How it started
In the past couple of years, three students committed suicide on the University of Toronto campus. These
deaths reflect the mental health struggle that students endure while they're attending university. But with
the high expectations of attending a reputable school, students can find themselves lonely, overworked,
depressed, and sometimes suicidal. The American College Health Association surveyed over 25,000 students
across 20 schools in Ontario and found that 46% of students "felt so depressed it was difficult to function"
and 13.7% "seriously considered suicide".
In one of my courses, my team and I decided to design a solution to address the mental health crisis at the University of Toronto.
Mental health is hard to talk about
The main problem with mental health is the stigma that surrounds it. It's like a taboo that we don't want to
talk about or makes us feel uncomfortable whenever it's brought up. In a way, that's completely
understandable: our struggles are rooted in the most personal and private aspects of our life, which we
don't want to reveal to anyone. As a designer, my first instinct is to always talk to users at the beginning
of the design process. But for the first time, this didn't feel like the right path: it would be challenging
to get students to open up to strangers about their personal struggles for a school project that we were
doing, and we respected that.
Our alternative to user research
Sometimes, we have to adapt our design process to fit the problem that we're trying to solve. Instead of going down the typical path of talking to users, we decided to take a different approach. We dove deep into mental health research to discover the various methods and strategies to treat it. If we wanted to solve this problem, we needed to understand which treatments were the most effective and which ones weren't. We were also able to interview the Chair of Health Promotions at the Ontario University College Health Association and the Health Education Coordinator at the University of Toronto. We got to learn about the university's past and current initiatives and understand which ones failed or succeeded.
Analyzing reviews from medical professionals
To complement our research about mental health treatments, we researched user reviews from mental health clinicians about existing mental health solutions. We found two reliable sources of user reviews: the ADAA and PsyberGuide.
The Anxiety and Depression Associate of America
The ADAA reviewed a large number of mental health-oriented apps. These reviews were conducted by mental health professionals with degrees in psychology, medicine, social work, and counselling. These apps were evaluated based on 5 key metrics:
- Ease of use: How easy is it to use this app?
- Effectiveness: How likely will the content provide the tools or methods to accomplish its purpose?
- Personalization: What is its ability to personalize individual needs?
- Interactive/Feedback: How interactive is the app in giving feedback?
- Research Evidence: Does scientific research demonstrate its effectiveness?
PsyberGuide is a non-profit funded by One Mind, a leading non-profit organization in brain health research. PsyberGuide operates out of UC Irvine and Northwestern University and its members are experts in mental health, technology, and technology delivered care. These apps were evaluated based on 4 key metrics:
- Credibility: Looking at the research supporting the technology and the credibility of the development process
- Transparency: Reviewing the privacy policies to see if key pieces of information about what happens with entered data are addressed
- User Experience: Exploring how fun, functional, easy-to-use, engaging, and interesting the technology is
The essential characteristics of a mental health solution
Based on our research findings and the key metrics used by mental health professionals, we determined that the most effective mental health solutions satisfy the following:
The solution must be supported by credible mental health research and clinical studies.
The solution must value the privacy of any information disclosed by the user since mental health is a very personal topic. It must also be transparent about what data is being collected and stored.
In addition to ease of use and engagement, fostering an environment that is psychologically safe and trustworthy is paramount.
Picking the right treatment
If you search online, you'll find dozens of methods and strategies to treat mental health. We ended up choosing two types of therapy: Cognitive-Behavioural Therapy and Peer Support. We selected those two types of treatments because:
- They are proven to be some of the most effective treatments based on multiple research studies
- We can implement them on a large scale with many students
- They complement existing mental health services provided by the University of Toronto
Cognitive-Behavioural Therapy, more commonly known as CBT, is a short-term form of psychotherapy. It's a
goal-oriented approach and focuses on the daily problems that a person encounters. CBT aims to train people
to "identify, question and change how their thoughts, attitudes and beliefs relate to the emotional and
behavioural reactions that cause them difficulty". This is done by recording our mood, thoughts, and
behaviours which increases our emotional self-awareness and helps us identify distortions in our perception
of day-to-day experiences.
The Centre of Addiction and Mental Health states that CBT is "the gold standard" to treat different types of mental health illnesses and is supported by 375 clinical trial studies since 1977. You can learn more about CBT on CAMH's website or by reading this quick CBT information guide.
Peer support is a relationship between people who have shared common experiences. Peer support can help
people share their personal stories, learn how to deal with problems, and support one another. According to
the Mental Health Commission of Canada, peer support can "inspire hope and demonstrate the possibility of
recovery" to those with mental health illnesses. The effectiveness of peer support lies in the shared
experience between people, which can eliminate the fear of asking for help and accelerate recovery.
You can learn more about Peer Support on the Mental Health Commission of Canada's website.
Picking the right medium
We decided to deliver the selected treatments digitally through an app for multiple reasons:
- Ease of access: students can get busy and have trouble finding time to visit a mental health clinic or therapist. A digital solution allows them to access these services on demand.
- Privacy and anonymity: students may value the privacy and anonymity that comes with receiving these treatments digitally, which presents a much lower barrier compared to visiting a therapist in a clinic.
- Reach: the University of Toronto has over 90,000 students enrolled, and a digital solution can help us offer our service to the entire student body.
Our initial sketches
Now that we understood what treatments were effective and how to conduct them, it was time to start brainstorming. We brainstormed different ways of implementing aspects of CBT and Peer Support, and also incorporating services and resources from the University of Toronto.
The first prototype
Now that we had a lot of ideas, it was time to unify them into a single experience. We realized that we could group our ideas into 4 categories:
- Personal: Tracking your mood, daily diary, goals, and completing self-training courses
- Social: Interacting with your peer community, liking and commenting on posts, messaging others
- Professional Help: Calling or chatting with a certified therapist
- Other Resources: Accessing resources (articles, videos, hotlines) provided by the University of Toronto
The "Home" page groups the daily tasks and activities that the user can complete. These activities, such as mood and thought tracking, are derived from CBT. The "Self-Training" section would offer mini-courses that teach strategies and approaches that students can follow to manage their mental health.
The "Peers" page contains the social component of the app where students can interact with their peer community and discuss mental health.
Before gaining access to the community, students have to opt-in. We included an opt-in to comply with the Mental Health Commission of Canada's Peer Support guidelines. The guidelines stress the importance of self-determination, which they define as "having faith that each person intrinsically knows which path towards recovery is most suitable for them and their needs, noting that it is the peer's choice whether to become involved in a peer support relationship".
If the student decides to join the Peer Community, they can access the community feed, like/comment on posts, or ask questions.
Creating a post
When creating a post, students can choose to hide their username to stay anonymous. We believe it's crucial to provide a sense of protection and privacy to increase the overall psychological safety when asking questions about a topic as sensitive as mental health.
Students can also be matched with a "Buddy", another student who will act as a mentor. The Buddy system enables more personal, 1:1 support which is difficult to obtain through the community feed. After testing with students, we later learned they did not like being automatically matched with another student. Instead, they preferred having the freedom to chat with anyone on the platform as it would lead to more organic and productive conversations. The Buddy system was eliminated during the next iteration of the design.
The "Contact" page is where students can call or live chat with a licensed therapist available 24/7. This service is currently offered by the University of Toronto but has low awareness among students. To cater to all students, we included a language selection functionality. International students make up 22.5% of the undergraduate population and 16.8% of the graduate population at the University of Toronto. For that reason, we wanted to give students the chance to talk to a therapist who speaks their first language to better express themselves and find comfort.
Lastly, the "Resources" page would display mental health resources provided by the University of Toronto. Currently, these exist across the university's multiple websites.
Testing with students
Unfortunately, we couldn't test students in person as lockdowns and social distancing were enforced during
the COVID-19 pandemic. Instead, we resorted to remote testing through Google Hangouts.
The challenge of testing a mental health app is validating whether or not your solution improves the user's mental health in the long term. That's difficult to test during a 30-minute session, but we still wanted to hear students' thoughts and impressions regarding our design. We tested with 5 students remotely and were able to get some valuable feedback to improve our design for the next iteration, most notably:
- Negative reaction to the Buddy system: all 5 students had negative feedback surrounding the "Buddy" matching system and expressed their desire to have more freedom in their communications. They did not want to be forced to talk to someone; they prefer chatting with anyone at their own discretion.
- Clear display of data privacy and protection policy: we included a basic signup process in the low-fidelity prototype where students enter their name, email, username, and password. We had planned to include the data privacy and protection policies near the app's settings. However, 3 out of 5 students expressed concerns about how their data would is being used and if the university owns it.
- Lack of visual distinction between different types of resources (articles vs videos)
- Inability to search the community feed using specific keywords
Iteration + high-fidelity design
In our next iteration, we wanted to address the problems we discovered from testing. The major changes were:
- Displaying data privacy and protection policy before signing up: we decided to show the data privacy and protection policies as soon as users wanted to create an account and before they provided any information.
- Replacing the "Buddy" system with a general messaging feature: instead of matching students by default, we decided to include a more general messaging feature that allows students to message anyone.
In our final design, we created a more detailed signup process which begins with a data privacy and protection acknowledgment. As we learned from testing, this was a critical component to start building trust with users before they sign up and provide their personal information.