Talking Minds

Case Study


Psychosis refers to a range of experiences such as hearing, seeing, feeling, and believing things that are not real to other people. Existing digital information on psychosis was considered mostly overwhelming, unrelatable and not always trustworthy. Furthermore, images associated with psychosis portrayed the condition as a dark, chaotic and depressing disease that only strengthened the stigma associated with mental illness.  

Dr Ivana Nakarada-Kordic and the DHW Lab design team were approached by a group of mental health pharmacists to collaborate on developing a user-friendly digital resource to educate young people (16-25) experiencing psychosis and their families about the importance of medication and early intervention. The research project became compelling to the design team when the mental health pharmacists expressed their openness to embark on a co-design journey holding young people experiencing psychosis and their families at the core of the process. This process resulted in Talking Minds – a comprehensive online resource on psychosis, that also includes information for friends and families, and provides insight into other people’s experiences.  

The extent to which the research enquiry introduced a new way of thinking about something or its distinctivness.

Mental health care in NZ and around the world remains underprioritised and underfunded. Early intervention is key to supporting recovery. However, in NZ, the bulk of the resources specifically for young people are allocated towards helping those with more common mental health issues such as anxiety and depression, with fewer investment directed towards helping about 3 in 100 people who experience psychosis.

This project was initiated by clinical pharmacists who worked with adolescents in a mental health inpatient unit. These clinicians recognised that young people have poor adherence to their medication treatment and were willing to approach solving this problem differently. Based on the research of others and their own experience, they understood that young people needed and wanted to be involved in understanding their treatment and that they often report not receiving sufficient information. Not having access to financial support from their organisation, they applied for and received a substantial external grant to involve young people who have gone through experiences of psychosis in the co-design of a user-friendly online resource to help with medication adherence. They assembled an interdisciplinary team of health professionals working in mental health in both hospital and community settings and commissioned the DHW Lab to oversee the co-design process.  

At the time, clinicians were using a paper flip chart in a consultation session to help communicate to their patients the information on medication for psychosis. Initially, the aim for the project was to co-create an app modelled on such a flip chart to make the information more appealing to young people and make it available for them to use in their own time and at their own pace. The information sources patients could access up to that point on their own mostly contained generic information and lacked a patient-centred, tailored approach. Online resources were often untrustworthy, poorly presented, full of jargon, and often stigmatising. In addition, no resources were available that considered psychosis in the context of cultural differences in worldviews characteristic of Aotearoa NZ’s population.

We were not aware of any studies at the time that involved people who have experienced psychosis in the various stages of the design of educational resources that would suit their needs, let alone initiated by clinicians open to trusting this somewhat ambiguous process.

The very first co-design session revealed a gap in knowledge wider than just related to medication for psychosis. Young people we worked with on this project reported not knowing much about psychosis in general. Psychosis was often not mentioned explicitly during the initial consultation and the young person and their family did not understand enough to ask questions. Patients were sometimes prescribed medication without much information being provided, and if their symptoms persisted or worsened, the clinician would often simply increase the medication dose. This sometimes made the symptoms even worse, leading the young person to stop taking their medication altogether.

There was clearly a need for a patient-centred resource to be developed that supports patient education and recovery in mental health in a consistent and effective manner. A need was also expressed by the young people for such a resource to be available to those supporting a young person experiencing psychosis, such as their friends and family.

Having (a) external funding that allowed the project team to not have to be constrained by the requirements of the healthcare system, (b) healthcare professionals that were open to trying new things and prioritising patient needs, and (c) having the time to thoughtfully tailor engagements methods so that all of these diverse perspectives could be expressed and come together while putting the patients' needs and wants at the fore, were some of the conditions that made this project possible and unique.

The thoughTful and systematic way the question was addressed through the research enquiry.

Research Question

  • How can we co-design a digital resource that helps patients understand and take their medication?
  • How can designers engage young people in co-design in the context of age and mental health status, meeting people where they were at?

It was important to engage young people and their families early on, and throughout the entire design process, to ensure a truly user-centred local resource is created. Following the UK Design Council’s (2005) Double Diamond design process model, we used a co-design approach to conduct a series of discovery, prototyping and evaluation workshops with young people, their families/carers and clinicians in hospital and community mental health settings. With sufficient time and resources available, we were able to carefully craft methods to enable engagement with all participants, regardless of their confidence or physical/mental capacity to verbalize or materialize their thoughts, feelings or perspectives. The co-design sessions were largely inspired by young people’s extensive use of social media metaphors and were adaptable to their interests, preferences and mood. We used storytelling through emojis and a relatable persona with emotion mapping to gain insight into the experiences, needs, motivations, emotions and interests, a card sorting activity to prioritise content, and an icebreaker that involved the group co-designing a pizza for our lunch. In the prototyping and evaluation workshops, emotion abstract sketching was used to guide the look-and-feel of the future resource, and simple A/B tests were used to evaluate the amount/length of content. Developing the content for the final prototype to achieve a user-friendly language and tone-of-voice for the resource would have not been possible without the generous input from consumer representatives and cultural advisors on our transdisciplinary team.

Early in the process, we found that existing resources on psychosis were mainly grim, scary, visually cluttered and overwhelming. There were no Aotearoa NZ specific resources available, let alone those that considered ways Māori and Pasifika traditionally contextualised experiences associated with psychosis. Through the co-design process, we found that there was a disconnect between what patients needed and what clinicians thought they needed. First off, young people in our workshops wanted a website, not an app, that would be a one-stop shop for young people and their families to learn more about psychosis and how best to manage it. Young people in our workshops clearly expressed the need to know more about psychosis than just the importance of medication – starting with what it is, what questions to ask early on, and what the diagnosis meant in terms of their daily life and management. Families wanted information on how to help their loved one to manage their experiences of psychosis, and they all wanted to hear other people’s stories and experiences. The language and the look-and-feel of the resource needed to be hopeful, empowering, simple and clear, take a patient’s perspective and experience, and allow for self-directed learning for those who want it.

Despite the general stigma, misrepresentation and bias existing around what people with significant mental health difficulties are capable of in terms of engagement, this project demonstrates that, given the chance, young people experiencing psychosis can be meaningfully engaged in co-design using simple, flexible, solution-focused, creative participatory methods. Early in the workshops it was clear that our participants’ youth and associated unique needs and interests presented a far greater challenge for us as researchers than the fact that they had experienced mental health challenges. It was important to consider young people as equal partners in the design process, by valuing them as experts in their condition and experiences and to adapt the workshop activities to their interests and age, so that they did not feel intimidated, bored or patronised. Incorporating their ideas in concept designs helped to validate their input, and kept them motivated, resulting in enhanced ongoing engagement.

The extent to which the work changes thinking or practIce.

Designing with people experiencing complex mental health challenges, where the focus is on solutions rather than problems is not common practice. Co-creative methods are not traditionally used with young people experiencing psychosis, therefore, our approach was very much experimental and adaptive.

This project reinforces the importance of involving end-users of health services and resources as equal partners in all the stages of the design of solutions that will fit their needs. Consequently, what was originally intended to be simply a medication education tool grew to become a comprehensive, empowering online resource on psychosis for young service users and their support persons.

The study raised new questions, especially around methodology related to engaging young people. Engagement should be tailored with the age and interests of participants in mind and should be directed towards actively and collaboratively seeking solutions, rather than only focus on problems.

Having a diverse team, external funding and little support from the healthcare decision-makers resulted in questions around who should own the resource and who should be responsible for managing the content and website maintenance so that the resource can grow and remain up to date. Project teams should discuss these issues at the start of the project. Questions remain around how best to evaluate impact and what indicators of success are best suited for this kind of evaluation.

The findings of this research were disseminated via journal articles, national and international conference presentations and published proceedings, symposia (including a mental health service user-led symposium), news articles, radio interviews, design awards, public healthcare officials, social media, digital artefacts, and posters/pamphlets about the resource disseminated to clients visiting mental health services. The resource is also currently being used by clinicians in the mental health services settings as part of the consultation visits with users.

Talking Minds has been well accepted and used by end users and mental health professionals. It has resulted in further collaboration with both public mental health services and NGOs on various other projects and opened up opportunities to involve design students in projects in this space. Describing in detail our entire research process and methods led to this research being used as a great demonstration of the potential of co-design, with such detail often lacking from research published to date. Dissemination of findings via multiple channels lead to our group being contacted by international researchers seeking advice on conducting design research in the context of mental health.

“Great, this is great! Now this would have helped me when I had my son – I would have gone in there and gone 'Oh my gosh! It’s all here.'”

— Family Member

Resources and Links

The website –

Ivana Nakarada-Kordic, Nick Hayes, Stephen D. Reay, Carla Corbet & Amy Chan (2017) Co-designing for mental health: creative methods to engage young people experiencing psychosis, Design for Health, 1:2, 229-244, DOI: 10.1080/24735132.2017.1386954

Best Awards — Silver in Public Good

Best Awards — Finalist in Small Scale Websites

Fresh from the field, Design Assembly — Article

DHW Lab — Project Page

Conference Paper D4H Melbourne —

Nick Hayes talking about the project at UX Homegrown 2017 —

Stuff News Article —

AUT News Article —

Talking Minds research featured as a case study in