Service Design Thinking For Campus Mental Health

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How can we better understand the thoughts, feelings, behaviours and experiences of a student navigating campus mental wellness services?

By answering such a complex question, we can learn how to improve all aspects of a student’s interaction with a service, starting from how they enter the service in the first place, to when and how they choose to leave the service. By placing the human experience at the center of the way we design health services, we end up improving not only the processes and efficiencies of the service, but creating services responsive to real human needs.

Service design’ is an innovative approach for improving how students experience and navigate campus mental health services. Through observational research, student/practitioner interviews, service ‘blueprints,’ and systems maps, we have been working towards the design of more humanistic and compassionate service experiences at OCAD U, and even across the greater mental health system. I’m delighted to be leading a project that is the first of its kind in Canada and working with prominent design leaders to do so. Here I’ll share some of our work to date.

In the summer of 2013, I led a workshop with the OCAD U Health & Wellness Centre to create an initial service map of counseling services (you can see a sliver of it above in the image for this post). By working with the entire clinical team, we were able to capture individual and group insights and understand the basic service journey of a student accessing mental health services.

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Stages of mental health counseling services

Not surprisingly, when you ask people for their perspectives and observations of the same process from their different vantage points within the clinic, you start to stitch together interrelated but unique narratives. By going through the various stages of the service (help seeking, service entry, intake, counseling, exit, etc., see above) you can start to break down the complexities of the student’s experience. This served as a helpful exercise in elucidating and confirming process and, importantly, helped us start to construct an empathic understanding of the student. Layering the thinking, attitudes and behaviours of practitioners and students on top of this map has helped us identify positive and negative service experiences as well as opportunities for change.

The artifacts and insights from the workshop helped lay the groundwork for a couple of projects I initiated with the OCAD U Strategic Foresight and Innovation (SFI) Program with leading healthcare designer, Dr. Peter Jones. We are engaging SFI students as key stakeholders and researchers through a staged strategy of course work and project work. Through one-on-one interviews with practitioners and students (service users and non-users), and ethnographic research, we are visually mapping out the overall service structure and process. Our plan for redesign of the Centre will start by focusing on creating change within multiple layers of the service including its goals, service offerings, branding, evaluation and physical space.

Meaningful provision of mental health services also necessitates an understanding of how these interventions and changes interact with the wider University and provincial mental health system, which is why we decided to engage a second SFI team around the creation of a systems map of the postsecondary mental health system. Applying a systems lens enables us to situate OCADU’s mental health services within the greater service system.

I look forward to the outcomes of these projects and am particularly excited to see their impacts on the mental health system and the way we approach our strategy and redesign work. Service design in particular tends to be a less common practice in Canada, making this project a real test case for the postsecondary sector. Please let me know if you’ve done any work in this space – service design, systems mapping – on your campus. Feel free to comment below.

 

Design Thinking for Campus Mental Health

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tl;dr Design thinking as a strategic framework for campus mental health

A “mental health strategy” is a coherent and coordinated effort to move an organization closer to a place where it can begin to introduce new and stable patterns and opportunities related to mental health. This is about engaging in many intentional maneuvers, positioning and advantageously repositioning an organization so it can get closer to reaching a new state of being, thinking and doing. Along the way, these movements should aim to help increase the organization’s mobility and ability to adapt to change, and weaken and redesign the unhealthy structures that inhibit this progress. This, at least, is my understanding.

In considering what a framework for a campus wide mental health strategy can look like, I have turned to “design thinking” as a way of organizing my own intentions and approach.

And what exactly is design thinking?

Design thinking is a term I’ve given a lot of attention to over the past few years and has become wildly popular in the business, healthcare, and social enterprise space. I had a good discussion about the term more recently with several colleagues as we started working through the IDEO+Acumen course on Human Centered Design. While there is no clear consensus around its definition, there are common threads that emerge when people talk about design thinking as it is applied to generating innovative solutions to complex social issues. To me, there is merit in what “design thinking” can offer to a making and/or problem solving process. While I have no fully formed definition, here are some components that I think bring some level of concreteness to what I refer to when I say “design thinking”:

  • A stance or mindset that supports the development and realization of products, processes and services that impact people and contexts in new ways
  • This stance is centered around the human experience, and how people engage with the larger systems in which interact and are embedded within
  • It is a term that has been distilled from the creative/design industry and re-configured into processes and concepts that can be applied to other industries
  • It intends to produce change, from one state of being, to another
  • It is deemed to be particularly advantageous when navigating issue areas that possess a high level of uncertainty, ambiguity and complexity
  • A more tangible process associated with design thinking is as follows: understanding a ‘problem space’ through empathic methods, ideating various ‘solutions’ and ways to address the issue at hand, prototyping the potential ‘solutions’ in the real world, and evaluating the impacts

Based on this understanding, I see “design thinking” as enabling a campus to develop a response to mental health that is intentional, promotes social change, and deeply rooted in the human (student) experience. As a highly complex, invisible and broad issue that is traditionally addressed by the health sector alone, mental health is well suited for a design driven approach. Distilled into the visual I created above, here is how I see design thinking intersecting with a mental health strategy:

  • UNDERSTAND: “Understanding” can also be referred to as “research/assessment” and necessitates a multi-pronged approach that moves beyond traditional surveys and focus groups by incorporating observation, journey mapping, participatory methods, and storytelling. Empathy and experiential learning lay at the heart of understanding mental health on campus. Capturing a full range of perspectives must take place from multiple vantage points and mediums. This is particularly important when working with a creative audience whose communication channels may be verbal, visual, olfactory, gustatory, and/or auditory. Information captured in this phase can be used to identify critical issues where there is a desire or need for change.
  • IDEATE: While understanding is an ongoing process, there is a point where there is a healthy amount of information that can be used to generate informed ideas that will lead to desired change. Ideas can be wild, practical, broad or specific. Ideas can transform into concepts/frameworks that help make some sense of how they can be executed.
  • MAKE: Some ideas that meet certain criteria around feasibility are then moved into a stage where they are brought to life and tested in real world contexts. Rapid prototyping enables for quick wins or misses, leading to reflection and iterative revisions. In a mental health context, ideas need to prototyped with a heightened level of care and consideration.
  • REFLECT: Reflection, much like understanding, is ongoing. Reflection is necessary for evaluating and learning from the process and outcomes that take place. This is an important part of accountability and responsibility to the greater community, and particularly key in the making process when trying to define and measure impact. An outsiders perspective can also help gain new insights and reflections.

The visual implies a lot of nonlinear movement and overlap within and between the identified ‘phases’. Design thinking here lends itself well to a change making process, and nicely frames the different spaces through which our campus wide Committees will move through in order to offer and implement recommendations that improve mental wellbeing.

While I don’t know that applying design thinking to an issue like mental health will lead to any more innovative or better ‘solutions’ for campus, I think that it does offer a helpful framework for working through this type of ‘wicked‘ issue and supporting innovation by putting people first.

 

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

Reframing the Role of the Service Provider: We are All Designers.

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In brief: In the post secondary setting, the work of the institution is often framed within the context of customer service and student-centeredness. While these terms are helpful in focusing and re-focusing our efforts on students, we can often lose sight of the fact that a large part of our work and job responsibilities is about serving each other — that is, our very own colleagues and peers. In order to work together and encourage people to see mental health as a part of their everyday job responsibilities, I suggest that we reframe our jobs titles, positioning ourselves as designers, first. As designers, we act as ‘problem’ solvers on campus, approaching issues like mental health with empathy, understanding, critical insight and importantly a systems perspective. This reminds us of the greater contexts in which we work and people we need to work with in order to serve students.

As staff and faculty in the post-secondary setting, who are we serving? 

The automatic answer: We are serving students, of course! The student experience is built around a model of “customer service” and student-centered service development and delivery. This framework positions what we do within the context of service provision. This can be helpful in terms of grounding our roles and responsibilities around services we offer and reminding us that it is the student who is our ‘end user’ and whose interests we need to be mindful of.

The emphasis placed on students and services, however, can be less helpful when we lose sight of our position within the greater service system. There are often multiple departments, groups and individuals that work to create positive experiences for the end user. More often than not though, we design only within the context of our service space. This is further exacerbated with departmental silos, lack of trust, divergent perspectives, and organizational conflict. When the people who are in charge of creating the architecture and systems that will shape the student experience are not working collectively to complement each other’s efforts, it is the students themselves who end up losing out. As providers on campus, it is important to remember that we are serving students in so much that we are serving each other.

Designing a mental health strategy is largely an internal effort that requires buy in and support from all levels of an organization. Recognizing the provider’s role as one that is highly collaborative is a necessary step to ensuring greater flow in the student’s journey as she/he is seeking mental health supports and resources, enhancing complementary offerings and reducing replication. And while working with those internal to the organization seems like an intuitive and necessary practice, we tend to lose any formal association of our roles as being about building relationships with our own colleagues. When we lose sight of our colleagues, communications start to break down and we start to impose our own practices on each another as opposed to with each other.

Our job titles define what we do (and think we ought to do), how we do it, and why. I’ve been thinking about how to conceptualize our titles so that we move closer to an understanding that we all have a shared job to play, institutionally, when it comes to mental health. This brings me to ask, how do we position mental health as being an integral part of everyone’s job? While this can be established more concretely through policy, it is only meaningful when people genuinely consider themselves accountable, are able to contribute to a greater change making process, and feel that it is a part of their mandate.

So, what would happen if we reframe our roles in a bigger way?

An idea –> On campus, let’s say we’re all “designers”…and by designers, I refer to social problem solvers: people who bring compassion, empathy, creativity and understanding to a ‘problem’ situation and frame these situations within the context of the systems from which they emerge. Thus, from a teacher to a janitor to an administrative assistant to a dean, we are all hired designers. Our first and foremost responsibility then is to use a designer’s mindset to address the problems we see around us. This involves recognizing that we have a direct role to play in the design of structures, services, and spaces around us…this also means we are responsible for their re-design in order to meet changing and unmet needs. Even if we have specific and diverse areas of design focus/craft/skill (e.g., administration, teaching, coordination, counselling, etc.) the designer’s lens reminds us that we are playing our part within the greater organization to help us function as a whole — hopefully one that is coordinated, adaptive and healthy — in order to promote student success. As designers, it would be difficult to do our work without appreciating the greater context in which we work and without connecting with our fellow designers in order to affect change, particularly when the issue at hand is complex, ambiguous and systemic. As such, it becomes everyone’s job to improve designs that we recognize as weak and concerning as well as celebrate beautiful, delightful design we’ve created together.

This reframing helps me elevate my understanding of the greater roles we play in an organization. Using the title of designer in no way aims to diminish the talent and skill set of the many design specialities that exist, but rather is meant to suggest that we all possess elements of design thinking and doing that enable us to respond in more adaptive and empathic ways to issues we see within an organization, including mental health. When we are all considered designers of the student experience, we all have something to offer when it comes to creative problem solving on campus. Whether it is demonstrating empathy through a conversation with a student around her experiences with depression or working with student groups to re-design a policy that promotes anti-stigma through institutional practices, there are small and large ways we can demonstrate design in order to improve health.

A little mental help: Action cards

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Depression.

I know many who have and continue to experience it on a day to day basis. Given my training and work on mental health initiatives, I’ve had people approach me to ask about recommended resources on depression (websites, trusted literature, etc.) and tools that inspire motivation and action. And generally speaking, there are some great, evidence-based self-help resources out there:

While there isn’t a shortage of accessible and reliable content, it seems that the bulk of existing resources tend to be extremely text-heavy, look and feel somewhat dated, and come across as a bit dry, drab and ‘clinical’ in nature (e.g., included images are limited to charts and surveys or photo stock images like this). This is not to criticize any particular resource, including the ones I’ve mentioned. Rather, it’s more of a commentary on what I’ve seen and would expect to receive from my own health care practitioner.

To me, managing depression is about bettering one’s own mental health with the support of trusted friends/family and professionals. At the same time, I believe that this process shouldn’t have to feel like undergoing an academic or clinical exercise. It can be daunting enough to acknowledge the need for change, to seek out supports and embark on a treatment plan. Doing so within a clinical context while supporting yourself with dense and somewhat sterile resources probably doesn’t help minimize the overwhelming and uncomfortable feelings that can arise. Perhaps this is a common experience among those who go through the medical system to ‘fix a health problem’, but I think that addressing a mental health issue also comes with unique layers of stigma, challenge and complexity.

I have found few tools that are visual, colorful or feel friendly and personalized to my interests. While it’s actually quite exciting to see soft/hardware being developed that can help track mood and behaviour and enable us to interact with mental health issues in new ways, I think that the existing ‘old-school’ resources out there deserve a re-vamp too — in reality, these are the resources that the majority of care professionals continue to use and recommend in practice.

I decided to make some ‘action cards’ that suggest tangible steps one can take to help overcome depressive feelings. These cards are informed by cognitive behavioural therapy approaches to treatment and aim to be quick, ‘on-the-go’ actions that someone can print out, shuffle through, and carry around. They were also designed for someone familiar with CBT concepts and would probably play a more supportive role to someone undergoing treatment. These were created with a personal intent but are shared here if they (or the idea of them) can be helpful to someone else. Inspired by my own deep dive into the world of animation and cartooning, I decided to create a character who would accompany the cards and (hopefully) can appeal to a general audience. My hope was to create something more playful, personable, less ‘institutional’ feeling, and appealing to adults.

At the top, you can see ‘side 1’ of the cards with the “problem” being faced. ‘Side 2’ below offers a practical action response. I welcome your feedback and ideas on how to improve these cards.

 

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