Service Design At Scale: Digital Mental Wellbeing

Service Design At Scale: Digital Mental Wellbeing

Jennifer  Bagehorn
  • Jennifer Bagehorn
  • Service Designer

Livework was invited to speak about delivering service design at scale at the 2017 Service Design Global Conference. We shared a project we did in London about Mental Wellbeing.

Part 1: How did you sleep last night?

Do you ever have difficulty sleeping? Have you experienced anxiety, stress or low mood? If you answered yes to any of these questions, you are not alone. When we polled the audience at the conference, we were met with an ocean of hands.

In 2015, we received a brief from Public Health England which explained that here in London, a third of those surveyed report low happiness, with half describing themselves as anxious.

We also learned that most Londoners haven’t received clinical help for their difficult experiences. Some are stuck on long waiting lists, others are discouraged from seeking help due to social stigma and others are unaware that their experiences can be helped, or that help is out there.

In addition to the personal consequences, poor mental wellbeing is costly. In London, £7.5 bn is spent each year by health and social care on treatment, benefits, education and criminal justice. A further £10.4 bn is lost each year to London business and society.

We were given the challenge to design a service to address this unmet need, at scale. We began at the human scale, by designing for individuals. This service could then be scaled to reach the whole of London. The future vision is to scale the service to reach the entire UK.

Part 2: What do Londoners need?

Years of research and effort were already invested in addressing this challenge. This resulted in a business case, which argued that Londoners’ needs could be met by a combination of access to information and services, safe online spaces and peer to peer connection. There was a strong sense that these could all be delivered through a single centralised website. The stakeholders assumed that if they built this website, people would come and use it.

It was our job to question this assumption. Is that what Londoners need? In order to explore this, we went out and spoke with Londoners in their own homes.

'Christina', an avid reader, who seeks information and support independently

We met with Christina, who has suffered from insomnia and anxiety since a burglary at her home. She said, “I think lack of sleep will make you anxious, and that does make you depressed, and obviously because of the trauma of what happened, but I just tried to sail through it and I don’t think it has gone away.”

Christina was already seeking information and support in peer to peer forums like Netmums. She finds it useful to hear other people’s stories and to share her own. Christina is aware she has a problem and is willing to seek help. She’s the kind of person who’d be open to a centralised website about mental wellbeing. Christina is who the stakeholders thought they were designing for.


'Martin', who has not sought help to cope with stress at home and work

And then there was Martin. When we asked him about his experiences, he said: “I don’t really know what causes it, but I know I sweat profusely when I sleep at night. I don’t know why, but it wakes me up.” And then he said, “Other than that, I don’t know what else to say to you.”

Later in the conversation, we eventually asked something like, “so how long have you been living here?” He explained, “I got my own house, that I own.…but I’m not living in it since I split with my wife. I get to see my child every weekend…I used to love going home, helping her with her homework….I’m back living in the room that I grew up in….It’s not ideal, is it? That could be a contributing factor, I don’t know.”

Then we asked him what he did for a living. Martin works on a team that digs ditches for the sewer system. They crawl forward on their hands and knees, and with each inch they progress, Martin needs to extend the support structures. Otherwise, the tunnel can collapse. Martin remembers the panic of past collapses and finds it stressful to be responsible for everyone’s safety. Maybe this was a reason he couldn’t sleep.

We asked Martin if he ever spoke with anyone about his stress or sleeplessness. He hasn’t. A bad childhood experience put him off doctors of any kind.

Martin would never knowingly go to a government healthcare website about mental wellbeing. Speaking with people like him, we learned that the real challenge is in reaching those who are unaware and disengaged.

We realised it is not enough to make a centralised website. We need to take a different approach to imagining service experiences. We need to meet Londoners where they are. In Martin’s case, this means meeting him where he is in his journey, in his ability to identify and express his experiences. Secondly, it means bringing relevant information and services into the digital spaces he visits, so he’ll find help whether he goes looking for it deliberately or not.

Part 3: How can we deliver this?

Now that we had some insight into what users need, we asked: how can we deliver this?

A still from an animation that made to explain how the NHS is structured. Watch the full video:

The NHS has many strengths and challenges. Its scale gives it capacity, but also makes it slow to change. Its departments give it specialisation, but often create closed silos. Its processes promote quality, but can also create barriers to accessing services. Its professionals animate this infrastructure and provide the humanising force within the health system, but they struggle due to limited time and resources. As we learned, the current system is not reaching many of those in need.

A social media campaign designed to encourage conversation about mental wellbeing

Social media also has both strengths and challenges.

It’s quick to change but difficult to control. Information moves easily between open channels, but its quality is hard to assess. Access is immediate, but it’s also easy to quit. The vast network of digital citizens often has the time to interact, but their contributions are not necessarily healthy and can be dehumanising. As we know, social media has the attention of millions of Londoners.

We’re arguing that the strengths and challenges of the NHS and social media complement each other and can be combined to better meet Londoners’ needs. In short: integrate, don’t duplicate. This works on two levels. Firstly, Londoners already use Facebook, Whatsapp and sites like Netmums, to connect with peers and share information. Don’t duplicate channels. Secondly, mental health charities and local organisations already provide quality information and services. Don’t duplicate effort.

These insights led us to develop a vision for the future, a world in which mental wellbeing services are distributed into the environments where people already are.

We brought this vision to life with visual design, using Martin’s story as a starting point. We shared this vision of a distributed service, which challenged the initial assumption of a single centralised website. Our client accepted the challenge and made a video to explain the service to their stakeholders.

The video uses Martin's story to illustrate how the service reaches Londoners who might not actively seek help Watch video
The video uses Martin's story to illustrate how the service reaches Londoners who might not actively seek help

So, what impact can this have?

Remember, the systemic cost of poor mental wellbeing is immense and far-reaching. By meeting Londoners where they are and integrating delivery, we can reduce the cost on the system, whilst still reaching those that might not seek out help on their own.

It’s not easy to know what will help us. Some people benefit from meditation. Others exercise, try sleep apps or share their experiences in cafes or online forums. And of course, some people visit their GP and get referred for therapy. The key is connecting with information and services that work for you. The aim of this service is to facilitate that connection.

To test our hypothesis, the team conducted a small study. We wanted to learn more about engaging people online, so the project team created sleep-related ads, placing them on Google, Facebook and Twitter.

More than thirty-five-hundred people clicked on these, indicating that social media is an effective channel for reaching Londoners experiencing mental wellbeing challenges.

This is the first step towards using social media to scale the service, to connect Londoners with the information and services that can help them cope.

Part 4: But what about today?

As excited as we are for the development of this service, it will take time to be fully implemented.

So, for all of you currently experiencing stress, anxiety, low mood, and sleeplessness: what steps can you take today? You can connect with someone like you: find a forum or a local meetup. You can seek out information: connect with mental health charities or national health platforms. Or you can try a new service: download a meditation app or go on a retreat.

We also recognise that there are many degrees of mental wellbeing challenges. What some of you are experiencing might go far beyond what we have described here. If you feel you’re in a situation that is unsustainable, please reach out to someone. This could be your GP or a friend or family member. You can also call the Samaritans for free, for any reason, on 116 123.