A social entrepreneurship seeing the very poor as customers using 12 mental health design principles
People with disabilities in the United are the poorest of all minority groups. People with mental health diagnoses are the poorest of all people with disabilities, so we are the poorest of the poor in our country. It’s important to keep this in perspective, though, because the poorest people in the richest country in the world have a different set of challenges than the 3 billion people on our planet that live on $2 a day or less. This handy website lets you put in your salary, and figure out where you are on the Global Rich List. A $540 per month disability payment still is in the top 14% of all world incomes. So keeping this in mind, what can we learn about creating mental health design principles to alleviate poverty?
First of all, ask us. The slogan of our mental health civil rights movement is “Nothing about us without us.” Here is an excellent video about how to approach problems in handling poverty from Paul Polak. In his book, Out of Poverty, Paul Polak says that leading economics professors would say that poverty in developing countries comes from war or income inequality, or poor legislative agendas, or bad infrastructure. Recently I talked about how the recovery movement IS the cure for mental illness, and getting our stories out there with correct mental health outcome statistics is essential.
What Paul Polak found is that when he would talk to the farmers, they would say, “I’m poor because I don’t make enough money.” Thus the solution was to help people make more money using entrepreneurship training, and in his case, small scale irrigation system so farmers could grow high value vegetables instead of low value grains.
Why we need new mental health design principles: Many in our community are unaware of programs like Ticket to Work that help people make money and not lose disability benefits. I think entrepreneurship is the way out of poverty for many folks with disability since we have some of the cheapest labor costs in the United States. People on disability can write a PASS plan that allows them run a business and possibly earn income from self-employment for three years before it counts against their disability. Although these ideas have good mental health design principles, they don’t reach nearly enough people because they lack effective marketing.
The timing is right for new mental health design principles. John McNammy from Knowledge is Neccesity says, “Right now, there is a perfect storm of convergent factors: 1) The brain science offering alternative and more authoritative answers than psychiatry to human behavior; 2) The recovery movement; 3) Pharma getting out of the game due to no new meds and loss of patent protection for the old ones; 4) Major funding cuts everywhere, and 5) A psychiatric establishment that has run out of ideas. Things are realigning all over the place. Who knows where the dust will settle? But things are definitely changing.”
I would add to this that social messaging is giving common people and psychiatric survivors a marketing ability equal to or greater than some of the existing forces that allowed the Disability Industrial Complex to grow.
To tackle our issues in the face of current budget cuts, we need much better mental health design principles focused around our needs. I’m going to show a brief modification of the 12 principles of program design for very poor people. This is adapted from C.K. Prahalad’s the Fortune at the Base of the Pyramid which talks about how to market products for the very poor.
12 mental health design principles (adapted from C.K. Prahalad):
1. Focus on (quantum jumps in) price performance. Sometimes the product must be 30 times cheaper. This is possible in mental health if peer support, which has been shown to be most effective, comes first. Then expensive diagnoses and medications can come last because these help some people, but not everyone, and may be why we are increasing disability in our country.
2. Blend emerging technology with existing technology. We are wanting to create a video based warmline that uses Google’s Gigabit 100 times faster internet. This will only be available in Kansas City. I need lots of help with ideas for how to update mental health design principles, so please let me know your ideas.
3. Scalable solutions. Many peer provided programs have higher recovery rates at lower cost than traditional mental health services, but our programs haven’t grown because they don’t pay for themselves. I want to create a self-funding mental health system where we are customers, not benefit recipients. Because this program is self-supporting, it can be expanded indefinitely.
4. Reducing resource intensity – peer supporters at the initial stages of mental health contact mean much lower labor costs. Helping people in their own communities rather than building additional facilities both increases community engagement and reduces building costs.
5. A deep understanding of functionality. My job is not to get people into the mental health system, my job is to get them out. Complete recovery is our desired outcome, not a lifetime of medications, therapy, supported housing, and charity.
6. Process innovations are critical. We are using people that are so recovered that they no longer have contact with the mental health system. Previous mental health design principles miss these “escapees” and instead peer programs rely on people still on disability or advocates who have committed to a lifetime of reforming the mental health system. Finding “escapees” means that we have role models that have already built a life outside the traditional supports.
7. Deskilling work is critical. We plan to use peer specialists, volunteers, “escapees” and other people with less mental health specific training and thus less barriers to overcome about the true possibility of recovery.
8. Educate customers in product usage. This is the most important part of our mental health design principles. We need to get the word out that recovery is possible, and lots of people can come to a place they no longer need mental health treatment.
9. Products must work in hostile environments. Grameen Bank gave very small loans to street beggars and found an excellent repayment rate. Living in disability is tough, and many of our brothers and sisters are homeless or out of touch due to phone or internet bill paying issues. We also have the tendency to drop out of social contacts when we are feeling overstressed.
10. Research on interfaces and heterogeneity is critical. We plan to keep strong contacts with African American communities as well as LGBTQIA (gender identity), women’s, Hispanic, and many of the other oppressed communities in our city and country.
11. Distribution methods designed to reach both highly dispersed rural markets and highly dense urban markets. – We plan to use social messaging, video and phone conferencing, and other ways to access geographically disperse people like the “frontier” regions in Western Kansas.
12. Flexible platform to add new features – Who knows what will help people to recover in the future?
What do you think are the best mental health design principles being used in our country? Which current programs are the best models?