Designing for the vulnerable - Chapter Two - Livework

What does it take to design healthcare for vulnerable people? This Saturday, at the Service Design Fringe Festival, we’re hosting a joint event between Livework and Coloplast, where Jennifer Bagehorn and Lilith Hasbeck will each be bringing a different perspective to the table. In advance of the talk, the two of them have contributed to a three-part long read. This is the second of three blog posts. Start with Chapter One.

LIVEWORK’S PERSPECTIVE: A case study on understanding Londoner’s needs to design a 24h mental wellbeing service

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 billion is spent each year by health and social care on treatment, benefits, education and criminal justice. A further £10.4 billion is lost each year by London businesses 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.

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.

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.

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.

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. 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.

Read Chapter Three