#Weeknotes 45 (26 Nov) — Consequence of systems-led vs user-led services

This week for work, I interviewed people with varying mental health needs and learned about their experience accessing NHS health services to receive mental health support.

It wasn’t a surprise that all of them had very different experiences with the NHS in getting the care they needed. What they all had in common was the shared feelings of frustration, worry, anger, and helplessness in their interactions with different health services.

And the cause of such anxieties is often attributed to the health care system trying to fit patients within its rigid and established service structures rather than looking at the needs of the patient and then adapting support services around them.

What does this look like?

• Situation: Someone who needs ongoing therapy getting told they can only receive 12 sessions because there’s a long waitlist
  Outcome: After 12 sessions, the person loses support and the risk of deteriorating mental health increases
• Situation: Someone in need of specialised mental health support only to be rejected of that support due to being pregnant and not fitting into their patient profile
  Outcome: The person gets denied the support they need and is left to manage on their own which increases the chance of them going into Crisis
• Situation: Someone with a diagnosis of personality disorder and gets put on the waitlist for 5 years to get support
  Outcome: Mental health is left unmanaged which leaves the person vulnerable and unable to cope on their own and thus puts their health at risk
• Situation: Someone with complex health needs gets support from multiple care services and has to manage communication between these services because they don’t share information amongst themselves, leaving the patient to be the middle person to be on top of their health situation despite them not being in a good place to do so
  Outcome: They forget who they need to see and when. When they miss appointments, they risk being ‘kicked out’ of the care support they rely on
• Situation: Someone with lived trauma has to repeat their history every time they see a new health care provider because critical information isn’t being passed on
  Outcome: Patient becomes reluctant to receive health support in fear of reliving trauma and don’t get the support they need and further putting themselves at risk

This comic illustrates another example of how people don’t get adequate care and are often left to manage health on their own even when they are unable to. Comic credit to Randy

The above are just some stories shared by those I spoke with. I can’t help but feel their helplessness in trying to get the support they need in a rigid system that seems to keep them out rather than in. And this idea of trying to fit people in boxes reminded me of an earlier post I wrote on Design for people, not systems which captured highlights from a talk delivered by Jennifer Briselli. Efficiency and effectiveness can’t happen when we take the human out of the equation in delivering services. Great services always put their users at the heart of delivery. Only that way can they remain valuable and relevant.

While NHS recognises the need to move towards a more patient-centred care model, they know they still have a long way to go to break from the rigid systems and established ways of working. This makes the work for us service designers all that more challenging but also rewarding as the impact of delivering health services in the right way is immense: better health outcomes for all. I’m glad I can contribute albeit a small part to that future.