stödja – to support someone in distress

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In brief: Mental health training is a popular tool for addressing mental health issues within organizations. This often involves teaching people how to identify signs exhibited by a person in distress and address them (often) through an appropriate referral. I make some observations about the content and approach of existing trainings, and make an attempt to simplify what training can literally look like by borrowing from the instruction manual design used by furniture giant, IKEA.

Mental health “training” is a popular way for organizations to address mental health issues by teaching people how to better “refer”, “assist”, “support”, “help”, and/or “address” those who are in distress to mental health services and resources. These training programs come in different shapes and sizes and tend to focus on knowledge and/or skill development that, at a very basic level, enables trainees to understand how to identify the signs of distress, engage with a person who exhibits these signs, and make a referral to an appropriate support.

I have been contemplating ways that mental health training is designed and implemented, and taking a look at what is out there. In considering what it means to offer “mental health training” on campus for students, staff and faculty, I have been carefully assessing the guiding values, messaging and practicality of training content. There are benefits and disadvantages of existing trainings and while I am still early in the process, I’ve noticed a few trends:

  • Personal Boundaries: Most trainings fail to consider the boundaries, assumptions and expectations of the person offering support. At a baseline level, I think there is something we can all do to provide some level of support to someone in distress, but at the same time, it takes a careful understanding of oneself and her/his concept of mental health, personal values, and comfortability to ascertain how this actually looks in practice. In order to “do no harm” (borrowing from primum non nocere) and not escalate a situation, it’s important to know to what extent one is expected and able to intervene.
  • Symptom Focus: While the aim of trainings aren’t to equip people to act as “pseudo-professionals” who can diagnose mental illness, there appears to be a lot of emphasis on identifying the symptoms of various illnesses and problematic behaviour changes. I agree that there is great value in recognizing these signs, but the emphasis placed on symptoms (by illness) can be overwhelming to remember and may encourage people to diagnose others. Coupled with a lack of understanding around personal boundaries and without coaching on how to incorporate ‘illness’ signs/symptoms into a conversation, the symptom focus may lose its effectiveness, in my opinion.
  • Social Construction of Illness: A lot of content doesn’t take a look at mental health in context including its various histories, perspectives, and determining factors. I find this most interesting as I imagine it would be challenging to appreciate and begin to address mental health without a better understanding of it, particularly since it can be a highly stigmatized and contentious issue to raise.
  • Memorable Messaging: Trainings tend to describe “steps” to follow in a help scenario. While useful, in the moment it may be difficult to recall what one has been trained to do if the messaging is too long, highly specific to a disease or host of symptoms, and not memorable. More often than not, reams of training text are compiled into a guide or book of sorts for people to read through, but I find this is personally more helpful as a reference than a practical, front-line tool. I think that people could greatly benefit and remember more if a condensed aid is available, particularly if it is visual.

From my perspective, I think one of the most interesting things about “training” is that it relies on exercising something that is innately human: our interpersonal skills.  This includes conflict resolution, validation, de-escalation, talking, observation, physical language, active listening, personal boundaries, values, empathy, and guidance. While these might seem like natural qualities, they are skills that we do not make time to practice or teach each other in formal contexts…and it is interesting to see this as such a massive need when it comes to health and wellbeing. Consequently, a lot of practical skills related to training comes down to having a conversation with one another in order to reach an understanding of what’s going on and what we can do about it.

In considering ways to ‘simplify’ training skills and step and make them more memorable and accessible to a general audience, I thought about how to convey training content in a minimalistic yet still informative manner. I also wanted to place focus around interpersonal skill development and interaction than disease states, which I think is a helpful shift to make.

One of the first examples I thought of was IKEA instruction manuals. IKEA is well known for its focus on its modern, simplistic, accessible and easy-to-assemble design. It was only a few years ago that IKEA’s change in typography caused a massive backlash from designers, demonstrating how a change in IKEA’s design standards could have a huge impact on the design world. In any case, over the years I have come to appreciate how visual IKEA’s instruction manuals are as they illustrate the tools, parts, and process required to assemble furniture. I thought this was an accessible way of conveying information…and as an ode to simplicity and more visual responses to distress, I created the above “manual”. Without text, I think it communicates a lot about the interpersonal nature of the skills needed for ‘intervening’ in a situation, placing emphasis on a collection of encouraged interactions and responses. It doesn’t get into the details, but I think is a helpful visual starting point.

If you’re unfamiliar with IKEA’s naming scheme, here’s a little bit of context. I chose “stödja” as the name of this manual because, in Swedish, stödja is described as meaning: “to support”, “to be helpful”, and “to be attentive.” I think is a relevant term that communicates the intention of manual. Also, please forgive me if I am using this word out of context…my Swedish is only as good as Google translate 😉

An aside: I just came across this NY Times Opinion piece and thought it was completely relevant to the discussion above: How Not to be Lonely by Jonathan Safran Foer. While it focuses on loneliness, I think it still applies. Here are a couple of helpful quotes from the article:

Most of the time, most people are not crying in public, but everyone is always in need of something that another person can give, be it undivided attention, a kind word or deep empathy. There is no better use of a life than to be attentive to such needs. There are as many ways to do this as there are kinds of loneliness, but all of them require attentiveness, all of them require the hard work of emotional computation and corporeal compassion. All of them require the human processing of the only animal who risks “getting it wrong” and whose dreams provide shelters and vaccines and words to crying strangers.

“Attention is the rarest and purest form of generosity” – Simone Weil

Mental Health Tetris

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In brief: Visual experimentation of mental health concepts using Tetris blocks.

I have been thinking about ways to represent various concepts in mental health using basic shapes. I started to play around with squares to see what I could come up with, but ran out of creative juice quickly. Recently, I stumbled upon the work of Graphic Patrick who created some clever posters about mental health terms which inspired me to return to my square experiment. What I came up with were Tetris-inspired visuals, as you can see above and below.

I was a big fan of Lego and Tetris when I was a kid, so I’m not surprised that my experiment led me to create some visual concepts inspired the very building blocks that kept me creative and busy during my childhood. I received a Game Boy for my birthday (way back when it was first released) and was absolutely thrilled that it came with my very first portable video game: Tetris. Really, this was the best tech toy a kid my age could get for her birthday in the early 90s <<YouTube video: 3mins of pure Tetris nostalgia here>>

Tetris aside, I decided to experiment to see if the notion of adding/removing building blocks (perhaps representing positive and negative events/stressors?) could help describe some topics in mental health. My intent here is to find alternative/complementary ways to explain complex mental health issues. I realize Tetris may not be the best analogy, as I don’t consider mental health a “game” of sorts nor something you can really “win” or “lose” at. But for the sake of trying something different, I selected a few issues that I thought would be worth exploring. And yes, this is an exploration that aims to challenge me and my own understandings of mental health and hopefully encourage others to think differently too. Using Tetris as a back drop is meant to describe terms in a playful and accessible way but is not intended to minimize their seriousness or depth. The decision to position the blocks the way I did here comes from both the way the game is constructed as well as the player experience.

Illustrated are the concepts of recovery, depression, bipolar, ocd, coping, and determinants of mental health. I’d rather not provide an extensive explanation of each image, rather, I’ll let you interpret it for yourself. I’ve included a definition of each term below each diagram for your consideration. As always, feedback and ideas are welcome.

An aside: When I googled “Tetris” and “mental health” to see if there were some existing work in this area, I came across articles referencing an Oxford study suggesting that playing the game could possibly prevent PTSD flashbacks. Some food for thought.

tetris_rec“Recovery is understood as a process in which people living with mental health problems and illnesses are empowered and supported to be actively engaged in their own journey of well-being. The recovery process builds on individual, family, cultural and community strengths and enables people to enjoy a meaningful life in their community while striving to achieve their full potential.” (Toward Recovery & Wellbeing, MHCC)

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“Depression is a medical illness that causes a persistent feeling of sadness and loss of interest. Depression can cause physical symptoms, too.” (Mayo Clinic)

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“Bipolar disorder — sometimes called manic-depressive disorder — is associated with mood swings that range from the lows of depression to the highs of mania. When you become depressed, you may feel sad or hopeless and lose interest or pleasure in most activities. When your mood shifts in the other direction, you may feel euphoric and full of energy. Mood shifts may occur only a few times a year, or as often as several times a day. In some cases, bipolar disorder causes symptoms of depression and mania at the same time.” (Mayo Clinic)

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“Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by unreasonable thoughts and fears (obsessions) that lead you to do repetitive behaviors (compulsions). With obsessive-compulsive disorder, you may realize that your obsessions aren’t reasonable, and you may try to ignore them or stop them. But that only increases your distress and anxiety. Ultimately, you feel driven to perform compulsive acts in an effort to ease your stressful feelings.” (Mayo Clinic)

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“Coping is the process of attempting to manage the demands created by stressful events that are appraised as taxing or exceeding a person’s resources” (Taylor & Stanton)

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“Multiple social, psychological, and biological factors determine the level of mental health of a person at any point of time. For example, persistent socio-economic pressures are recognized risks to mental health for individuals and communities. The clearest evidence is associated with indicators of poverty, including low levels of education.” (WHO Fact Sheet)

 

The Elements of Design Thinking (Version 2.0)

As a follow up to my original post on the Elements of Design Thinking (Version 1.0), I present to you the Elements of Design Thinking Table, Version 2.0.

This second version builds on the feedback from version 1.0, and has been organized differently into families and periods based on my ever-evolving understanding of the concept of Design Thinking. I have had the good fortune of interviewing incredibly intelligent and insightful designers and design thinkers through a research study I am co-leading called Design Thinking Foundations. My learning through this project has prompted me to reorganize the elements the way I have and has brought some more clarity to my own personal definition of design thinking. As my Adobe Illustrator skills have also evolved (for the better, I hope!), I give you a more polished graphic above.

As you can see, there are more elements then last time, but I suspect the list will keep growing and the elements will continue to be reorganized. Compared to the first version, this one has fewer gaps — maybe indicative of some cohesive thinking around my own definition of design thinking?

In any case, I’m still facing the challenge of determining if something is truly an ‘element’, that is, a basic building block of design thinking, rather than a higher level concept that would be constructed from a combination of these elements. Understanding how these elements relate to one another in order to formulate higher level “molecules” is a design challenge in itself. I think it’s worthwhile putting some more thought into this though as it might help visually and conceptually explain the varying approaches and unique interpretations of design thinking that people have. For instance, you’ll probably notice how I have included elements that reflect my public health background such as “Sj: Social Justice”. This is an element I would expect to be very prominent in building a design approach or stance in health promotion, but probably not for someone working in the area of business design, for instance.

In this 2.0 version, I have included definitions below for each of the elemental categories for some additional context:

Mindset: Elements that refer to ideas, constructs, and attitudes with which a person approaches a situation

Meaning: Elements indicating the significance of design

Humanize: Humanizing elements that bring design closer to human nature or human use

Interaction: Social elements denoting the ways things effect or relate to one another

Process: Elements emerging throughout the creative/design process

Understanding: Elements representing mental processes for comprehending information

Included here as well is a “2.0” version of the Design Thinking trading cards that pair with this version of the table. I’ve included a preview below, and the full pdf can be downloaded here: DT Trading Cards 2.0. Currently, they are only one sided but have been resized into full sized playing cards (2.5×3.5 inches).

The next steps for the Table and cards are to more fully put together the definitions of these concepts…and any suggestions in this area are more than welcome! Be prepared for further iterations and more text!

I’m also excited to discuss the periodic table of design thinking further with the Plexus Institute today! Feel free to join in on the conversation by phone at 1PM EST, it should be a lot of fun 🙂 Details are in the link.

The Grade School Dance

I’ve been thinking about the state of health promotion and design, and in some ways, it reminds me of a grade school dance, hence the name of this post. Hair styled up, make-up on (or cover up for that matter, because who can forget that middle school acne?), and wearing your best garb, a grade school dance can be quite a nerve wracking experience, especially when it comes at the beginning of the year.

At the dance there are streamers, balloons, low light, and inviting banners to set the mood. You don’t really know all the other students, so at first, you stick close to your peers. The wall flowers stand back chatting amongst themselves, keeping dibs on who does or doesn’t get asked to dance. A few teachers encourage the kids to find a partner, get out on the dance floor, and have a little fun…and you and a few others actually muster up the courage to do so. You walk up to someone, ask politely for them to dance, and move to the middle of the dance floor. Yeah, you might not know how to dance but you go for it anyways, wiping the sweat off your clammy hands before placing them on your partner — that moment of physical contact sparks excitement and nervousness throughout your body. Feeling a bit stiff and arms length apart you look around at the other couples, trying to pick up on their dance cues. Not sure what to do, someone starts to take a lead: shuffle forward, shuffle back.

Your feet may feel a bit clumsy but you repeat the actions: shuffle forward, shuffle back. Double checking that your partner’s face is free of any signs of confusion or angst, you continue with the rhythm. Halfway into the song, you feel slightly more comfortable, relaxed and confident, even going so far as to try out a new step or spin, or even drawing your partner in a bit closer. Over time, new rhythms slowly form and you become more dynamic and fluid on the dance floor. Soon enough, you may even try something different by switching your partner or changing the music.

That’s how I see health promotion and design. It’s new territory, no one really knows what they’re doing, and we still have to get to know each other. It may feel a bit awkward or unfamiliar at first, but with time and experience, things come together more smoothly. The art and skill of dancing takes, time, experience, relationship building, and some risk-taking but it seems that right now is the perfect time to take bigger strides and pull each other closer so that we can find new rhythms, patterns and movements that bring health promotion and design to the next level.

I think this quote from Gordon MacKenzie helps sum up some of these thoughts nicely:

On the dance floor, people are not boxed in, and they manage very nicely to avoid tripping over one another. If we are to achieve the quantum leaps the future seems to be demanding of us, we must risk to leave our containers-turned cages and find the grace to dance without stepping on toes.

Others’ or our own.

– Gordon MacKenzie, Orbiting the Giant Hairball, Page 97

The Charrette

Charrette [shuh-ret]: The French word for ‘cart’ used in 19C design schools in France to collect the final projects of design students for the purposes of grading. Within a contemporary design context, charrette is a word popular in urban planning used to describe an intense period of design, often occurring over a concentrated period of time within a team or group setting, in which a design solution is developed.