PROJECT 99: CO-DESIGN OUTCOMES THE IDEAS DEVELOPED BY A CORE TEAM OF YOUNG PEOPLE DURING TWO CO-DESIGN SESSIONS.
SNOOK
OUR APPROACH TO SHARING THE PROJECT 99 REPORT MATERIALS: Open Access, Some Rights Reserved The outputs of the Project 99 exploration of internet-based approaches to support youth mental health have emerged through a coproduction approach, involving Greater Glasgow and Clyde NHS (GGCNHS) as commissioning body, a three agency consortium (consisting of Mental Health Foundation, Snook and Young Scot) and young people, all supported by a multi-agency steering group. In turn, this project is an agreed action within the Board’s Strategic Framework for Child and Youth Mental Health Improvement, ratified by the Child and Maternal Health Strategy Group in June 2012.
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You are welcome to ask for permission to use this work for purposes other than those covered by the creative commons license. GGCNHS gratefully acknowledges the work of Creative Commons in inspiring our approach to copyright for this report. To find out more go to www. creativecommons.org Potential for Future Development and Collaboration GGCNHS and its local community planning partners will now be actively considering all the material and recommendations contained in this work with a view to formulating a response and a forward development programme, as part of the wider body of work to improve child and youth mental health in Greater Glasgow and Clyde. In recognising the emerging nature of this agenda, the Health Board would welcome dialogue with partners and potential partners who may be interested in collaborating in aspects of this work, and in discussion with agencies who may already be engaged in similar work, with a view to sharing good practice. For further discussions please contact us via the wegot99.com contact form.
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CO-DESIGN SESSIONS OUTLINE The young people were encouraged in free and imaginative idea generation through games, sketching and visual brainstorming techniques. An entire wall of vibrant ideas was created. The young people were then asked to categorise their ideas into: Intitial Ideas These were interesting thoughts and could make up fragments of potential services. Specific Service Ideas These comprise the ideas that could be worked up as entire services in their own right. We then present two ideas that the young people chose to develop and think about further: ‘Button Wall’ and ‘Support2’. These are by no means finished designs, but provide stimulation for discussion and insights. Youth guide Finally, the young people created advice for other young people on mental health considerations in relation to digital media, and an innovative format to present this.
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4.1 THE YOUNG PEOPLE’S IDEAS: INITIAL IDEAS Below are catergorised the initial ideas that the young people put forward as means for helping develop services. They could provide inspiration for a visual identity, mood, function or touchpoint for services. They are written in the young people’s own words. Advice sharing: ‘Share ways for coping in different ways; the feeling – use ice instead, use a pen – draw it on/scribble on paper, tear paper, hit a pillow.’ ‘Share tips and tricks of how to cope with mental illness from people with experience’ ‘Give advice on reacting well to difficult situations.’ Ideas to help externalise negative thoughts then to attempt to move on from them positively: ‘You could write you problems in bubbles then pop them away.’ ‘Write your thoughts on a paper plane and throw it off a hill.’ ‘Put all your negative thoughts and
your anger into a drawing of a stickperson and then you choose how to destroy it.’ ‘Tell it to the man on the moon!’ Thoughts on externalising problems: Have a confession box: anonymity options allow people the security of letting out their secrets. Helpline – you could sign-up, and it would help you solve problems and work through problems. Meet ups and Events: Have mental health group trips – to share feelings and talk honestly together about your flaws. Have a mental health cruise (to Gartnaval - suggested as a joke!). The event would be called ‘We’re all in the same boat’: to show that you’re not alone and to make friends. Events in a butterfly sanctuary! Hold a mental health treasure hunt across the city.
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4.1 THE YOUNG PEOPLE’S IDEAS: INITIAL IDEAS Aesthetics and approach for new services:
cuteness, butterflies, just generally nice things to look at.’
‘The film Scott Pilgrim is great to think about for style; it is all about someone’s mental health, but it is told in a really awesome and stylish way. It is funny and it looks good.’
‘Have a jar full of good thoughts/ things that happen.’
‘Mental health shouldn’t be dramatised in a really serious way.’ ‘Cats can be used as they naturally make people happy!’ ‘Have a contrast of styles – Spongebob Squarepants is an example, it is fun and deep. ‘People should be shown what you should do to help yourself, rather than what you shouldn’t.’ Ways to support wellbeing and recovery: ‘Have a list Short/long-term do’s and don’ts. Practical and emotional things.’
‘Write a letter to your future self.’ ‘Pets for everyone! Looking after something else is really good for you.’ Gaming: ‘Games for guys – they could shoot their problems!’ ‘Digital pet, where looking after it teaches you how to look after your own mental health.’ Campaigns: Have videos where celebs and fictional characters give messages of hope and positivity.
‘Have a recovery tracker.’
Have a campaign that lets guys know that it is a sign of strength to express your thoughts: ‘ Be a MAN and share your thoughts’
‘Send people small things - like motivational cats - to brighten up someone’s day; animals – cats,
Find positive symbols of freedom & recovery, such as the butterflies associated with The Butterfly Project”
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4.1 THE YOUNG PEOPLE’S IDEAS: INITIAL IDEAS Emotional release: ‘You could shout horrible things through a megaphone and a only nice things would come out.’ You could have an anger translation service. You would say all the angry things you want to say to someone, then they would be translated into calm polite phrases. There would be a really polite cat butler saying them and he would be dressed in a suit.’
‘We need specialist mental health teachers.’ ‘We should learn about young people with videos, worksheets, role play.’ ‘You could educate through drama workshops – where you put yourselves in someone elses shoes.’
Ideas about education: ‘We need better understanding of mental health: talk about how it can affect everyone.’ ‘Better training on mental health in schools: have a lived experience training expert.’ ‘Regular and really good mental health education in school: better training for teachers.’ ‘People must be educated better in school to understand and break stigma.’ ‘It’s about educating the younger generations.’
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4.1 THE YOUNG PEOPLE’S IDEAS: SPECIFIC SERVICE IDEAS Ideas that the young people felt could be best worked into services included: Youth Are Not Alone ‘A Safe online community for all mentally ill young people to talk and share stories and tips.’ Flow ‘A planning app where you write down what you want to achieve and it reminds you. It checks later in the day if you’ve done it, if not it makes you feel ok about it.’ Button Wall ‘A wall of badges (clickable) with fun pictures, messages and tips and other helpful things.’ Cope ‘Sending you own coping mechanism for others to use’ Support2 ‘A service specifically for those supporting people affected by mental health.’
???!!! ‘Post/submit serious statements relating to mental health then someone makes a funny cartoon about it (maybe a comic/ have reoccurring characters)’ Anger Translator ‘A website where you can go when you feel angry/frustrated; you can write down and it will tell you something you can say instead that won’t cause problems/a fight. Helps you get the anger out.’ Thoughts & Crosses ‘Public post-it note like wall of thoughts. You write out your thoughts and cross out negative thoughts … then write a positive thought in return.’
The young people selected ‘Button Wall’ and ‘Support2’ for further development, as explained in the following pages.
Postcards ‘Other people’s stories and feelings in postcard form.’
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4.2 DEVELOPING IDEAS: BUTTON WALL As the young people developed button wall, the initial idea for a badge-based aesthetic was left behind and the core of the concept was expanded upon. Users would be able to search through and compile their own themed ‘streams’ of information. These streams would contain tagged images, videos, music, quotes and helpful tips and advice. Rather than these streams being displayed in a linear, chronological format as is common on social media sites, the content would be represented by a series of connected points. Each point would contain one easily shared and digested piece of content. These points would interconnect with similar content in other streams, allowing the user to consume information in interesting and thoughtful ways, and to see connections between themes and other users. When the site launched, it would contain official information and advice streams. There would be a wide variety of streams. Examples could include:“Positive coping mechanisms” / “What it is like to suffer from Depression” / “Positive
change theme
YEAH, CATS!
BUTTON
wall
by jamie
search:
‘inspirational Images’
by jenny b
inspiration, cats
#inspiration #cat #comeon
Keep on keepin’ on! Even grumpy cat is cheering you! ADD TO MY STREAM
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4.2 DEVELOPING IDEAS: BUTTON WALL steps to good mental health� / Antibullying inspiration� amongst many others. All visitors would be able to flick through these streams or search for one specific piece of content using a search bar. If they decided to join up and use the service more actively, users would be able to create their own information streams. They could add content they enjoyed from the official streams to their own, or add their own uploaded content. Users streams would be held on a home page and kept private by default. However, they could also choose to share the streams with friends using the site, provided that they were able to give the email addresses of these friends. If the user wanted to make a particular stream public, it would have to be sent to a moderator first, as would any information added. No direct communication would be permitted between users to enable safeguarding, but you would be able to see if content in your own stream appeared in other streams.
change theme
BUTTON
wall
search: MY STREAMS Inspiration Coping mechanisms My moods Cute animals!
PUBLIC PUBLIC PRIVATE SHARED WITH ...
NEW STREAM ADD TO STREAM DELETE STREAM
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4.2 DEVELOPING IDEAS: BUTTON WALL A connection link would be made between streams when content was added from one to another. The poster of the content could tag it and leave a comment, but others would not be able to comment back.
change theme
BUTTON
wall
Useful template streams could be in place for users to add to. These could include templates for mood trackers. Users could set attractive themes and backgrounds for the visible appearance of their account. The young people were very keen that the site (and app version) be beautiful and poetic, to encourage positive use of it. It was to have a clear central mission statement an ethos.
search: MY STREAMS Inspiration Coping mechanisms My moods Cute animals!
PUBLIC PUBLIC PRIVATE SHARED WITH ...
#cute #seal #hope
Feel good!
NEW STREAM ADD TO STREAM DELETE STREAM
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4.2 DEVELOPING IDEAS: SUPPORT2 Support2 was imagined as a platform site with a selection of tools available. Central to the idea is the framing of the site; it should be aimed at young people who are concerned for, or actively supporting, someone with a mental health problem. The site would involve a wider media campaign encouraging young people to look out for each others wellbeing. The side would include: A story sharing section Young people could share their own stories and concerns and read stories of others. This cold be done through plain text for longer stories, or they could choose to use the visual tool for short ‘confessions’ and advice. This tool allows them to choose an image from a user generated, but moderated, bank as a background, and add text in a font of their choice. Forums These would be themed and allow young people to discuss their concerns with other users and experts. Experts would have designated time slots where they
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4.2 DEVELOPING IDEAS: SUPPORT2 would answer questions in real time, but also play the role of the administrator. Negative comments would be able to be blocked and reported. Users would have to set their own trigger filters in order to begin using the forums. Messaging The young people we keen on being able to send each other messages and have chats through the site. They understood that this could be risky and came up with the idea of setting conversation parameters. These would be displayed on the young persons profile, and they would be sent programmed reminders to check that they were sticking to these.
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4.3 SESSION OUTCOME: YOUTH GUIDE In the final co-design sessions, the young people came up with advice they would like to give other young people. The advice aimed to help young people use digital and social media in a manner that would support mental wellbeing and was grouped into 5 categories: 1. Looking out for your friends. 2. Combating cyberbullying. 3. Social media addiction. 4. Expressing emotions honestly and appropriately. 5. Avoiding negative content. Together with the young people, we then created a digital format for the advice that would allow it to be accessed and shared easily online by young people. An attractive, humerous animated .gif was created for each advice category. These act as advertising for the site and Facebook page that host the young people’s advice. Animated .gifs are frequently shared by young people on social media sites and would allow for rapid peer dissemination. The advice was presented as a series of attractive graphic ‘postcards’ that can be shared individually via social media, but also stored together in an album.
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4.4 INSIGHTS ARISING FROM CO-DESIGN SESSIONS As a result of these sessions and ideas and a follow-up co-design session carried out with project team members from the NHS, we are able to draw some key insights to reflect the kinds of services that may aid young people: An imaginative, multimedia ‘moodtracker’ / tool for expressing and understanding mood and emotions There is a clear need for a ‘moodtracker’ type tool that goes beyond recording emotions and states of mind in numerical or ‘sliding scale’ form. For the young people we worked with, the subtlety of emotions was far better expressed and realised through images, animations and video clips, music, quotes from literature and poetry, and stories. An effective tool would ask young users to select and store such content in order to express their emotional state as richly as possible, but also prompt them to reflect on what they had chosen and to work out why they had done so. Such a tool has great potential for linking with services provided
by GPs, counsellors and CAMHS teams. In this case - particularly in regards to the tight timeframe GP appointments are governed by - it would be important that such a tool would prompt young users prior to an appointment to filter through and select the content they feel will be most useful to express their state of mind, and to work out how they could explain this to someone else. In lengthier counselling sessions, it may be feasible and advantageous to work through more of the content in greater detail. Online communities Online communities centred on mental health issues exist in abundance and thanks to the anonymity and solidarity they offer, vulnerable young people are often able to discuss and find support for issues that they otherwise might not offline. However, unmonitored communities can negatively affect young person’s wellbeing. Proanorexia and pro-self-harm online groups, for example, do exist. That is not to say that some online communities aren’t able to selfmanage very well, but there is a real need (and desire amongst some
of the young people we worked with) for properly controlled and monitored forum environments, that allow young people to share advice, stories and support amongst themselves, but also to receive expert input and guidance. Forum discussions could be monitored by professionals, who would offer official advice on the forum topic and respond to individual comments. They would essentially act as discussion invigilators, looking out for both the general mood of the discussions and for the wellbeing of the individual contributors. They would have the power to hide inappropriate comments and to contact any users they become concerned about through means of a private message. They would also be contactable for any users that become distressed or uncomfortable with comments made in the forum. Such professional involvement could prove costly, so again, the effectiveness of such a service would depend on the correct managing of users’ expectations of the level of professional involvement, but also on fostering a positive forum environment that
promotes self-regulation. There could, for example, be allotted times at which users can ask questions directly to a mental health professional; at all other times their involvement would be far more ‘hands-off’, perhaps only acting only if alerted to something by forum members. Forum themes should be framed in a positive manner and clear parameters set for the expected behaviour of users. Each user could be asked to set trigger warnings and appropriate trigger filters would need to be in place. Users would be encouraged to report anything inappropriate or negative to the professional moderator and to be extremely mindful of their own and each other’s wellbeing. More careful research and co-design would be needed to identify ways in which to foster the most positive forum environment possible, but, as was suggested by a young person in our core co-design team, the key to this may lie in creating a clear, beautiful and positive identity for the forum space and its ethos. We can see through the ‘Support2’ idea, it is a natural instinct for young people to seek to build friendships with those that they
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4.4 INSIGHTS ARISING FROM CO-DESIGN SESSIONS feel they connect with on certain issues. From this instinct comes the desire to be able to talk to others they might find on a forum on a one to one basis. Private messaging between forum users is not, however a function that we would recommend, due to all manner of problems with risk. Users should be asked not to give out email addresses and personal details, and this needs to be monitored by the discussion invigilator. Instead, forum users actively seeking friendship should be encouraged to attend local offline community and support groups. Trigger filters would also need to be in place. Users would be encouraged to report anything inappropriate or negative to the professional moderator and to be extremely mindful of their own and each other’s wellbeing. More careful research and co-design would be needed to identify ways in which to foster the most positive forum environment possible, but, as was suggested by a young person in our core co-design team, the key to this may lie in creating a clear, beautiful and positive identity for the forum space and its ethos.
Services specifically aimed at young people helping others through mental difficulties This could include a host of services, including story sharing, forums, tips and advice on what best to say and do in different situations delivered through various imaginative and interesting means, etc. The most important thing about to stress, however, is the importance of framing a digital asset in this way. A huge number of young people, who may not be experiencing mental health problems of their own, are acting as support for those who are, often without fully realising that this is what they are doing. It is important that this is recognised and that they are provided with a space that will allow them to do this most effectively, but also allows them to vent concerns, and encourages them to look out for their own mental wellbeing whilst bearing another’s burden. It may be that some young people, that are difficult for mental health support services to reach for a host of reasons, can only be accessed via concerned friends and peers.
Equally, providing young people with the premise that they are seeking support for a friend rather than themselves may allow for greater engagement.
Dissemination of advice on how to maintain positive mental health Some of the young people we worked with found it difficult to name positive, everyday measures that would allow them to look after their mental health. This was in stark contrast to maintaining physical health, which all could discuss with confidence. Advice needs to be compiled and promoted that will encourage the day to day maintainence of good mental health. The most comprehensive and ambitious means to do so would be through an extensive campaign that would extend beyond a single digital online asset to the school curriculum, and would also attract opportunities for private companies and third sector groups. However, the power of rapid information dissemination online could be harnessed with a carefully thought
through digital campaign, that targeted social media sites such as Facebook and Twitter. This would need to utilise a range of techniques, mediums, styles (and most likely celebrity endorsements) that tied in with internet trends amongst young people at the time. Crucially, the information would need to be in a format that young people could adapt and share easily and may require a well-publicised event to act to stimulate interest. The campaign could also encourage active user participation in order to create sustained impact; users could, for example, be encouraged to share a positive thought, image or action each day in a social media stream, or send a positive message to a friend.
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4.4 INSIGHTS ARISING FROM CO-DESIGN SESSIONS Practical, day-to-day tips for managing mental illness This is in close relation to the previous point, but specifically targeted at those managing a recognised mental condition. The young people highlighted the usefulness of creating ‘to-do’ lists and schedules that remind you to enact certain positive behaviours and give you a sense of reward for carrying out simple, daily tasks Feeling that you are able to take practical tangible steps to help you through the daily management of an illness is important. With the proliferation of smart phones, a calendar-type app designed specifically for different kinds of mental health management could prove a valuable digital asset. There was also an interest in sharing practical tips and positive coping mechanisms; this could be realised in a variety of online formats.
Empathy tools There was a desire especially amongst the young people to see and hear heartfelt, non-glamorised
accounts of what it is like to live with mental illness on a practical, day-to-day basis. These could be in a variety of formats; video, audio including song and spoken word, comic illustration, or simply written. Such accounts were seen as not only important to those suffering from mental ill health as a means to contextualise their own situation, but also as a means to fight stigma. A digital space for sharing such accounts, backed by a wider campaign, would be welcomed. -
Emergency 24 hour Instant Messaging service for people in distress This would act as an addition to the phone lines and drop in options provided by organisations such as the Samaritans. Young people, as digital natives, are very much at home communicating via instant messaging and online chat functions. For some vulnerable young people experiencing distress this could be a far more comfortable and intuitive option than a telephone conversation; some may even feel an inability to call for help. This would of course require
a great deal of training and for infrastructure to be put in place, but could be crucial.
Further exploration of the possibilities of gaming Gaming was discussed quite frequently during our initial engagement sessions, and although discussed in these co-desgin sessions, it did not feature heavily. This may well have to do with the fact that the core co-design group was entirely made up of young women. It was suggested that gaming might be useful to help young men in particular as an empathy tool or emotional release. There was also one idea for a game put forward that was not discussed in terms of gender, which involved young people looking after the health (both mental and physical) of a virtual pet. It wold act as a means to help young people best look after themselves.
‘Humour’ as a Support Tool Humour, used appropriately, is a powerful tool. There was a sense of frustration amongst the young people with recognised mental health problems that issues surrounding mental health were either addressed too delicately and seriously / clinically or with ignorant insensitivity. A well-informed, humorous approach would be favourable; careful co-design would be required in order to gauge this. It is a case of humour being used as a tool to enable young people to make light of their own situation in a constructive way in order to better cope with it and to share it; simultaneously insensitive jokes need to be called out as unacceptable.
Aesthetics of Digital Assets Any digital asset created should have distinct, interesting and beautiful identity and ethos, and clear expectations for use and behaviour. It is important to set the mood and personality of a digital space as carefully as that of a physical space. When a digital space
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4.4 INSIGHTS ARISING FROM CO-DESIGN SESSIONS is bland and without clear rules and aims, its identity becomes solely defined by a critical mass of users. Whilst this may create positive results, it also allows negative behaviours to push to the fore unchecked: Askfm is a worst case example of this.
STEPS TO WELLBEING There was a consensus amongst the young people that we worked with that the ability to understand, express and share problems and emotions appropriately and constructively is crucial to mental wellbeing. It was understood that this would not necessarily prevent the onset of mental illness, but that such ability was necessary for positive self-management. Four basic steps to wellbeing began to emerge and the subsequent ideas they devised for mental health support services can be seen to align to these. >>>
1. Help young people
to express, understand and contextualise their emotions and problems.
4. To help young
people to maintain and promote mental wellbeing.
2. Help young
people to share these emotions and problems in a constructive and supported way.
3. Help young people to manage or work through their problems and emotions; to get the appropriate support to achieve this; to encourage them to help others do the same.
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