How to design with mental health accessibility in mind

6 min read Guest Blogger

Helena Beckert is a tester at Xero, an online accounting tool for businesses. Joining her onstage at UX New Zealand 2017 is Andrea Bates, co-founder of charitable trust Wellbeing Wellington. Ahead of their presentation on testing the mental health of UX in New Zealand, Andrea and Helena pen their thoughts on designing with mental health accessbility in mind. 

Designers, coders and testers have a wide variety of tools, methods and techniques available when it comes to user experience. A common one is ‘Personas’, we spend a lot of time thinking about the people who use our software but there’s one thing that these personas almost always have in common — they’re all happy.

Thinking outside your standard happy personas

‘Amy the busy mother’ or ‘Bill the college graduate’ (don’t worry, we know these aren’t things you’d ever use) are in good spirits. Even if they have dislikes (too many clicks, really busy), they’re still happy people. We assume that the people using our software are happy people because we don’t talk about people who aren’t happy. So what if you had a persona that was experiencing a different mood or state of mind? Maybe Amy is a busy mother and she is also experiencing postnatal depression, or something that means that the person looking at and using your software may get stuck in those bits that you pass off as “forgiving” or “delightful”. Maybe Amy doesn’t really want or need to see witty computer responses or error messages that are bright and terrifying and, ultimately, unhelpful. In New Zealand, one in five people experience some form of mental distress in their lifetime and could benefit from the inclusion of madness as an accessibility consideration for designers. One in five is the statistic generally used, but if you refer to the last national mental health survey (from 2006) it predicts that 46.6% of New Zealanders will experience some form of mental health condition at some point in their lifetime. It does mean boldly heading into a new area, but whether it’s almost half the population, or one in five people in our communities it is a hard number to shake.

A look into UX for people who experience extreme states

In the instances of UX researchers and designers using personas as a framework, it shows the distance between UX and the community of people who experience extreme states of being.  A personality is a socially constructed concept, not an innate part of existence. The ‘diagnostic’ manuals that are used in the mental health world are highly contentious, mostly due to their assumptions of authority and absence of science. These manuals tend to claim that some people experience ‘personality disorders’, but ‘personality’ is both very modern and very western so it’s hard to create a believable psychiatric label from this starting point. And if there is such a thing as personality, that is the building blocks of a person’s personhood, to claim that it is ‘disordered’ is exceptionally invalidating, and there is nothing healthy about that. It’s also really important to shake yourself out of thinking this community is perpetually ‘vulnerable’, ‘hopeless’ and/or ‘suffering’. People who experience mental health conditions have hard times, sometimes extremely hard times, but they are resilient and often proud of the knowledge they gain about themselves through their experiences. 

UX is absolutely on target for creating accessibility for people who experience mental health conditions by focussing on the person, not on any psychiatric label that might be attached to a person. The causes of mental distress are in a bucket labelled ‘possibilities’ at this point in time. There’s a good chance that at some point a combination of genetic, biological, social, spiritual and environmental causes will be identified. Currently the strongest evidence of causation is for social determinants, particularly in the form of trauma. Trauma is sometimes a meaning-laden word, but if you think about it as an experience that the person wasn’t prepared to deal with that caused them distress — you’ve got the idea. Examples of trauma include the experiences used in the Adverse Childhood Events study, natural events such as earthquakes and volcanic eruptions, historical trauma, intergenerational trauma, job losses, financial pressures and other significantly disruptive events or ongoing occurrences. If you think about a time in your life when you were really at a loss about something, the UX fails in this cartoon are obvious (and pretty funny): 


Source: Saturday Morning Breakfast Cereal by Zach Weinersmith

Another useful phrase to bear in mind for these experiences is psychosocial disability, and to think about psychosocial disability in terms of the social model of disability. In a nutshell, the social model says that people are not disabled but that the society in which they live disables them. Participation in everyday life is a huge part of this, so UX can have a massively positive impact on how included people who experience psychosocial disabilities are, and how included they feel. Simple things to focus on are language, communication styles, and how your design makes people feel.

One of the main reasons UX is now starting to include people who experience madness as part of the design brief is both the increasing size of this community and the increasing visibility they have. Some of our local media have put a real focus on exploring the prejudice and discrimination that “crazy people” experience of late, though some outlets are still stuck in the damaging and ignorant myth that ‘mad equals dangerous’. The media who are doing the decent thing by sharing stories of lived experience are bringing to the public consciousness some useful approaches and supports that everyone can identify and act on.

How to design with mental health accessibility in mind

As this community includes one in five New Zealanders you can be guaranteed it isn’t a homogenous group. The best way to support your UX work is to talk with a lot of people who have lived through experiences of extreme states. This means more than your friend, your cousin, that story you heard from your mate at the pub or someone who knows someone who had such an experience. And no matter how thoughtful an analyst you may be you’re best to go to the source, so gather a group(s) and get listening. It may be scary to talk about feelings with a group of people who you think have feelings that you can’t personally identify with — but focus on the fact that it’s a group of people who will be determined to put you at ease, so that the people in their community can benefit from your work.

As UX designers, you’re all familiar with talking to people, and that’s the only way we’re going to be able to start moving mental health accessibility into the light. Because mental health has been a taboo subject for so long, not many people have started incorporating it into their UX toolkit. No screen reader or contrasting colors will help here, mental health accessibility is all about involving those who have experienced extreme states. Bit by bit, we can start to build a new tool set and bring some light back into the field of mental health. Nothing creates a feeling of shared humanity like knowing that the people on the other end of the pen, or the keyboard, care about what you think and how you feel. 

Want to hear more? Come to UX New Zealand!

If you’d like to hear more about mental health and UX, plus a bunch of other cool UX-related talks, head along to UX New Zealand 2017 hosted by Optimal Workshop. The conference runs from 11-13 October including a day of fantastic workshops, and you can get your tickets here.  Got a burning question you’d like to ask before the presentation? You can tweet Helena here: @Maltekk