Closing the Mental Health Understanding Gap
By Nathaniel Hundt & Ethan Axelrod. Graphics by Gerre Mae Barcebal.
Imagine you are a physician starting a virtual visit with a patient. “I have been having trouble sleeping,” the patient begins. “Perhaps I haven’t had enough exercise. But I’ve been trying to meet a project deadline,” they continue. “Yesterday, in the middle of a meeting with a coworker,” they say, “my heart began to race. Cold beads of sweat began pouring down my underarms. I felt like I was having a heart attack.”
“Hmm,” you muse, taking a pause to consider details of the episode before adding, “I’m not sure it was a heart attack. But it sounds like you might have had a panic attack.”
“A panic attack?! Really? Is this going to happen again?” the patient asks. You try to be reassuring, offer comfort, and provide an explanation of how panic attacks can mimic the symptoms of a heart attack.
Meanwhile, you observe the patient is jotting down everything you are saying. You empathize with them. Perhaps they never thought they might need therapy or could benefit from mental health support — things you are explaining. You can tell your suggestions may be overwhelming.
This scenario is one that we at Dr. Katz have heard countless times from patients and providers, alike. It may be a situation you’ve experienced or can relate to. The question is, what can be done to bridge the mental health understanding gap between patient and provider?
Last year, when we asked two dozen mental health providers, including social workers, nurses, psychologists, and psychiatrists, to identify their biggest professional challenges, the second-most frequent survey response was around this very problem of information-sharing.
Providers told us how, pre-pandemic, they shared informational materials in face-to-face environments, ending appointments by handing over highlighted materials to reinforce key discussion topics. But during the pandemic, providers were not easily able to share copies of physical books or distribute articles to patients just learning about cognitive behavioral therapy, how antidepressants work, or how to deal with challenging behavior from their children. Providers were instead spending hours scouring the Internet, reviewing online articles and YouTube videos, building lists of appropriate resources for patients and caregivers while also reviewing links sent to them by patients, trying to determine an evidence-basis where too often there was none. The necessity of providing accessible, trusted information was becoming an unmitigated burden.
Even when providers were able to share information securely with their patients, they had no way to know if their patients understood it. Providers were left wondering: Is this even helpful? Was the information easy to understand? What does my patient really want to learn more about? How can I provide this support more efficiently?
The upshot was clear. But to promote better patient outcomes, we knew we needed to empathize more with the patient experience. We dug in to learn about the barriers and obstacles to education and engagement and find ways to overcome them.
Today, in the collaborative spirit of building a healthcare learning community, we are open-sourcing our findings with respect to patient education.
We hope this information helps organizations interested in providing welcoming patient experiences and equipping clinicians with easy-to-use tools that eliminate friction and improve the quality of care.
1) Health systems and providers can introduce mental health care to patients using video-based education
Those seeking mental health care often feel alone and overwhelmed. One way to make the process less overwhelming? Accessible, assignable video content. People are used to video consumption in nearly every facet of their lives, from Netflix entertainment to FaceTime family catch-ups and Zoom-based work and school. After viewing sample patient education videos, participants are nearly unanimous in their belief that a healthcare network providing this content could improve the way they choose a clinician, incorporate mental health practices into their own lives, and understand treatment options.
2) When instructional design techniques are incorporated into videos, they will feel more concrete
Patients prefer advice that helps them make sense of information. This can be accomplished by giving patients specific action items, such as contact information or takeaways at the end of videos. Animations and text-on-screen graphics that call out key terms, provide layman definitions, and suggest clinical tips are useful. Helping providers understand when videos ought to be shared — before visit versus post-visit — can also help contextualize information.
3) Electronic resources can supplement what patients might get during visits
There’s a strong positive reaction to videos that give practical advice for people to implement in their lives. For example, people want to know how to practice self-care, incorporate yoga into their lives, and have better, more frequent conversations with their children. They also want the ability to let their providers know what they thought of video assignments. The feedback loop matters and gives patients a means of collaborating with a care team asynchronously.
4) When providers reveal a bit of personality in videos, they build trust and rapport with patient viewers
When clinicians introduce themselves at the beginning of videos, it humanizes and personalizes them. While patients appreciate hearing about clinicians’ credentials, white coats are not always needed to establish credibility. Instead, anecdotes and stories help ensure clinicians’ advice is well-received.
5) Taped conversations between doctors will hold patients’ attention
Patients preferred videos where the clinicians appeared unscripted. Patients appreciated seeing multiple people having a dialogue. This format was described as casual, approachable, accessible and relatable. Viewers found that it personalized care and seemed more engaging than traditional conveyance of information.
6) Educational materials should feature a diverse group of clinicians
Several study participants told us that their biggest challenge seeking mental healthcare has been finding clinicians with whom they feel a connection. One woman shared that finding a black clinician has been her most significant barrier. In this context, patients show interest in learning from female presenters and people of color.
7) Videos should avoid overly clinical, complex language
Offering sources, citations, studies, and tips on additional resources can be useful for patients and care partners. This information adds credibility. However, videos loaded with statistics may be criticized for being “too clinical.” It’s a tough balancing act when thinking about content creation, but a single video shouldn’t attempt to say everything to everyone, nor should it be expected to cover each nuance of an individual’s conditions or lived experience.
8) Videos offering hope are viewed favorably
When patients are trying to learn more about their illness, understand how to recognize symptoms, and consider side effects of potential treatments, they often feel stress. Positivity, encouragement, and empathy go a long way. Videos that include music and purposefully incorporate b-roll can create this effect, while not sacrificing authenticity.
9) Patients prefer short, focused videos
Videos ranging from one-two minutes in length were met with higher percentages of our study participants agreeing that they were the appropriate duration, as well as more positive overall engagement. Participants felt it was more difficult to maintain attention throughout longer videos, even while they were generally appreciative of the content. This means that where possible, creators should try to break down large topics into shorter videos covering subtopics in bite-sized chunks.
10) Videos can confront social stigma and touch on current events
There exist many misconceptions and stigmas related to conditions, ranging from anxiety and depression to bipolar disorder and schizophrenia. When presenters are explicit about the dangers of misusing specific terminology, such as “psychosis,” viewers are able to infer how this could be useful to caregivers or others who know people that may be experiencing symptoms described. When asked directly what topics they’d like to see, patients mention PTSD, suicide, climate anxiety, and mental health issues caused by social media usage. These responses speak to an interest in having resources that shed light on stigmatized topics and issues they may be learning about in the news.
Above all, listening to and learning from both providers and patients reminds us how important it is, especially when designing enterprise software, to consider everyone’s perspective. We need to empathize with people’s feelings, as well as investigate the sources of frustrations. When we, as product builders, are intentional about creating an inclusive design process, we elevate the mental health experience, increasing access with an improved quality of care for all.
