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Cortex

Designing a mental health app for students

Timeline February 2020 - April 2020
Type Course Project
Role UX Designer
Responsibilities Research
Prototyping
UI Design
User Testing
Teammates Michel Daher
Seif Elashry

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:

PsyberGuide

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:

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:

cartoon about research

Research-backed

The solution must be supported by credible mental health research and clinical studies.

cartoon about privacy

Privacy-focused

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.

cartoon about empathy

Human-centred

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:

Cognitive-Behavioural Therapy

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

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:

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.

sketch sketch sketch

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:

We created a low-fidelity prototype and used these 4 categories to define the navigation structure of the app.

Home

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.

homepage

Peers

The "Peers" page contains the social component of the app where students can interact with their peer community and discuss mental health.

Community opt-in

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".

community opt-in

Community feed

If the student decides to join the Peer Community, they can access the community feed, like/comment on posts, or ask questions.

community feed

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.

create a post

Buddy system

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.

buddy system

Contact

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.

contact a therapist

Resources

Lastly, the "Resources" page would display mental health resources provided by the University of Toronto. Currently, these exist across the university's multiple websites.

resources

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:

We also discovered two usability issues:

Iteration + high-fidelity design

In our next iteration, we wanted to address the problems we discovered from testing. The major changes were:

Signup process

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.

signup process

Tracking mood, thoughts, and activities

From the "You" page, tapping on one of the five moods would open up a sheet where a student can write down their thoughts and select the activities they did that day. We also wanted the design to react dynamically based on the user's mood: if they're happy, we write some words of encouragement. If they're sad, we display a comforting message.

mood and thought tracking

Viewing your mood summary

When a student starts using the app regularly, they'll be able to see how their mood changed over time and access all their past entries. This offers the student a way to self-reflect and increase their emotional self-awareness: they may find trends or patterns that they didn't notice before.

mood summary

Creating and tracking goals

A common component of mental health therapy involves behavioural change, which requires people to change their old habits and form new ones that have a positive effect on them. To encourage students to develop new habits and stay consistent, they can create goals and track their progress. Some suggested goals are included, but students can also create custom goals.

goal tracking

Learning therapist-approved strategies

Due to the stigma surrounding mental health, some students are uncomfortable talking to a therapist or asking others for help. To help address that, we included "Self-Training" courses that students can complete on their own. These courses would span different mental health illnesses including depression. In each course, students will learn different strategies that can help them overcome their struggles. For demonstration purposes, I used the "Managing Depression" course offered by the Big White Wall, an excellent resource for many mental health courses. If this app were to be implemented, a partnership with an organization like the Big White Wall to provide content would be ideal.

self-training courses

Discussing mental health with other students

If they wish, students can join the peer community to ask or answer questions posted by other students. Once they join, they can access the community feed where they can like and comment on other students' posts.

community feed

Creating a safe environment

It's essential to create a safe environment for users to comfortably ask and answer questions, whether that's on the community feed or by chatting with other students privately.

messaging feature

Integrating existing university services and resources

Students can also make use of the University of Toronto's existing services which they may not be aware of. This includes 24/7 access to therapists and a vast library of resources.

resources

A final thought

In tech, we're often told to "move fast" on any product or service we're creating. Although this should be done in most cases, we have to adopt a different approach when designing a product that aims to improve someone's mental health. Unlike designing a product like a food delivery app, there's no clear path from A to B to improve someone's mental health. To see if our mental health solution benefits others, we need to test it over a more extended period to observe its effects. The last thing we would want is to launch a mental health app that doesn't benefit the end-user or even worsens their mental health. Although extended testing requires more time and resources, we're more likely to arrive at the right solution and truly help people overcome their struggles.

It's an investment worth making.

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