Intervention Signage for Mental Health Crises

What sits at the intersection of “user experience” and “mental health management”? This is the basic question that I’ve been repeating in this course throughout the semester. But the first question to myself should have been “what do you mean by mental health management?” At the start, I was wondering if I should focus on the symptoms, if it would be helpful to identify ways of diminishing the effects of anxiety or depression respectively and pointedly. But I realized this was going deep into a rabbit hole that would make it harder to define a design problem space where I wanted a result that appeals to the average user.

So at some point, I had to stop and think of a sequence in which mental health problems can occur, and choose a point in that sequence. So I started to think about the importance of having timely access to resources and support. A UK study about help-seeking behavior in young adults identified that while generally 3/4 of psychiatric disorders emerge before age 25, participants age 18-24 are least likely to get care for mental health problems. With this known, I wanted to focus on the time frame between emerged symptoms and self-harm/attempts on life, where intervention can take place.

In October, I went to a talk held by rhetorician and Chair of Disability Studies Dr. Margaret Price. The talk was titled “Sustaining Mental Health on College Campuses”, which focused on how academia was not built to support faculty or students with mental illness and presented ideas for what design thinking can offer to this area. While the entire presentation exhibited many thought-provoking ideas, one aspect that I found interesting was a critical assessment of the sign placed in one of the campus parking garages by OSU’s newly established Mental Health and Suicide Task Force after the recent tragedies on campus.

While the intent is sound, the sign itself leaves a lot of room (possibly too much) for interpretation. The number’s source is unidentifiable. Dr. Price called the number when she spotted the sign, but it had gone to voicemail and asked to call back later. It turned out that the number led to the OSU Counseling helpline and its hours of operation were from 8AM to 5PM, which means availability had also not been identified. Here are other questions to consider: Is this for students or faculty? Both? What about those unaffiliated with OSU? Also, what happens next if someone doesn’t answer? Additionally, these voicemail messages instruct the caller dial 9-1-1 in the case of mental health emergency. There is also the concern for how prepared local law enforcement are for addressing mental health emergencies, but that is another topic to address in the future. I started to consider examples of this kind of signage in public spaces. At the base of Mount Fuji lives the scenic Aokigahara forest aka “the Sea of Trees”, aka, “The suicide forest”. Rates have varied since 1993, but the police have reported over 200 attempts and 54 complete suicides in 2010.

While the deeper parts of the forest have been blocked off, there are also signs placed at entrances to the forest. To summarize, the sign above reads “Your life is something precious given to you by your parents. Think of them, your siblings and your children once more. Seek counsel if you are feeling alone,” and provides a phone number to Japan’s Suicide Prevention Association.

It seems that in these public spaces, the signage seems to only become necessary when a death has already happened. They also stand as an effort to stave off potential copycats, which is a valid goal. But they also run the risk of creating a misrepresentation of a space (example below). This is one of the reasons why the authorities near Aokigahara had chosen to stop reporting the forest suicide rates in recent years.

Starring Natalie Dormer, The Forest is a horror movie was released in 2016 based on and set in Aokigahara Forest.

Next, I wanted to see how this plays out online. Search engines like Google have a similar set up, mostly if your query specifically states intent or ideation of ending your life. It highlights the National Suicide prevention phone number and online chat service before other related search results.

Just to note, this appeared mainly when searching with direct reference to suicide. There is a slightly weaker call to action for queries citing depression, anxiety, grief, or even self-harm as seen below:

There are also varying results for what hotline number to suggest.

So next, I look at social media, which provided a couple unique experiences. Tumblr has a pop-up it for when you search for posts related to self-harm, anorexia/bulimia, and suicidal ideation. Instead of a phone number, it provides services that connect the user to someone anonymous who will listen (by phone, chat, etc.) and suggests using positive reinforcement by following blogs that post affirmations and other supportive content.

Facebook provides a more robust tool giving you resources whether you are at risk or you might know someone at risk. However, this doesn’t necessarily shield you from triggering user-generated content.

[Note: Image has been cropped at the bottom due to a user’s photo exhibiting self-harm.]

Facebook presents a variety of tools for the user in distress: A way to contact a friend on your friends list, hotline numbers, including those for LGBTQ users and veterans/military personnel.

There’s also a list for self-supporting activities. The page gives you a moment to breath before advancing to the list. It provides activities such as going outside, writing in a journal, or “just relaxing”.

I do, however, wonder how this is received by someone who’s query may suggest that they could be self harming or planning suicide. Twitter and Instagram do not have signage according to search query by individual users, but they have a protocol listed under the Safety section of their websites. A user can report any posts that suggest self-injury or ideation. A web administrator can then reach out to the poster. And because Instagram is a Facebook product, the same resources are provided.

Of course, I have only scratched the surface of my search, there are many other examples of intervention such as adding to structures, social movements such as “RUOK?”, and organizational guidelines.

Suicide net added onto Golden Gate Bridge

It is unclear which stakeholders were involved in the development of this signage, whether they included researchers, designers, those with experience in mental illness or those that simply want to help. But this has become the point of exploration that I want to pursue.
So ultimately my question could be this: what does the design of intervention and suicide prevention look like for the target group, a non-target audience, and those involved in the creation of these elements?

Next steps:

  • Explore other types of intervention signage, mental health-related or otherwise. I plan to investigate into how viewers react to other types of signage and what may be applied to signage trying to prevent suicide.
  • Establish relationships with people who are tasked with creating this kind of signage in order to understand the process of their development. This would ideally include OSU’s Task Force, support groups for mental health, and other initiatives dedicated to mental wellness.

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