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This is a place for digital teams in the NHS to work together and develop the NHS digital service manual.
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"Mental health", "mental illness" and tone for mental health content #244

Open amyj2110 opened 4 years ago

amyj2110 commented 4 years ago

What

Guidance for how to talk about mental health. How should we say "someone living with mental illness"?

Why

I have been working on the urgent mental health crisis pages and found it difficult to know what to write when trying to recruit users. Do I say "mental health conditions"? It would be good to get some advice in the service manual about how to write about this.

Anything else

None at the moment.

sarawilcox commented 4 years ago

@amyj2110, have you seen this? https://service-manual.nhs.uk/content/inclusive-content/disabilities-and-conditions

I think it would be good to develop this further though.

amyj2110 commented 4 years ago

@sarawilcox I did! But yes, definitely good to develop as I've read different things on different websites.

sarawilcox commented 4 years ago

Feedback from a psychiatrist:

The Mental Health Act (1983) uses "mental disorder". Patients who appeal against their detention usually have a tribunal which requires written reports which the patient can see. These are likely to use Mental Health Act terminology and thus mental disorder.

"Mental health problem" can be cumbersome. Note misuse of the phrase e.g. people say “I’m suffering from my mental health” when they mean “I’m suffering from my mental ill-health”.

sarawilcox commented 4 years ago

Some findings from our recent work on mental health:

'Mental illness’ features quite highly as a popular search term that we don’t rank very highly for, but it feels quite negative and we haven't tested it against other options.

Currently we separate mental health ‘problems’ (or symptoms - such as low mood, stress, anxiety) and mental health ‘conditions’ (diagnosed) - we’ve never encountered any confusion, questions or negative feedback to these phrases in testing.

sarawilcox commented 4 years ago

Some feedback from a user: "The website MUST NOT use the term "serious mental illness" ... As shown here ... nhs.uk/conditions/hallucinations/ It is very destructive language + not in line with the NHS long term plans to move from dependence to empowerment + healthy conversations ... The term now used is experiencing mental ill health."

sarawilcox commented 3 years ago

We had a separate ticket for Softer voice and tone for mental health related service content. I'm bringing the content of that ticket into this one to rationalise tickets and will close that one.

@beccagorton182 commented:

What

Softening the voice and tone of content for services that are for people who have a mental health condition (or care for somebody who has a mental health condition)

Why

There currently isn't any specific guidance about slightly softening voice and tone for this user group. But altering the voice and tone is referenced here https://service-manual.nhs.uk/content/voice-and-tone We have created and tested new pages and services for this user group and have found that users respond well to softer content that uses words like 'please' and more reassuring content like 'you're not bothering anyone' etc. We have tested the new mental health helpline finder with around 25 users and most have responded well to softer and longer H1 form questions, rather than short questions. Users have also responded well to reassurance, and using words they would use, rather than triggering words like 'crisis'. There are other teams working on mental health services at the moment

Anything else

This has been fed back to Barnardos who are working with Snook on a designing for mental health pattern library https://www.designpatternsformentalhealth.org/pattern-library

Will also link to a designing for cognitive load issue when I've made one! 👍

sarawilcox commented 3 years ago

Also from @beccagorton182: We had a particular issue with our H1 form questions. We originally had this, but it proved quite triggering for users

Screenshot 2020-11-09 at 16 38 58

We went with this as it tested well but wasn't the best in terms of following service manual guidance Screenshot 2020-11-09 at 16 39 31

We're going to test with this for our age question and have a similarly written question for location

Screenshot 2020-11-09 at 16 40 12

Tosin-Balogun commented 3 years ago

This was ranked 2nd from the proposed group at the content backlog prioritisation workshop held on 24-Nov-2020

RoseMunro commented 3 years ago

Mental health and Pregnancy usability testing session, November – December 2020 Tested with 11 participants with varying experiences of mental health issues during pregnancy.

Potentially relevant observations:

• Where we did a search task and a participant typed the words 'mental health', they didn’t use any terms like ‘illness’, ‘condition’, ‘disorder’. o However, participants were more likely to type the name of the specific issue they were facing, such as ‘stress’, ‘anxiety’, ‘feeling snappy’ than use the term ‘mental health’.

• In one instance, a participant brought up that she didn't had both positive and negative feelings about using the term 'mental health' about herself because she felt like she was 'jumping on the wagon'.

Participant 5: “I think it’s good because we all talk about it so much now (the term mental health) but I guess, in a bad sense that you kind of feel like you’re jumping on the wagon a bit. It’s like ‘oh, another person with mental health - we’re in a mental health crisis. I feel like there is a negative connotation attached to it, and that then attaches to you as part of it. It feels like at the moment everyone has a mental health issue – there’s a mental health condition for everything and it feels like there’s no normal any more – everything is mental.”

• There appears to be a differentiation in participants’ minds as to whether somebody is experiencing a diagnosed condition or whether it's a situational/impermanent thing.

o One participant was saying how he thought the page we were looking at (Mental health in pregnancy’) was for people with a condition and people who might be feeling a bit down or experiencing something non-permanent might feel 'excluded from the conversation'. o Another participant said that she had looked up information about mental health but would not classify what she had as a condition. o Another participant said that she hadn’t thought about stress as a MH issue until she went to the doctor and was told that it was.

Participant 3: "It's more for people who have diagnosed conditions (...) you might feel excluded from conversation because you're not suffering from a strict MH disorder."

Moderator: Did you think of what you were experiencing as a mental health issue or more something that you were just feeling? Participant 8: It was more something that I was feeling – I always thought that mental health was something – I don’t know what the word is but something a lot more… hard-hitting.

P5: That keyword is such a big thing isn’t it? Because you don’t necessarily identify that stress is a mental health condition until you go through a few things and you speak to a doctor and the doctor’s like ‘you have pregnancy anxiety’ and you’re like ‘Oh!’ and then you’re affiliated to a mental health…

• And finally, one participant did not like the use of the term ‘Mental ill health’ which she thought sounded convoluted in the below sentence…

P5: “It’s common for women to experience mental ill health in pregnancy.” “Mental ill health?” That doesn’t sound right… Immediately that’s very strange wording. I would think that’s a spelling mistake. Why is it worded like that. I think that’s a very convoluted statement.

beccagorton182 commented 3 years ago

There appears to be a differentiation in participants’ minds as to whether somebody is experiencing a diagnosed condition or whether it's a situational/impermanent thing.

There's a few things that Mission Team 3 have worked on here that should support some of the feedback you gathered here.

Feelings: we have a few feelings related pages on the website that are being surfaced in the new mental health IA, in a topic hub at the top of the page, named 'Feelings, symptoms & behaviours'. The aim of this section is to help support users who may not be diagnosed, and are just worried about how they're feeling. Stress is included in this section, as well as the conditions section. This has tested well and both users and clinicians have found this useful for users who haven't got a diagnosis.

Situations: We found similar things in our card sort around user mental model and situations involving mental health. The page you tested was in our card sort, and users placed this in 'Advice for life situations and events' category. This is another topic hub that is being surfaced so that we can support users who are thinking more about the situation rather than with mental health as the forefront.

sarawilcox commented 3 years ago

Do we know of any examples of services that ask users about their mental health?

sarawilcox commented 3 years ago

A partner shared some user research with us that indicated that we should:

sarawilcox commented 3 years ago

We've had a conversation on the NHS.UK Slack about how to ask people if they're considering suicide.

111 online use "ending your life" but this is due for review. image (26)

The NHS.UK team that transformed our mental health content say:

We've used 'suicidal thoughts' in the recently-reviewed self-harm content (which also went round to a huge number of expert clinicians and charities). That's also used in the title of our health A-Z page. Both of these pages went through user testing (almost entirely adults) so I think we have evidence that people understand this term. Based on that I think it would be clear to ask someone if:

sarawilcox commented 3 years ago

The NHS.UK reviews team finds that "suicidal thoughts" is much more widely used than other terms, e.g. "ending my life" or "commit suicide".

sarawilcox commented 2 years ago

Gerard said that he'd be interested in taking this one forward.

sophiejordan commented 1 day ago

Sharing some findings from Venus team on tone of voice while writing mental health topics. We've added this to our gudiance for content designers on how to write mental health conditions topics.

These key themes came out of our user research (usability testing of mental health exemplar topics - generalised anxiety disorder, bipolar disorder and bulimia) as being important for the tone of voice on mental health topics: