Eleven: A Mobile Mental Health Outreach Application Methodology
The process of spreading ideas, regardless of content, gravity, or meaning, has changed somewhat radically since the widespread adoption of the Internet. Many individuals, groups, and companies now hope to spread their message over the
applications layered on top of this network quickly and effectively -- to spread virally. Communications applications like Facebook and Twitter have created spaces where people, groups, or ideas rise to fame and fade just as quickly. Memory on the Internet has become both simultaneously short and painfully long -- mobile applications are downloaded and forgotten, posts are written, read, and discarded. But these artifacts can remain long after downloads have slowed and readership has waned.
Many have attempted to capitalize on this process. Most self-appointed social media “gurus” tend to preach enlarging the size of one’s audience rather than actually contributing to the large-scale conversation that is taking place with quality, longevity, and understanding of that audience. This same approach must be taken when designing a mobile application.
It is with this in mind that Eleven has been designed and developed. Longevity rather than short-term bursts of downloads and audience size is the goal of Eleven’s existence. Hours of conversations and countless email threads have been exchanged to triangulate exactly what this application ought to grow into. While it started as a mere location-aware database of healthcare providers, the design has since developed into something quite a bit bigger. Close ties to Penn State’s Counseling Center and its department of Science, Technology and Society Studies have allowed for this growth. The willingness of Active Minds to connect me to other like-minded organizations like HealthCentral’s Mood 24/7 allowed me to discuss feature sets, development processes, and the project’s longevity beyond what I was capable of understanding alone.
Findings
The current design incorporates what I set out to do: Create a stand-alone mobile application that would allow for users to discover mental health resources in State College. This was developed initially as a mobile web application. However, after much
research into the development and distribution of mobile web applications, it became apparent that it ought to serve more as a prototype than the final product. Strong, established distribution channels exist for native applications (i.e., iPhone and Android App Stores) which would allow for simple advertising and discovery of the application, whereas none currently exist for mobile web applications outside of conventional
advertising. In addition, it is no understatement that users of these devices have become accustomed to downloading through these stores rather than opening their browsers.
Continued discussion with Chris Hall of HealthCentral, Ben Locke of PSU’s CAPS, and most recently Jason Marshall of CollegeResponse have led the design of this project in unexpected directions. Much of the reading and conversation centering on usage of mobile applications indicates that they are quite easily forgotten if they do not provide daily value to the user. It does not take much intuition to understand that only providing a small-scale phonebook to a user does not equate to daily value, only short-term, one-time usage. As such, I found that other features ought to be included if this project were to be adopted beyond State College. Three primary feature sets ought to be included if this project were to be pursued in the future: Mood-tracking, screenings for mental health, and a private section for chapters.
Mood-tracking would give users a strong reason to return to the application on a daily basis. It would allow for users to not only reflect on their daily behaviors and emotions but to make use of this data in other meaningful ways, the least of which not being sharing with a healthcare provider. Research into the so-called “quantified self” movement will show that trends towards data-driven health care are gaining traction. Fitness, nutrition, sleep, and mood are some examples of what people are quantifying using mobile devices and otherwise. After lengthy conversations with Chris Hall of Mood 24/7, it is apparent that there is a gap in the space of quality mood tracking on smartphone devices. There exists a space for partnership with existing groups and companies which would allow for this to occur, including with Mood 24/7.
The inclusion of mental health screenings would allow for users of the application even more self-discovery and reflection. After conversation with CollegeResponse’s Jason Marshall, it is apparent that there is overlap between their college and university clients and Active Minds’ chapter locations. This ought to be made use of meaningfully by both Active Minds and CollegeResponse, and this application would provide the
space for this to occur. Further discussion is necessary to understand what this would look like.
It is for the chapters that I see this application also being useful. Currently, Active Minds polls its chapter leaders via SurveyMonkey to check on progress, membership, and other chapter activities. I would like to see a private space within the application to allow for direct communication between the national office and individual chapters. More granular measurements of chapter performance, membership, and outreach
would be possible through mobile check-ins through the month rather than at the end of it. Quantifying performance would become much simpler and would occur as events happened. This would allow for quicker response by the national office to chapters that either were doing very well or needed additional assistance. Further, social media integration would allow for chapters to broadcast photos and messages to their respective accounts from within the application.
Dissemination
Given the publicly available features -- mood tracking and screenings -- this application could be advertised through the chapters as they reach out to their college or university. Any class presentation could become a promotion of this application as well. As chapter members stand at the front of the class, encouraging others to seek
understanding of their own mental health, they can provide tools to students to empower themselves.
In terms of distribution of the application itself, mobile app stores would allow for a simpler discovery process. It would be categorized in with other health care applications, and its features would be detailed within its page on the app store. Other means would be to advertise through Facebook using targeted ads, specifically to college students who may be interested in the efforts of Active Minds. Lastly, and most
importantly, it could be marketed using Active Minds existing channels -- newsletters, emails, and member communication.
It is apparent that there is a tremendous gap that exists in the mental health space between what is socially and technologically possible and what currently exists. I attribute this mostly to lack of funding, technical understanding, and level of interest in those who have this understanding. Active Minds is in a serendipitous position,
potentially having access to these requirements. The mood data could be anonymously digested to analyze for trends. Friends could suggest the Active Minds app to their friends who are coping with a mood disorder.
Access to strong developers was one of the biggest barriers to this project thus far. With my recent hire at a small mobile application development company, I have found myself able to distribute the work to other stronger programmers than myself. If this project were to be pursued further, it would put Active Minds in the position to be a leader in the mental health field not just socially, but technologically. And judging by the state of the mental health landscape with respect to technology, this could be a rare, coveted position to hold.
Lessons Learned
As I mentioned on the conference call last month, being reasonable about the scope of the project was the most important lesson to be learned. It was easy to see infinite possibilities at the start of the project -- primarily because boundaries did not exist. Once resource limitations were introduced, especially financial constraints and programming skill, the boundaries were more apparent.
To be candid, finding myself in serendipitous positions such as this one leads to tremendous excitement. This is absolutely necessary and generally leads me to believe that I am chasing the right aim. However, it is necessary to understand that this excitement must be personally understood, digested, and communicated effectively in order to be worth anything. So, candidly: I see tremendous potential in this project, and would love to continue the discussion towards what it would take to continue building this for Active Minds.
I have attached a social impact statement which was available at the Fellowship meeting in Washington as well as a number of scenarios previously submitted to Sara Abelson to detail what usage of this application might look like. Additionally, I have linked to the prototypical web application available online as well as a video of the
native iPhone application which visualizes available resources on a map in State College. What follows are the scenarios. Please find the social impact statement attached to this document.
SCENARIO: Friend on a Bus
Two old friends are traveling by bus to their college town after a week spent at home over a break. They are discussing their time apart: Sophie, 19, discloses to James, 21, that she has been feeling rather down and not very much like herself. She confides in him that she spent the majority of her break sleeping and not eating very much of anything. She tells him that it had been going on for a few weeks, though it became unavoidable through the break.
James happened to see an ad in the campus library some weeks ago asking a simple question: "Are you willing to help a friend?" Indeed he was, he thought, and walked up to the advertisement. At first glance he noticed a picture of a smart phone, similar to his own, and a eye-catching logo reading "Active Minds". The ad explained that mental health issues are common, and that this program was there to help people through. Interested but in a rush, he took a picture of the flyer and carried on.
Now faced with this dilemma, James remembers the flyer. Piqued with curiosity and wanting to help Sophie, he returns to the flyer and does some quick reading: "Active Minds has released a mobile application dedicated to helping people get help.... One in every five people will be diagnosed with a mental illness of some sort. Our application aims to help people find the support they need."
Sophie tells James that she is hesitant to spend money on treatment, that she just had to quit her job to help maintain her high GPA. They both look at the screen, noticing that the first option is to choose from an insurance provider. She is relieved to see her parents' provider listed, and they begin to explore providers around State College.
Weeks later, Sophie has continued her treatment with a counselor and psychologist she found using James' phone. She has since downloaded the same application and has begun tracking her daily mood using another feature within the application. She feels more mindful and in control of her state now that she is able to keep an eye on it over time.
SCENARIO: Transitioning Freshman at Large University
Andrew is 18 years old and a recent high school graduate. He is moving to a Big 10 university in the fall. He had his first bout of major depression through his early years in high school, and has seen mental health providers on and off since. He is obviously pretty anxious about the upcoming transition, and his parents share his concern. He fears not finding a group of friends, his parents fear him not having the support system they understand he needs.
Andrew happens to be a Facebook user, routinely checking for updates on his mobile device. He lists himself in his university’s network, and -- coupled with Facebook’s targeted ad system -- finds himself looking at an Active Minds App ad one day: “Interested in helping to change the conversation about mental health at your
university? Be part of a network of over 300 chapters dedicated to eliminating mental health stigma. Download our app to find local resources, track your mood over time, and connect with others at your school!”
This piques his interest. He was just in conversation with his parents about finding a provider at school, and knows that it will help him do well once he gets there. He installs the Active Minds app on his phone and explores some of the features. He is able to see a map of mental health care professionals near his dorm. Not only does he find some leads, he begins reading about the organization which has already been established at his school.
Andrew decides that this is a great organization to become a part of, and decides to join the local chapter once he gets settled.
SCENARIO: Mental Health Care Provider Outreach
Dr. Eli has been a practicing psychologist for over 10 years in a suburban college town. Frustrated with the common “boy’s club” referral process in his area, he desires a better way to reach out directly to his main clientele -- students. He knows students use social media, but has also read that leveraging these sites can be difficult. He worries that a Twitter feed is woefully inefficient to reach out to his target audience.
He checks his email, finding a note from a president of a local Active Minds chapter. In it is a request to include his practice contact information in a growing, open database of practices and resources of mental health care facilities. Inclusion in the database would require payment of a nominal yearly fee to cover costs, but would open his practice up to an audience intentionally seeking out these facilities.
He searches around the web for more information on Active Minds first. Finding the organization to have already scaled nationally, he sees tremendous potential in being included in such a database. Further, he refers a number of his psychologist friends to the president who also agree to be included.
