Applying Design Approaches to Advance Recovery-Oriented Mental Health Policy

Warwick, Laura (2019) Applying Design Approaches to Advance Recovery-Oriented Mental Health Policy. In: Fourteenth Workshop on Costs and Assessment in Psychiatry: The Value of Mental Health Services, 29th - 31st March 2019, Venice, Italy.

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Abstract

Background: Designing policy for mental healthcare transformation is attracting a wide interest in both design and health research, where service design and co-design are recognized as valuable approaches for addressing complex policy challenges. These challenges include fostering person-centred care with often misaligned mandates across the health and social services necessary for a recovery orientation. Integral to service design and co-design are the involvement of service users or people with mental health concerns. Service user involvement in mental health services has at least five decades of history, with service user movements developing in opposition to the biomedical model and psychiatric institutions. While service design and co-design initiatives to transform mental healthcare are promising, they are also controversial as they can challenge ideological paradigms, traditional treatment approaches and professional hierarchies. Mental health services can be a site of contestation and designing for transformation in this space must account for these complex dynamics.

Aims of Study: The aims of this paper are to: disentangle the contentious issues of designing for mental healthcare transformation; explore how collaborative design approaches can be facilitated; and highlight key considerations for addressing these issues in research and practice in complex mental health systems.

Methods: This article brings together an interdisciplinary team of researchers investigating and applying service and participatory design approaches to encourage paradigmatic changes in the ways that people with mental health concerns are perceived and supported. Collectively, our experience touches on converging areas of study, such as therapeutic engagement, peer support, co-production and recovery within mental healthcare systems and policy across 10 projects in Italy, United Kingdom, Canada and Sweden. We employed a case study approach that enabled an in-depth exploration of the multifaceted issues faced when developing and delivering co-design initiatives in various mental healthcare settings. To facilitate cross-case reflection, emerging issues and insights from each of the cases were detailed. Then, by finding patterns across these cases, themes were established related to contentious issues and key strategies to address them in light of concepts from complexity theory.

Results: A number of contentious issues were identified when it comes to applying design approaches to mental health policy. Each issue was clustered within large themes that include culture clashes (e.g. social vs. medical approach); power dynamics (e.g. defensiveness of traditional hierarchies); ensuring meaningful participation (e.g. authentic vs. tokenistic engagement); organizational constraints (e.g. operations vs. project time); and adopting a systems approach (e.g. working within and outside the health system) and analyzed using that align with concepts from complexity theory. Design strategies to address each issue are presented.

Implications for Healthcare Provision: Design approaches can foster dialogue to deliver recovery-oriented services that better meet the individualized needs of people with mental illness.

Implications for Health Policy: Strategies are presented to overcome contentious issues in the mental health context that may otherwise impede mental health system transformation toward recovery-oriented policy and planning.

Implications for Future Research: Fostering greater interdisciplinarity in research to advance mental health policy opens up the potential for new strategies to address long-standing challenges. The issues and strategies identified are a basis for an international research program in mental health policy and design.

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