Hunter-Jones

Dr Rachel Spence

Chloe Spence