Case Study: OTR

As part of our Relationships Project, we’re collating a series of case studies from a range of sectors and contexts that demonstrate the benefits and workings of relationship-centred design. Whilst we hope they help build a case for prioritising deep-value relationships, we recognise that – especially at this early stage – we are still learning. We therefore welcome comments, insights, critiques and ideas for case studies from people and organisations across sectors. Please don’t hesitate to get in touch at

OTR: Using Strengths-Based Collaborative Relationships to Support Young People to Improve their Mental Health

You can read the full case study below or take a look at and download the infographic which provides a short, print-friendly summary of the case study here.

Introducing OTR

Off the Record (OTR) works with young people aged 11-25 to improve their mental health and wellbeing. Self-described as “more like a social movement than a typical mental health service,” it offers peer and one-to-one support and a wide range of co-produced activities and psychosocial groups for people across Bristol and South Gloucestershire. OTR’s excellent work has seen it come third in Nesta’s 2018 Good Help Awards and win a GSK Impact Award in 2015.

How does OTR work?

OTR offers a huge range of projects across Bristol and South Gloucestershire, including:

  • The Resilience Lab: Fun, informal self-care workshops.
  • Inspiration Works: A programme of creative, arts-based workshops to promote good mental health and wellbeing.
  • Nature Works: A nature-based programme promoting good mental health and wellbeing.

  • Mind Aid: A six-week group-workshop programme for people struggling with depression, anxiety or stress.
  • Shameless: A six-week workshop for anybody concerned about body image and low self-esteem.
  • Armed: A six-week workshop for anybody using self-harming as a coping strategy.
  • Freedom: A gender and sexuality youth group with specialised one-to-one support.
  • Zazi: A variety of group and one-to-one support exploring mental health, race, ethnicity and culture.
  • Corner Man: A twelve-week programme for men from BAME backgrounds, run with Empire Fighting Chance boxing gym.
  • The Mentality Project: A volunteering project that uses social activism to challenge stigma around mental health.
  • 1:1: A variety of one-to-one therapies, including arts- and creative-based support.

All these projects involve relationships with other young people, OTR advisors and people working for partner organisations. “We believe that relationships are what makes the difference – so our approach is fundamentally relational,” OTR’s website reads. “We believe in the power of networks, and so we emphasise peer relationships, professional partnerships and organisational collaboration in our approach.”

But OTR’s relationship-centred approach really shines through in how it frames these relationships. Crucially, OTR believes the relationships young people form with one another and OTR should be participatory and collaborative – not dependent or transactional. OTR rejects rigid, prescriptive mental-health services that try to impose solutions on people. Instead, it starts with people’s “capabilities before their vulnerabilities,” encouraging young people to “take back ownership” of their mental health and how best to improve it.

OTR ensures young people retain ownership in a number of ways:

  • All OTR projects are co-created and co-delivered in collaboration with the young people they aim to support.
  • This spirit of co-creation and collaboration runs through OTR’s strengths-based approach, which takes as a starting point young people’s own capacity to lead on the best solutions for them.
  • Individual OTR projects are overwhelmingly concerned with supporting young people to develop agency and confidence.
  • OTR’s services are incredibly flexible and non-prescriptive. As well as the sheer range of projects on offer, OTR hosts regular, informal drop-in days called ‘Hubs’ which allow members – not ‘users’ – to access services and activities at times best for them.
  • Over 40 young people have also trained as Peer Navigators: volunteers who are often the first point of contact for members. Peer Navigators hold strength-based conversations with members, co-create self-care plans and otherwise help members make good choices and build on existing resources. Allowing young people to take the lead in this way has unexpectedly seen Peer Navigators grow into a culture and service in and of themselves, meeting members’ needs even though they were initially intended only as first points of contact.

OTR’s approach recognises that relationships are valuable for improving mental health, but only providing they are empowering for the people involved.

What impact is OTR having?

Over 3,000 young people access OTR services each year, and OTR reaches a further 5,000 through its community outreach work.

Over the most recent quarter, when asked to identify what OTR has helped with, young people reported:

  • Improving self-understanding: 27%.
  • Learning new skills: 25%.
  • Gaining confidence: 24%.
  • Improving their relationships: 20%.
  • Feeling happier: 18%.

In terms of the relationship between young people and their OTR therapist, from November 2018 to April 2019:

  • Over six sessions, young people aged 13+ reported a session rating scale score of 38/40.
  • Over six sessions, young people aged 11-12 reported a child session rating scale score of 37/40.
  • Both groups reported an improved score and relationship with their therapist over time.

What do we think OTR can teach us about effective relationship-centred design?

Even supportive relationships should not be passive and dependent

OTR is very clear that the young people it works with must lead the way in their own development. OTR should not ‘solve’ their problems. Instead, it gives young people agency by co-creating with them, allowing them to access services when they wish, helping young people train as Peer Navigators and using a strengths-based approach. The very agency that stems from this approach helps young people tackle their mental-health challenges.

Especially when complex personal development is at stake, relationships are more effective when they are personalised

OTR explicitly rejects a ‘one size fits all’ model. By granting young people agency, it allows them to tailor the support they receive. This ensures high engagement, and increases the chance young people benefitting from OTR’s projects.

Accessible space can help foster meaningful relationships, providing it is welcoming and accessible

OTR’s ‘Hub’ days ensure their space offers a relaxed, flexible environment in which young people can access services – one populated at the frontline by Peer Navigators who are familiar.

What’s next for OTR?

OTR turned 50 in 2015, and has never been in better health as its co-created portfolio of projects continues to grow. The OTR website says it best: “Lots of things have changed in the years we’ve been around; the issues young people bring, the funders, the city! Fundamentally though, we’re still offering the same thing – free, confidential, support for anyone aged 11-25 that doesn’t rely on an adult referral, and doesn’t have thresholds that turn you away if you don’t meet our criteria.”

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Has this case study inspired any comments, ideas or critiques?

Please do get in touch with us at if so. An essential part of the Relationships Project is learning from others engaged in thinking about relationship-centred design. We don’t have all the answers, so hope some people reading will contribute suggestions.