Designing For Path Dependency: The Case of Mental Health

Our paths through the world are not always clear so making them obvious can help you determine if you’re on the right one.

Path dependency is a concept in complexity science that refers to the way in which the past patterns influence the perceptions and channels associated with action and decisions. Path dependencies are fascinating because they are both visible and invisible drivers of behaviour to the point of locking in our choices (unconsciously) by design.

While much has been written and sung about history repeating itself and others suggested that history is dead, there are things we can learn from our past and present patterns to shape our future.

In times of great turbulence and change our dominant designs created by path dependencies can cause great harm or limit our ability to help if not considered or designed for.

Mental Health Services

We are seeing this right now in what is becoming the slow-moving train-wreck that is the global population-level mental health crisis due to COVID-19. A national survey sponsored by the Canadian Psychological Association and other leading mental health organizations profiled how Canadians felt about the current state of mental health services. Among the findings were some strong attitudes toward how mental health services are provided:

At 73%, the majority of Canadians prefer to receive psychological services face-to-face. Although older Canadians (55+) are more likely to say they would prefer to receive services face-to-face (80%) than those 35 to 54 (70%), and 18 to 34 (65%).

What’s interesting about mental health services is that, despite all of the scientific research on treatment and prevention, our clinical outcomes are still relatively consistent over time and often aren’t tied to what psychotherapeutic approach we use (with some exception). What seems to be the key is making the right match between the person, the problem, the process, and the provider and most importantly: just showing up.

COVID-19 is changing the calculus of this by limiting our ability to show up in person. While e-mental health services are better than nothing, they disrupt the ability to create a strong therapeutic alliance between the mental health provider and the client. Anyone who has formed a relationship online – whether social, professional, or romantic — knows that there is often something ‘missing’ from those connections when you never meet face-to-face. The data suggest people also simply prefer face-to-face and (anectodally from providers and clients alike) there is a distinct difference in quality reported by those who’ve done f2f and online mental health counselling. Not necessarily the quality of support, but the quality of the entire encounter.

While this might seem a subtle distinction, it’s worth noting because it is in these subtleties that we find the greatest value.

Digital encounters lack the richness in which we communicate so much about what we’re experiencing. The tone of our voice, the pace and style of breathing, the fidgeting, the eye contact (are we looking at the camera, the other person, ourselves, somewhere else?) and the simple presence of someone else. Zoom and other online tools flatten all of that – the sound (tone, tenor, directionality, volume), limited vision and overall lack of sensory engagement is what reduces this richness. Yet, we are involved in eMental Health services partly because of how we’ve set up the entire system of mental health support in the first place.

We forget that while there is a path in the snow to get somewhere, we could take another path if we are willing to put the effort in to forging one.

Designing New Paths

Much of mental health services is crisis-oriented. This is the first of our pathways. We’ve designed mental health services as something you use when you’re feeling low, can’t cope, or are in mental or emotional distress. There is a pathway that shows itself in how we think about mental health and how we think about what problems to deal with and how to do that.

Just as we might have a pediatrician, dentist, or family health practitioner who we see regularly and consistently to help us develop as humans (while repairing some of the damage that human life brings such as ailments, injuries, or wear-and-tear) why not do such things for mental health? There are cultures where the idea of being in therapy (which is a poorly named descriptor) is normal and considered healthy

Another related pathway is the idea of ‘fixing‘ problems. We see this in our language about COVID-19 all around in use of phrases like ‘bouncing back’ or ‘new normal’ rather than speak of what we’re facing as challenges that are a part of the life we live. The straight and narrow progression through life is a myth. Every life has its turns from what was expected or planned for — so why do we design services the same way? Why not build in resilience, adaptation, growth and non-linear development, by design? .

This makes mental health (or healthcare more generally) that is treated with the same kind of supply and demand relationship that might work for bread loaves, but not care. We do not, as my colleague Peter Jones writes, design for care.

A third pathway is tied to the venue of interaction. While we now see Zoom serving as the medium for much mental health care we would be wise to reconsider our ties to the clinical office once our pandemic restrictions are finished. This isn’t that the office is bad, it’s just unimaginative. Why must care be something that is constricted to a clinic, a hospital, or Zoom? Could we not do therapy while going for a walk? How about on a park bench? Bots and services like WoeBot are AI-powered tools that basically do a form of therapy through text messages.

What we need for positive mental health is the availability of someone to interact with in a positive, safe, and secure manner and that is not tied to place, space, or time.

We can design new paths. In doing so, we also design new possibilities and that is good for everyone’s mental health.

Please keep and care for yourself and others as much as you can, with whatever you can spare.

Photo by Timelynx on Unsplash and by Stephanie Bernotas on Unsplash

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