Can we redesign our approach to mental health?

One of my guilty pleasures is to grab a cup of coffee on the weekend and read over the transcript of advice columnist Carolyn Hax’s Friday live chat. Why guilty? Because when you get your head wrapped around your own axle, it’s sometimes good to be reminded that everyone has their own set of issues. And Carolyn gives such practical, non-nonsense advice, that I almost always learn or reinforce some “get over your own ego” lesson that I needed to hear.

There are times, though, when the problems people face are sobering. Repeatedly, you read stories of people actively resisting therapy or counseling as an option. Just last Friday in Carolyn’s chat, one person wrote in about her chronically unhappy friend. Carolyn recommended encouraging the friend to get screened for depression:

“For understandable reasons, going from zero to therapy is actually more difficult than getting screened, in part because therapy often involves a burdensome search for someone who offers the type of therapy you need; is a good fit as far as location, hours and chemistry; and who is affordable and/or accepts any insurance, much less your plan. Plus there’s the obstacle that I find totally crazy-making, the perception of therapy as an admission of weakness, nuttiness or defeat, none of which is true.” [emphasis added]

Yes, it is indeed crazy-making, our resistance to mental health. This theme plays over and over in Carolyn’s chats, as if getting help to figure out how your mind works is the absolute worst thing in the world. I see it playing out in the workplace, where we are afraid that we’ll lose our security clearance, or we’ll be judged by our colleagues, and forever required the brand “crazy” or “unstable” on our foreheads. I see it in older generations, that never had the options we now have when they were growing up and seeking help is absolutely a sign of weakness, a stigma carried over from their childhood. Then imagine older generations who have immigrated to the United States – the rooted cultural stigma against mental health treatment can be even stronger for them.

In Committing to the Start, I touched upon my imperative for this blog. I quoted a Washington Post article, Mental toll of extended unemployment looms large the discussed the looming silent mental health epidemic stemming from “foreclosures, substance abuse, family battles and – worst of all – widespread depression that some experts say has reached startling proportions since the recession.”

So, what can be done? Do we start a wide-spread campaign that will hopefully stick as well as Breast Cancer’s pink ribbon? Perhaps. But what I have in mind is more of a re-design our approach to mental health.

In the past few years, I’ve become a student of innovation. Through this research that I have come to learn about design thinking, a few years after the methodology’s height in popularity. Like this Fast Company article, Design Thinking isn’t a miracle cure, but here’s how it helps, I believe looking at the human at the center of the design is something mental health practitioners could stand to do.

In my research, I took a trip out to Standford’s Design School and met with the staff there. They showed me the attached photo – a story about what design thinking has done for medicine.

Plain MRI

The original MRI machine

Designing a new MRI

Working with kids to designing a new MRI machine

Redesign MRI - Cozy Camp

The redesigned MRI - Cozy Camp

The story is of the designer of the MRI, who normally worked directly with doctors and nurse to design the machine. One day, while visiting a hospital, the nurse to whom he was talking had to excuse herself to give sedatives to a child in preparation for going through the machine. The designer was surprised and horrified to learn that 80% of all child patients had to be sedated before receiving an MRI. He worked with the kids to redesign the machine so that it would be a less scary experience. The new design, “cozy camp,” resulted in a dramatic decrease of sedation rates – only 10% of all kids had to be sedated before getting an MRI.

What if we could design the equivalent of the “cozy camp” for mental health treatment? What might that look like? Consider the following story from the Moth, the acclaimed not-for-profit organization dedicated to the art and craft of storytelling.

Andrew Solomon tells the story of a West African Treatment for Depression. After he battled depression, he researched how other cultures treated the illness. His story about going through ndeup, a Senegalese tribal ritual exorcism to drive the unwelcome spirits in the depressed, is hilarious and poignant. I won’t tell you how it goes, but the prescription involved 7 yards of fabric, a calabash, 3 kilos of millet, sugar, kola beans, 2 live roosters, and a ram. Listen to it yourself (it’s only about 10 minutes long).

Now, I’m not suggesting that our design include exorcism or live animals. But listen to the end of Andrew’s story, when he goes to Rwanda some five years later to compare notes on local mental health treatments there. When he described his Senegalese experience to a Rwandan friend, his friend noted the similarities in the ritual and then said, “We had a lot of trouble with Western mental health workers shortly after the genocide and we had to ask them all to leave.” When Andrew asked why, his friend explained, “Their practice did not involve being out in the sun. There was no music or drumming to get your blood flowing again. There was no sense that the everyone had taken the day off so that the entire community could come together to try to lift you up to joy. There was no acknowledgement that depression was evasive and external and something that could be cast out of you. Instead, they would take people one at a time into these dingy little rooms and sit around for a while talking about all the bad things that had happened to them. We had to ask them to leave.”

You know, it’s hard enough for a person to decide they need help with depression. But if that help consists of going in a room and talking out painful stuff with one other person, then how much harder is it to arrive at that place? This is true for most Americans, but double, triple the level of difficulty for the older generation, or folks from a different cultural tradition.

When I listened to Andrew’s story, I think of how it really is supposed to take a village, or a community to wrap our proverbial arms around someone, while being careful to not also be held hostage to their problems. What if there were a way to create an environment more conducive to helping a person arrive at that decision that they need help to make a change? Something culturally specific, relevant to the person? The depression equivalent of the cozy camp MRI?

A few years ago, I started seeing a therapist to deal with issues related to low self-esteem. I went because someone whom I respected greatly admitted to me that they went to therapy. I had resisted it, but then decided to give it a chance. Even for someone like me, willing to embark on the therapy course, it was difficult to translate the lessons from each session into action. Until I picked up a few hobbies that reinforced the lessons I was getting from therapy.

When I talk about the head fake, a term borrowed from Randy Pausch’s Last Lecture that describes how you’re taught a deeper lesson under the pretense of learning something else, it’s in the spirit of engaging in an activity where you learn how your mind works. For me, yoga and climbing and improv theater have done exactly that. These activities have complemented my time with my therapist, but that’s not why I engaged in them.

How could we redesign our approach to mental health?  How do we reduce the barrier to entry to mental health treatment?  Go back to Carolyn Hax’s description of the barriers to entry to therapy:  finding the right chemistry with a therapist who has the right hours, in the right location, is affordable and works with your insurance. Those are the barriers to sitting alone in a room with someone to work out your problems.  Can we look at the situation more broadly?  How could we change our approach to make it more wholistic, inclusive, and maybe involve head-fake opportunities, some sunshine, music, and a community that conspires to lift you up to joy?

The first step of design thinking to hear stories and collect information. What are you stories about making the leap seize good mental health for yourself? What made it easier, more palatable? What’s helped you?

References:

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