5 Ways Design Can Help Fix the Broken Mental Healthcare System
From jails to psychiatric hospitals, some lessons learned by an IDEO team
In the summer of 2011 I tearfully woke up my husband at 3am. I was up for the fifth night in a row and I couldn’t imagine feeling the way I did any longer. I told him I was in trouble.
This bout of depression came right after I gave birth to my son. Something felt wrong right after he was born but I ignored my feelings. I hung in there for a while then, ironically, insomnia began right when my son started sleeping through the night. The post-baby hormones brought a tidal wave of anxiety that I couldn’t get out from under. I felt trapped and filled with dread and shame.
We found help through a mom’s line that was affiliated with North Shore Hospital in Evanston, and I eventually formed a relationship with a woman named Suzanne. Suzanne talked me through some pretty rough moments. She helped me find a therapist and psychiatrist and guided me in overcoming obstacles that anyone in the throes of depression is unable to deal with.
My depression was terrible, but in retrospect I’m one of the lucky ones. I work for a company that offers paid maternity leave and great benefits.
I met Chantelle in Miami through an IDEO project looking to design better outcomes in mental health. She came to Miami looking to start her life over. Penniless and off her medication for bi-polar disorder, she quickly found herself living on the streets. One night, exhausted, hungry and scared, she took off her shirt and screamed at the top of her lungs down the center of a Miami boulevard. As disturbing as this sounds, unfortunately Chantelle knew this was her only option. Jail meant food and a bed. Sure enough, Chantelle was arrested, but besides securing dinner and shelter, she landed herself in a worse spot — the 9th floor of Miami-Dade County Jail.
Chantelle isn’t alone. In 2013, nearly 1 in 5 adults aged 18 or older (18.5 percent) had a mental illness and 4.2 percent had a severe and persistent mental illness (SPMI). Mental health centers that serve the most serious cases are closing across the U.S. and jails have become the new psychiatric wards where a large portion of the population have mental illness. Jails aren’t equipped to handle this population, and all too often, inmates with mental illness are abused (physically and, particularly among women, sexually), neglected, and released back out into the community without medication, support, or housing.
Throughout the project, we consistently met amazing, dedicated professionals tackling this problem with limited resources: Miami’s Jail Diversion Program, which moves non-violent mentally ill inmates to treatment; social workers doing bi-weekly home visits with patients at high risk for hospitalization or suicide; police officers trained to deal with mental illness when they receive calls of people in crisis. All of these people are doing vital work.
Design can play an important role.
5 Ways Design Can Make a Difference
1. Create interiors that rehabilitate, not repress
On our tours of the mental health sections of jails, the overcrowding and dearth of color could damage the heartiest of psyches.
As well as jail, we toured many hospital psychiatric units and crisis centers. The facilities haven’t been updated for fifty years and are designed mostly for suicide-prevention, which strips them of nature and humanity. The walls are beige, the lighting is fluorescent, and the floors are cold. We witnessed patients shivering under their gowns as they waited for a chance to talk to a doctor or social worker. We shouldn’t design something so lavish that people want to return, but the environment should be healing enough so that patients aren’t made more unstable.
Hurricane Irene destroyed the Vermont State hospital which had served the state’s most acute mentally ill patients, and its 19th century design no longer fit with today’s modern care models. Frank Pitts, of Troy, N.Y.-based architecture+ took the opportunity to spearhead the design of the new Vermont Psychiatric Care Hospital that took into account all the failures of the last century.
2. Design a discharge that doesn’t set people up for failure
Imagine checking out of a hotel and being told all of your belongings including your wallet have been lost. All you walk out with is your hotel bathrobe. We followed a man who astonishingly walked out of the hospital in his blue gown, hospital socks and flip flops because his clothing had been misplaced. We heard stories of people leaving jail at 2am with no place to sleep that night, and often without formal identification which leaves them unable to secure housing, an apartment or a job. The lack of dignity these folks feel sends them quickly in the wrong direction.
Another big hurdle after discharge is the transition from institution back into the community, with no support to ease back into “real life.” People often leave unstable and without the support or the stability of a routine. Linkage is also broken meaning people are left to their own devices to find their way back to care in their community. If we design better ways to give people structure post discharge and link them to care, the revolving door in and out of jails and hospitals could slow down.
Northshore Hospital in Evanston is one of a number of hospitals screening mothers for postpartum depression before discharge and if necessary, offers varying levels of treatment post-release. A small study run at the University of Calgary suggests that a pre-screen discharge along with intermittent follow-on phone counseling for those in need is effective. Not only for new mothers, but potentially as a widespread public health intervention.
3. Give field workers the tools they deserve
It’s 2015, but many social workers in the U.S. use pen and paper to track clients’ wellness and travel back to the office to re-enter information into systems that offer them no insight on the individuals they are treating. We witnessed homeless outreach workers carrying around heavy laptops to fill out forms the state requires of them. They are required to capture information like “is the individual on drugs”, which isn’t helping anyone because if they answer “yes” the person isn’t able to be housed (which is the goal of their program).
States and research institutions would gather more accurate and meaningful information and care would be improved if outreach workers had mobile applications and tools that worked in the field and a voice on what wellness indicators are worth collecting.
Medic Mobile is developing mobile applications for healthcare workers in the 3rd world that address patient needs in hard-to-reach areas. The software not only works on smart devices but is developed in “parallel sim” so complex apps can run on inexpensive features phones.
4. Design kindness and care into the system
Augustine is a cab driver who works for Miami’s Jail Diversion program. He drives members of this program to court or to assisted living facilities. Many who suffer from serious mental illness push away their families and friends which leaves them without support or guidance. We observed that his simple “how are you?” had enough power to send troubled individuals in the right direction.
The traditional model of relying solely on the limited capacity of community centers, therapists, or psychologists for treatment is not enough. There aren’t enough resources, and the resources that are available require two buses and a train to get to. Trained consumers in the neighborhood (known as Peer Specialists), caregivers, and others are underutilized resources who have the ability to make a difference.
Guilietta Carelli is the owner of The Trouble Coffee and Coconut Club, who has found a novel way to connect herself to her community and have the community be part of her mental health. “More than a café, the shop is a carpentered-together, ingenious mechanism — a specialized tool — designed to keep Carrelli tethered to herself.
5. Design for the public sector — it’s the last frontier
Good design has proven it’s worth to the private sector but it has yet to impact the public sector. Hotels.com allows real-time booking of hotel rooms across the world, so why can’t people in crisis like Chantelle easily find a hospital bed? Retail chains expertly market to us after checkout, so why don’t we harness what works for marketers and connect to people after hospital discharge? Foursquare allows us to tag our favorite restaurant, so why can’t our homeless outreach workers tag where they last saw a homeless client? We are skilled at designing disruptive products, spaces and services in banking, retail, hospitality — it’s about time to disrupt the mental health system.
At IDEO we arrive at design opportunities by deeply observing the problems that get in peoples’ way. Shame and stigma affected my ability to ask for help during my post-partum depression. Depression, anxiety and addiction continue to be a taboo subject at our workplaces, schools and homes. It’s about time we started talking so we can design better outcomes.
Conversations between the public and the justice system have started in Miami-Dade. The jail finally shuttered the doors to its infamous 9th floor mental health unit where Chantelle once stayed. They’re opening a new “one-stop shop” building that will include a crisis unit for unstable and non-violent offenders, short-term housing, a courtroom and therapeutic classes. It’s hopefully one opportunity of many to re-design, step-by-step, what mental healthcare should be in the United States.
Patient names have been changed to protect their identities
