CASE
Redesigning Psychiatry
Redesigning Psychiatry aims to innovate together for the mental well-being of future generations. By innovating from meaning, they jointly initiate the movement towards a reliable, accessible and flexible mental health network.
KEMs
INVOLVED
Redesigning Society Foundation, Reframing Studio, TU Delft, VU Amsterdam, Altrecht, Dimence, Espria/GGZ Drenthe, GGZ Eindhoven, GGZ North Holland North, GGZ East Brabant, Karakter, National Platform GGZ, Kwintes, Lister, MIND, Mondriaan, De Opvoedpoli and Parnassia Group
THEME
Health & Care
'What we want is to redesign mental health care.'
Designers Femke de Boer and Lotte Jacobse of Reframing Studio are working with researchers, philosophers, healthcare professionals and experts by experience on a new mental health care in 2030 – with a new vision of mental well-being in which mental suffering is no longer seen as an individual problem, but as an interaction problem. It is the complex interactions within people, between people and between people and their environment that cause people to get stuck. In these interactions, patterns can arise that perpetuate the problems.
How do you get such a huge system moving, and how do you then set it up? And which KEM(s) did you use? Redesigning Psychiatry, as the mega project is called, in addition?
'Everyone felt that things had to change, but no one knew exactly how.'
The second publication of Redesigning Psychiatry
“We have discovered that language is incredibly important in bringing about change.”
Workshops with managers, healthcare professionals and experts by experience from mental health care
Workshops with managers, healthcare professionals and experts by experience from mental health care
The social challenge
Femke de Boer of Reframing Studio, which specializes in 'reframing' and redesigning larger or smaller systems: 'Ten years ago we created an app on behalf of the mental health institution Parnassia Groep for people who hear voices. The app Taming voice consisted of language games, which distracted the part of the brain that caused the voices; and it worked. That – that relatively simple, innovative way of thinking – was so interesting to the mental health services that they wanted to apply it to the entire system.'
Lotte Jacobse: 'That's how we started eight years ago with the question: suppose we were allowed to completely redesign the GGZ (abbreviation for Mental Health Care), what could it look like? And how do we view mental health care in general, and its role in society? The emphasis was on the future, not so much on the problems with waiting lists and other challenges in current care. Everyone felt that things had to change, but no one knew exactly how. What we wanted to do was investigate how things could also be different if we were to redesign the GGZ.
The fact that we subsequently entered into this with a consortium of 11 mental health institutions without a very clear problem definition – it was also not easy to obtain a subsidy – is quite courageous of these organizations. They really surrendered to the design process.'
Pioneering
De Boer: 'The first thing that had to be developed was an umbrella vision. We had never done this at this level before, so it was quite pioneering. Together with design researcher Nynke Tromp from TU Delft, we formulated two central questions: what will the world look like in 2030? We conducted research for this and interviewed all kinds of experts. How will people live, work, and live in 2030, and what might cause them to get stuck?
And: what is a mental problem in essence? That also differs with time, in the Middle Ages for example it was seen as a punishment from God. And until recently it was mainly seen as an individual problem. We look at it with a different lens: we see it as the result of complex interactions with- and inside yourself, others, your environment and the system, society as it is organised – in which someone gets stuck.'
Language is crucial
Jacobse: 'Then the question was: how do we get the entire (care) system moving? We do that in all sorts of ways. Literally: by creating movement with workshops, summer schools and other forms in which we actively bring people together and stimulate exchange (see also participation & co-creationBy means of design research, with which we Redesigning Psychiatry continuously refine and further develop ideas...'
De Boer: ''And through design projects with which we work on innovations in practice. Such as Mental Gymnastics, in which we investigate with schools how we can increase the resilience of (systems around) children, and Mentaal Lokaal, which is aimed at keeping people mentally fit - just as it is important for people to stay physically fit.
We have discovered that language is incredibly important to bring about change. That is a side effect, but it is crucial. Yes, we are not only reshaping mental health care, but also the language used in mental health care. For example, we no longer talk about a disorder, but about getting stuck; that is more neutral and does not place the problem solely on the individual.
These activities, research, innovations and different language use are all steps that should lead to us achieving our goals for future mental health care: breaking patterns, developing capabilities and transitions in a human life support. With the 'higher' goal of a reliable, accessible and flexible mental health network.'
Workshops with managers, healthcare professionals and experts by experience from mental health care
'For us, innovation means creating new meaningful products, services or policies.'
The KEMs
Designing for the future
The overarching method (or KEM) underlying the mega transition is Vision in Design (ViP, Hekkert & Van Dijk, 2011; see also vision & imagination), which has two core principles: something is designed for the future; the domain – in this case mental health care and society – must be researched to understand the future context and the desired future image must be defined. And: behavior, or the human, is central; it is about designing for meaning.
The model, which has the shape of an inverted U, starts at the bottom left at product level with the old product and in this case the question: what is the current situation in mental health care? At the interaction level above, it is about the question: how is the current mental health care experienced by people? And finally, at the context level: why was this product (the mental health care) ever designed and does it still fit in today's world?
Then the model bends to the right (and downwards) and looks to the future. At the context level: what does the future world look like? At the interaction level: how should people experience future mental health care given the values we consider important? And at the product level: what would future mental health care look like?
Three design levels of the ViP model. Source: Vision in Design, Hekkert & van Dijk.
New meaning
Jacobse explains: 'In classical product design, an old product no longer suffices and you create a new, better product. But it is a shame not to explore the past and future context (the why) and interaction (the how) of the product, because then you do not properly understand its actual function in the bigger picture. It can also happen that a new product is not that much different from the old one, but then it has been proven that something is future-proof. For us, innovation means creating new meaningful products, services or policies. That does not necessarily have to lead to everything existing being scrapped, we want to understand what will remain meaningful in the future. This method is the common thread in all subprojects and interventions that we develop.'
De Boer: 'Because we applied Vision in Design (ViP) at such a high system level and for that reason we also needed a normative view of man, we also involved philosophers such as Sander Voerman. The normative framework makes explicit how we look at people and the world and what we find important in that. The individual values that we use as a guideline in everything are: development, dignity and relaxation. And as social values: diversity, inclusivity and compassion (see also value creation & scaling).
By the way, we are now in the phase that we are shaping the transition to 2030, and we will increasingly also need methods (KEMs) from transition studies.'
Stand at the Dutch Design Week
"It's been a very inclusive process so far. That's also a strength of design, to create accessibility."
Prototype of Mental Guidance, Mental Local Wassenaar project
The result
Not in survival mode
The idea of working with KEMs by the creative industry, such as ViP, is that it accelerates innovation. Has that been successful so far? Jacobse points to the classic design model and argues that ViP is much more future-oriented. 'So yes. From the start, Redesigning Psychiatry has not been reactive, but focused on a desirable future. Designers are good at that too, but we have also succeeded in getting others to join in.'
De Boer agrees: 'It has been a very inclusive process so far. That is also a strength of design, to create accessibility. In addition, the discovery of language as a design tool to bring about change has also absolutely contributed to a faster transition.'
Jacobse finally: 'When you design for the 'now', everyone is often busy with their own interests, existing agendas and perspectives. With Redesigning Psychiatry we work on a desired vision of the future, which has a very connecting effect. We temporarily take people out of survival mode, so that they can think freely about how things could be different. It would be great if we could organize the new mental health care in such a way that thinking about the future and innovation based on the meaning for people remain a structural part of the system. To prevent the system from getting stuck again.'
Want to know more about this project?
Visit the website here.
Written by: Nils Adriaans