Digital Design’s offer to mental health care
A previous blog by fellow Uscreature, Sophie Walker explained the steady digitisation of the healthcare industry, citing that 75% of people go online for health information. As we approach 100% digital penetration (wearesocial, 2016) this percentage is likely to continue to increase.
The last 50 years have seen a transformation and a shift in political action and public attitude towards mental health. However many are still suffering in silence; contributing to the rise in the number of people taking their own life. The Five Year Forward report published by the Mental Health Taskforce earlier this year highlights that three quarters of people with mental health problems receive no support. It is calculated that mental health issues cost health and social care services in the UK £21 billion annually. Yet, local authorities spend just 1% of their public health budget on mental health care (MIND, 2015).
Local authorities often don’t dedicate the necessary budget to mental health because of confusion about how to focus resource and create impact. Design offers a rapid process to gather insight on mental health issues, co-design with stakeholders and test and iterate solutions until they are as impactful as possible. Furthermore, digital design has the capacity to make solutions scalable to a wide audience.
Many service providers are creating digital mental health services as they offer a range of benefits that their brick and mortar counterparts cannot. While a traditional face-to-face service is limited in terms of resource and access, a digital service can offer 24/7 access to care. Digital services can also offer their users anonymity – something that can be extremely important for users to avoid feeling stigmatised. The anonymous digital service, Big White Wall currently sits at the top of the NHS mental health apps library. Big White Wall offers peer-to-peer support, courses, questionnaires and access to 24/7 trained professionals.
Although digital health services can offer many potential benefits, those designed without considering the user’s specific needs and experiences will fail. At Uscreates, our design process is guided by our four principles of: co-creation, deep human understanding, reframing challenges and prototype and testing. By following these principles we can design a service – whether online or offline – that is bespoke to each mental health challenge we work on.
Here are examples of mental health initiatives that we and other organisations have worked on that embody these four design principles.
Often services are designed for rather than with people. By co-creating with service users and stakeholders we create alignment and ownership in the final outcome.
Uscreates designed the Wheel of Wellbeing (WoW) brand six years ago and more recently delivered the digital components of the service. The WoW website operates as a framework to help raise awareness and change behaviour around day-to-day actions proven to help people feel happier and healthier.
The digital roll-out of WoW was guided by the Government’s Digital Service Standard to ensure a co-designed approach that places user feedback and usability data at the heart of the design process. We undertook a detailed programme of work to understand user needs; generate feedback; establish a multidisciplinary team and test and build the platform. The result is a simple, intuitive service that is deeply conscious of users’ needs. Furthermore, all content is crowd-sourced with users ensuring that the service continues to grow and develop in line with their needs.
In the last six years, over 15,000 people have engaged with the Wheel of Wellbeing framework through both online and offline touchpoints. To date, over 20 public and third sector organisations have adopted the framework to promote mental wellbeing.
Silicon Valley for Health is a social innovation project developed by Ravensbourne, Greenwich University and Loughborough University London. Their co-creation process will deploy a range of creative methodologies to engage local people in the development of technology-enabled solutions to support improved mental health outcomes.
Deep human understanding
A one size fits all approach runs the risks of isolating many. Digital design can tackle this by developing a deep human understanding of what is needed and offering tailored information to fit those needs.
A particularly interesting development in this area is a mobile app called SAM, developed by a research team from UWE Bristol, which enables personalised anxiety monitoring and management.
A survey with students at UWE and Plymouth revealed social anxiety was a ‘considerable concern’ amongst undergraduates. This initiated the development of the app through a user-centred design approach with the university’s students, various departments and an application developer. Using a process of face-to-face therapy as a template for the ‘therapeutic’ element of the app enabled the team to think about the aspects of therapy that are important in getting people to engage with mental health care. The result is that SAM allows users to understand what causes their anxiety, apply self-help techniques and connect with a community. The experiential journey through the app is different for every user depending on their individual circumstances.
When there are embedded ways of doing things it’s often difficult to envision change. Design can tackle this by reframing the challenge.
Traditionally welfare benefits for people with long-term mental and physical health conditions have been delivered through a top down approach, with specific benefits being assigned to a specific need and spend. This creates multiple complexities from a service user and service provider perspective. There is now increasing recognition that when a service user is empowered to make decisions about how they use their benefits, the same resources are likely to be stretched further and put to more effective use than through traditional care planning.
The personal budgeting approach is being increasingly facilitated by digital as shown through the pilot Universal Credit scheme (Universal Credit, 2016). Universal Credit is to replace six distinct benefits with a single monthly sum which the recipient can then assign to living costs as they see fit.
The true impact of Universal Credit is yet to be revealed as the scheme is not anticipated to be rolled out nationwide until 2022. Limitations of the current IT systems means they will be replaced by a more capable digital platform. By reframing this challenge, the reduced administration costs of this streamlined, digital system will allow for an estimated increase in entitlement of £25 per month for households on the lowest income levels (Department for Work and Pensions, 2012).
Prototyping and testing
Uninformed investment in digital technology is wasteful for both user and provider. Instead, a process of prototyping and testing results in a valuable solution that is deeply aligned with users’ need, all the while mitigating investment risks.
Uscreates have lead engagement on the London Digital Mental Wellbeing service in partnership with London CCGs, the NHS and the Mayor of London. This project looks at ways of normalising mental health problems and providing mainstream access to quality targeted health information to Londoners through a digital platform. We are instilling an iterative approach within the design of the service, allowing us to respond to insights as they emerge, in order to shape different features and modules of the service through a phased approach. The approach is aligned with the Government Digital Service Standard process; Discovery, Alpha, Beta, Live, enabling the testing of the evolving service with users it its early rough versions prior to developing higher fidelity and improved versions.
Digital has created unprecedented opportunity to open up access to mental health services and information. A golden era of mental health awareness awaits if these opportunities are considerately harnessed. As we develop online mental health services, it is imperative that we design in a way that is co-creative, understands human needs at a deep level, reframes the challenges that we face, and makes space for prototyping and testing.
If you would like to discuss your challenges around designing digital mental health services, get in touch at firstname.lastname@example.org.
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/220177/universal-credit-wr2011-ia.pdf / Department of Work and Pensions. (2012). Universal Credit, Impact Assessment