Week 1: Research -> Identifying Opportunities
Hello, world!
This is the first post from team DMHC (temporary name!) consisting of Chian Huang, Hafiyyandi, and Ridwan Madon. We are all 2nd-year grad students at NYU ITP, and this blog documents our process and journey for Microsoft Design Expo 2019: Empathy at Scale.
0: Context
Untreated mental health care can lead to fatal consequences. Depression is one of the leading causes of disability, and people with severe mental disorders generally have a life expectancy 10–20 years shorter than the general population.
According to WHO’s 2017 Mental Health Atlas, there is a global shortage of mental health workers. It is estimated that 1 in every 10 person needs mental health care, but the ratio of care provider to the population is far from ideal. In low-income countries, the ratio can go as low as 2:100,000.
So how can we provide mental health care more effectively, especially in areas where infrastructures to maintain such service are not necessarily in place?
1: Research
In our first week, we reviewed some research on mental health care service, existing applications, and conducted several interviews.
Literature Review
In a paper released in 2011, Kakuma et al reviewed mental health care services and initiatives in low-income areas such as Sri Lanka and post-tsunami Aceh, Indonesia. For each case, Kakuma gathered what worked and what did not, and eventually proposed strategies to improve delivery of mental health care service.
Here’s a distilled version of the strategies:
- Task-shifting approach: several tasks in the health care pipeline, such as detection and first-aid, can be relegated to non-specialists through short training.
- Community-based programs: volunteers can be recruited from the community and managed by the primary health care system. These volunteers should act as case managers, primarily concerned with referral and continuous treatment adherence.
Interviews
We interviewed a mental health care worker (pictured below), a mental health policy researcher, as well as a patient with mild depression.
Our key findings:
- Therapy and counseling, due to the high cost involved, has become a luxury.
- Due to the poor ratio of provider to patients, the process of getting help can be discouraging.
- There are other approaches to help mental health patients such as art-based therapy and mindfulness.
- To work as a professional mental health care provider, one needs to accumulate hours of practice. The more specialized the job is, the more hours need to be accumulated.
- There is a lot of paperwork involved. Especially for professionals, recordkeeping is crucial, the protocol is tedious, and it takes a significant amount of time for them to record and file properly.
Existing Products or Services
We decided to review three services in our initial research. The first two are meditation apps: Headspace and Calm. We want to understand how a mobile app can assist with personal efforts to maintain one’s mental health.
Both Headspace and Calm walk their users through a guided meditation. By comparing the two, we were able to pick out interesting similarities and differences in design:
- Regularity is the goal. Both apps facilitate user to build habits through easy scheduling and reminders.
- Specificity is key. Different settings call for different meditation experience. From sleep-inducing stories to calming methods for commuters, both apps offer a plethora of options.
- Visual and audio experience matters. Personally, all of us prefer Headspace over Calm. We find the color and animation both rewarding yet not-too-exciting, and the voiceover just perfect. However, we’re aware that preference is subjective — a lot of the comparisons in forums really boil down to personal preference.
Lastly, we looked for an application that uses emergent technology to improve the execution of governmental or non-profit programs. One such interesting case is Building Blocks, a blockchain-based system that delivers aid to refugees in Jordan.
For the refugees, the mode of operation is the same. They were given cash (or token in this case) that they could exchange for daily supplies. But behind-the-scenes, Building Blocks solve the following challenges of global aid delivery:
- Cost of transferring money. A signification portion of the aid usually goes to the cost of actually moving the money to the camps. Transferring with blockchain cuts the middleman fee.
- Lack of transparency and accountability. In conflict-ridden areas, logistical issues are inevitable. There are bound to be corruption, competing middleman, different accounting systems, etc. Blockchain puts all transactions on a ledger that can always be audited by donors or other involved parties.
2: Identifying Opportunities
After our research, we found several common themes in the existing landscape of mental health care systems. From these themes, we then identified opportunities where we can introduce improvements.
Centralized System -> Decentralization
Mental health care is heavily reliant on specialist workers. However, as Kakuma’s research showed, there are definitely processes in the pipeline that can be relegated from specialists to non-specialists. Tasks like detection, referral, first aid, and maintaining treatment adherence, through training, can be allocated to nurses, general practitioners, and even community volunteers.
Protocols -> System of Mutual Incentives
Specialists-in-training needs to accumulate practice hour, while patients need more access to help. WHO and the UN have a yearly budget for mental health care, and community members respond to monetary incentives. In theory, it is possible to design a system that mutually benefits the parties involved.
Conventional Inefficiencies -> Improvements via Tech & Design
Tedious paperwork, unstandardized workflow, ineffective leadership by government or organization, lack of transparency — the list goes on. These inefficiencies can be addressed by using technology that affords standardized workflow, reliability, and verifiability.
3: Our Proposal
We are proposing an app that facilitates the delivery of decentralized mental health care involving three parties: (1) managing organizations (e.g. government/non-profit/donors), (2) community volunteers (V) and specialists-in-training (SIT), (3) mental health patients.
We assume a setting where there is already a budget allocated for a mental health care program, and this app serves as the platform that the program runs on.
How does it work?
Care-provider: guided workflow, unlock incentives
SIT and V use this app to check-in with mental health patients. The app guides the SIT or V along, depending on the task required at the moment (e.g. treatment maintenance, first aid, detection). These tasks, are in turn verified by the patients.
After completion of care, SIT and V can unlock their incentives, be it monetary or clinical practice hours.
Patients: self-help tool, better access to a care-provider
Patients use this app to help them adhere to the treatment prescribed, as well as to report and make contact with non-specialist workers.
Management: verifiable and accountable work
For backers or central managing bodies, the app provides a verifiable record of interaction between the provider and the patient. The app also makes an external audit (if needed) more efficient.
What form will it take?
We are currently thinking of a combination of mobile and desktop apps running on a blockchain backend. However, there are still some questions we have that will affect the choice of medium:
- Is a mobile app most appropriate medium? Another possible medium is text-based interaction via SMS. We need to narrow down our target audience and see the mobile and internet penetration rate.
- Can conventional centralized system afford the verification and accountability that blockchain is known for? Blockchain is an emergent technology. Designing for a blockchain system means fewer references and more potential unforeseen challenges.
- Can we narrow down the scope? Designing a one-stop app is a mammoth task, and as found in our research, specificity is often key.
Prototype and Validation
Concept validation is an important first step. After narrowing down a target audience, we will need to validate the concept with professionals and patients already involved in a mental health care system or program. How will this idea sit or integrate with the existing system? What kind of resistance it will face? What are the crucial functions the app needs to have?
After concept validation, we are looking to build digital prototypes of this service. Interactive screens will be developed and will be used to test the functionality and usability of the platform.
