Designing for emotional need
What we learnt by researching the experience of starting treatment in drug and alcohol services.
By Emma Parnell and Christina Herold
When you walk through the door of a drug and alcohol service you will likely experience all sorts of feelings in a short space of time. These feelings may fight with each other as the elation of finally getting help is mixed with the fear of not knowing what to expect. And for those coming back to services you might layer on feelings of shame and regret around relapse. It’s a really difficult step to take.
“I was scared to death. I didn’t know what to expect. I couldn’t stop crying but they were so understanding. That first day I kept asking myself “why am I here?” — Client quote
After spending time with three of our local services to really understand what happens when people walk through our doors, emotion is the thread that runs through everything we saw and heard. This is not surprising, because the services we deliver are deeply relationship and people based.
Being one of the UK’s leading drug and alcohol charities, we help a lot of people — over 100,000 a year. However, we are always thinking about how we can give our clients even better experiences.
We wrote earlier about how we already saw a strong need for reassurance while starting treatment. This research has allowed us to break that down to different emotional needs at different stages of the journey.
Help me feel comfortable
“I deserve to be made to feel uncomfortable.” — Client quote
This quote was the most poignant thing we heard during the research. We only heard it once but we felt it a lot. This is obviously not the intention of any of our great staff when they go to work every day. Low self esteem and feelings of shame are common amongst the people we help, which means that we have to work harder to reassure people that they most certainly deserve to feel comfortable.
The need for comfort when people first walk through our doors became increasingly apparent as we moved through the research, especially in those first few interactions. Making people feel safe and welcome with small gestures can really make a difference. We heard how someone couldn’t remember anything from their first few meetings with our service except for being given a drinks token for the coffee machine, a lovely small gesture offered in our Bournemouth service.
A waiting room is usually the first space people find themselves in when they enter our services. The time spent here can trigger high levels of anxiety as people feel intimidated around others, anxious about what’s to come and find themselves sitting in an unfamiliar place with too much time on their hands. Often people wonder why they are there and find themselves fighting the urge to leave.
So as we move into our next phase of work we’re asking ‘how might we help people feel comfortable whenever they walk through the door of our services?’ Given what we learnt during our research, this idea of making people feel at home when they spend time in our services feels important to us.
Building trusted relationships
When people currently enter drug and alcohol services, one of the first things we do is get to know them by asking a set of questions — this is known as an assessment. We had a hunch going into this work that we might want to rethink this assessment process. Our research has shown that what matters is less about making this a seamless process and more about trust and relationships — relationships that are critical to the early days of recovery.
We saw and heard how deeply people connected with recovery workers — something we learned is easier to establish when ‘professional barriers’ like paper or badges are not there. We heard very few people calling our organisation by its name — rather they referred to us by the name of their worker. When we dug into the nature of these relationships and looked at the wider context of building social connections, we saw that it’s the ability to give a bit of yourself to the person in front of you that’s important for building trust, whether that is through sharing lived experience or connecting over interests.
Our staff currently do a fantastic job at building those early connections but this can be difficult when they have to balance getting to know someone with collecting the data required to bring someone into treatment. Services are also currently measured on how long it takes to bring people in meaning these first conversations are also often quite rushed.
The assessment is pretty intrusive, we’re asking them about their sex life and we don’t even know them. — Staff quote
There is a real opportunity here to look at the way these questions are worded, what we ask when, and to take a much more positive approach, building on people’s strengths. When people first come to service they start a journey of building a new narrative about themselves without their substance use. By focusing on problems we are starting that narrative from a negative point of view.
How might we get to know people while building the foundations for a trusted relationship?
Maintaining momentum
Getting help is a big step, whether it’s the first time you’ve asked or not. However it’s just the first step and often coming back is just as challenging both emotionally and practically. There are also consequences to not coming back, both for people’s perception of their recovery but also practically in terms of the processes we have in place.
“If you miss an appointment it’s easy to give up. When I failed, I went straight back to my old lifestyle”. — Client quote
We saw how difficult it was for people to turn up on the right day, at the right time for the right person. Missing these crucial early appointments may mean waiting for another appointment or even getting discharged from the service.
Recovery workers are doing great work to remind people to come to service, usually through texting. But this is labour intensive and prone to human error. It also starts to seed a dependency between people that can become unhelpful further down the line.
And that time between appointments can also be challenging to get through as you might be super motivated to change, but not really sure where to start, or you’re feeling your motivation drop, and you’re not sure what to do about it to keep yourself on the right track. Maintaining momentum between appointments is critical to reducing people dropping out of treatment. While our services offer outreach where possible there are obviously limits to this from a resource perspective — which gives us a big opportunity to support people through digital means.
How might we build on people’s motivation and support them to make a strong start that’s right for them?
What next?
There is so much potential for service design and digital solutions to help people connect and improve people’s experience of starting treatment. We see the opportunities we have outlined around comfort, trusted relationships and maintaining momentum fitting at key points in the journey of starting treatment and we’re thinking of this as a journey.
Ultimately we’re aiming to reduce drop outs from adult structured treatment in the first four weeks to improve people’s chance of recovery. Next year we will prototype some early solutions to some of the questions we’ve posed while continuing to learn about the technical, cultural and policy contexts we are working within.
If anyone else out there is designing for emotion or working to balance relationship building with data collection we’d love to hear from you.
