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Nudge Mental Health: Designing choice architecture through meaningful conversations

In 2010, I took on the position of Head of House in a large secondary comprehensive school in North London.  A major part of my work since then has been supporting young learners who are experiencing difficulties with their mental health.

 

As a teacher of psychology, my classes often have a significant cohort who take the subject in the hope that it might shed some light on a personal issue, or one that was being experienced around them.  Previously, I was not as perceptive to their needs as I could (or should) have been.  Whilst I wouldn’t be dismissive, I didn’t understand the causes, the impact or the consequences that poor mental health could have.

 

Being trained as a teacher, mental health was simply not discussed as a phenomenon that would be prevalent in the many learning environments.  This is not to suggest that it was completely neglected.  On the contrary, I attended several sessions where self-harming, diagnosed cognitive conditions and dealing with learner disclosures were all addressed.  However, these were treated as exceptions to what was normal.  As a teacher, during the year, or during your career, you may expect to deal with some of these instances – and it is on this basis that I assumed things would pan out.

 

Nine years on, the landscape appears to be starkly different.  Within this time, I have worked in four different leadership roles, all with a significant pastoral responsibility.  From my own perspective, it seems as if each year, more young people are dealing with challenges around their mental health.  A teacher entering the profession now would expect to encounter a young learner who is struggling with their mental health and be surprised if they didn’t.

So, what’s changed? 

 

Awareness:

Just as I was not aware of the impact of poor mental health, I think it is fair to say that young people too did not have as much of an awareness.  Indeed, the term ‘mental health’ was not as prevalent in professional vernacular for teachers and learners alike.  As we have become more aware, we have also become more confident in speaking about our personal issues.  Only last week, I had an email from a learner asking if they could ‘meet to discuss my [their] mental health’.  I think this increase in awareness and understanding has empowered more to identify and disclose compared to ten years ago.  However, our ability as a teachers and leader has not advanced in line with the rate of demand.

 

Technology:

An increasingly globalised, connected & technologically enhanced world of course has many benefits.  One of the side effects has been our ability to adapt our practices to keep pace with this change.  I include ‘our’ in its widest sense.  Parents, teachers, friends, siblings, employers, employees… We have all faced the challenge of balancing the benefits of what technology has brought us whilst trying to mitigate its harm.  The impact of technology on our ‘self’ has been rapid, broad & deep:

 

  • Self-worth linked to Instagram likes

  • Social worth linked to status in a social media group

  • Aspiration linked self-made / ‘found’ internet sensations

 

 

The depth of the impact can be seen in our habits.  In January 2007, Steve Jobs brought us three things:

“A wide screen iPod with touch controls, a revolutionary mobile phone and a breakthrough internet communications device”

 

This was of course the first iPhone. In 2007, just over 1.3 million devices were in use.  Eleven generations and twelve years later, it is estimated that 1 billion iPhones are in simultaneous use. This does not include Samsung  or other smart devices!

 

We can all reflect on our personal experiences of how the smart phone has changed our routines.  CD players, TVs, alarm clocks, navigation, reading, writing, cameras, talking, messaging have all dramatically been altered through integration.  I am a great fan of these advancements and am not suggesting that we give up our phones.  However, we cannot doubt that smartphones have had a profound effect on the way we live.

 

Only last week, I read an article by Kevin Roose: How I Ditched My Phone and Unbroke My Brain, whereby he takes us through his journey of overcoming his ‘phone addiction’.   Last year, my blog Connect by Disconnecting looked at changing the choice architecture to improve habits with your smart phone – particularly to create more time for others.

 

 

 

No doubt these significant technological changes have also impacted to our health and wellbeing, positively and negatively.  Whilst looking into this, I was curious if there was an evidential link between smart phone usage and mental health.  Interestingly I found that as the number of smart phone devices has increased, so to have disclosures in mental health conditions.  As a teacher of psychology, I must point out that this is a loose correlation.  I cannot say that smart phone usage has caused an increase in mental health disclosure.  However, the link is apparent and I think should be taken in consideration when speaking to young people about mental health.  Indeed, I doubt the graphs are a surprise.  Personally, I did not realise that iPhone usage was approaching 1 billion devices!

 

 

 

 

Solutions:

Of course, there is no single solution to such a complex problem.  However, I believe ‘choice architecture’ has a powerful role to play in enabling us to take greater control of our mental health.  For those of you new to Nudge Theory and choice architecture: paying attention to structures around us, adapting them where necessary will allow us to make better decisions, for example, keeping your mobile phone in the boot of your car (when you are driving!).  From a personal perspective, Nudge Theory and choice architecture in particular has reshaped the way I view problems and solutions from a learner, teacher and leadership perspective (www.teachernudge.com).

 

As a leader I have worked with my teams to create professional development sessions on how to enable learners to make better decisions with regard to their phone usage in lessons, such as having a ‘Phone Home’ (this is the nudge) section on the classroom desk.  Here learners have their phone in the corner of the table, face-down & on silent (not vibrate).  Successful implementation of this choice architecture allows:

 

  • Both teacher and learner to see where the phone is

  • The reduction of the temptation to secretly check a phone that is in a pocket

  • A common respect between teacher and learner that phones will be used when it is appropriate

 

Just as choice architecture can improve our decisions in the classroom, it can also improve our choices to enhance our mental health.  I cannot remember how many one-to-one conversations I have had with learners regarding their mental health.  I do wish I had kept a record!  I would estimate the number to be in the hundreds – possibly approaching one thousand, which has increased year by year.  Within the last five years I have had an increasing number of conversations with staff regarding their own mental health.

 

These conversations have sometimes been impromptu, a learner or member of staff will pop-in.  Sometimes it is via an email request and sometimes through a formal or informal referral process.  The end outcome is that I have a good few hundred hours of conversations looking to find solutions to an individual’s mental health issue.  As a psychology teacher, I have been fortunate to teach a subject that does shed a great deal of light on this phenomenon.  I must point out and emphasise that I am not a trained psychologist and have never offered support in this capacity.  I act as a pastoral port of call whereby I listen to learners and staff and refer to professional bodies where necessary.  Indeed, a good proportion of learners I speak to are already involved with mental health organisations or their local doctor.

 

I have however developed over the years a set of processes that I use when speaking to learners about mental health that I have found useful.  It is not something that has been developed over night. Rather, it has evolved over time, through reflection, thinking about how I can improve my conversations with learners as they come to me to seek support and guidance.  I have no hard evidence to demonstrate its usefulness other than learners telling me that they have appreciated the process they went through.  As a result, this ‘guide’ is more of a reflection of what I have done over the past nine years, pulled together and ordered in a loose but hopefully pragmatic way.  In the last four years, this process has been heavily influenced and shaped by the introduction of choice architecture.

 

It has also been informed by my teaching practice.  From cognitive psychology, particularly, the cognitive method in interviewing, the SOLO Taxonomy to ensure that I can ask probing questions, and a broad approach-based view to what mental health is.  I have included an age range, only to reflect the age of learners I have spoken to on a regular basis over the last nine years.

 

Meaningful Conversation Guide for 14-19

 

This guide will cover six features of a Meaningful Conversation aimed at helping learners work with their mental health challenges:

 

ONE: Framing

Looking at the last three days and then a week, I ask the learner to ‘frame’ how their mental health has been.  I find this to be a good starting point.  It gets the ball rolling and particularly for learners who don’t like to speak straight away, gives them time to get used to the environment.  I simply, let them get on with it and it takes between 2 – 5 minutes.

 

TWO: Knowledge & Understanding

With the above in mind I then talk to the learner about mental health in general terms.  I like to present mental health on a spectrum.  I go on to explain how everyone has periods of good and poor mental health & that it is rarely fixed.  For older learners, I talk about the many factors that influence mental health:

  • Biology

  • Cognition

  • Environment

I then go on to give a summary of what ‘normal’ / abnormal means.  From a psychological perspective I present three definitions:

  1. Statistical – defining normality in terms of what majority do

  2. Functional – defining normality in terms of being able function and engage

  3. Conforming – defining normality in terms of how we conform to societal norms / beliefs about mental health norms

I have found the above process particularly powerful in getting learners to understand mental health as something that is common, is normal and is something that can be managed.  This is something I first noticed in the classroom when teaching psychology, so much so that learners suggested we run an assembly for others, which again was well received.  The very notion that there are different definitions for what is ‘abnormal’ allows learners to see that it a complex area. 

 

THREE: Mode-Continuum of Feeling

Once the learner has an understanding of how ‘normality’ could be defined, I present them with a mode continuum of ‘feeling’.  Its purpose is to visually simplify the concept of having a ‘balanced’ approach towards our own mental health.  That at times we will feel negative and positive and that on reflection, most of our experiences will occupy a ‘balanced’ space.  This has been a useful tool in breaking down what I believe is a misconception, that if I am not happy, then I am sad:

 

I think this view has been perpetuated with the development of social media as well as trends in mainstream media.  Instagram profiles, for example, tend to exemplify extreme positivity.  Notions of how to be successful in shows such as the X Factor or I’m a Celebrity put forward a binary proposition that either you are successful or not.  If it is mundane then it is not worthy of attention.   Yet, life is more interesting than this and the mundane has much meaning.

 

Sometimes, I ask the learner to revisit the framing activity and use the terms within the mode continuum instead of the ‘very poor – very good’ range.

 

 

FOUR: Meaningful Calendar

Within the last five years, much work has gone into the notion that being bored is good for you.  This is against the backdrop of the environment around us which tends to promote a ‘go-go’ life style, where staying still is going backwards.  There is evidence to suggest that staying still, becoming bored, engaging in what does not appear purposeful can actually improve your wellbeing.  The key difference, is our approach to handling ‘dead-space’, or what I term, the ‘void’.  We all have times in the day when we are doing ‘nothing’.  Over the last thirty years, filling this ‘nothing’ has become much easier and perhaps this isn’t such a good thing.

 

When speaking to young learners, I ask them to think about ways of ‘creating meaning out of the meaningless’.  Critical to this process is using a ‘Meaningful Calendar’.  I have found that asking learners to take ownership of their time is fundamental to them understanding that they can actually control more than they think.  The calendar is completed outside of the meeting and is shared with me and other key stakeholders.  Importantly, I say to learners that ‘I’d rather you have a calendar that you poorly follow compared to having no calendar at all’.  The calendar is a fantastic tool of choice architecture.  To help shape the calendar, I ask learners to categorise their activities as well as colour-code.  There are many calendar apps, although some like to keep their calendars ‘off gird’ – even on paper!  I can hardly discourage this given what I have said so far…

 

The categories act as a way of taking control and adding meaning to a period of time.  Learners can add/adapt or remove categories to suit.  Below are my broad categories that I share (learners choose a colour for each).  For the purposes of reflection, I have included below the contrast of an empty calendar, a part filled one (typical of a college or sixth form) and a 'meaningful calendar'.

 

  • Lessons/compulsory times in school/college

  • Self-directed study time – voluntary

  • Employed work

  • Family commitments

  • Sports commitments

  • Social activities

  • Sleep

  • ‘Me time’

 

As have I stated in my blog on time-management, we only have 168 hours per week.  For a young learner, they should be sleeping for around 60 of these.  Adding in school and other things that ‘have to be done’, you can then see what you are actually spending your time on.  I deliberately give this list to all learners.  It prompts reflection.  For example, if you don’t have any sporting commitments, would it be useful if you did?  Do you identify any time in the week for you?  Do you identify time in the week when you will help others?

 

For the majority of learners I speak to, this process works reasonably well.  They are able to have a measurable action of creating a Meaningful Calendar which can be shared with those who can check-in with them.  However, I have come across a fair few learners who require further support, i.e. where the calendar isn’t enough.  Typically, this happens where there are large ‘voids’, blanks where they struggle to identify what the time is actually used for.  Breaking this down, I have found they are often doing something passive; on their phones, watching series/films, playing computer games, sleeping/lounging – generally not doing much.  It is for these learners that I look at their choice architecture at a deeper level.

 

 

FIVE: Deep choice architecture:

The vast majority of decisions we make are automatic.  Driven by our autonomic-nervous-system, we have evolved to not pay attention to things that our brain can simply get on with.  From breathing, to walking, even to knowing your route to work, there are things that we do that require little neurological effort – often referred to as the fast part of our brain.  Indeed, we have all got to work, not remembering the actual journey and this is the basis of habit formation.  Where something routine has become so engrained, to the extent that it has become habitual.  Both useful and less-useful habits form and this is the power behind Nudge Theory.  Planned nudges work at our autonomic, subconscious level, allowing a person or group to make better decisions.  Effective nudges are underpinned by strong choice architecture.

 

In terms of our young learners, I explore with them the choice architecture around their ‘voids’.  What is it that causes them to enter the void?  How can we design the choice architecture to ‘nudge’ them out of it?

 

 A common issue that learners present is poor attendance.  Getting ready, leaving the room, the house becomes a functional issue.  In these cases, I ask learners to reflect on their routines and habits that lead to them entering this ‘void’.  Is there anything that can be changed?  One learner for example, realised that their routine after waking up was to check their phone.  This routine became an engrained habit, one which would led to them staying in bed far longer than they had planned to.

 

Another learner reflected on how they would be the last person in the house, in their pyjamas with the TV on.  This was their weekly routine.  Alone in the house in the morning.  Once these routines have been mapped and identified, simple choice architecture can be applied to break the routine.  Here the choice architecture acts as a reset.  You cannot use your autonomic nervous system so readily and therefore have to make different choices.  In the cases of the two learners above, having the phone outside the bedroom stopped the routine of waking up and checking social media.  The other learner decided to immediately have a shower and get changed before their mum and brother had left for school.

 

These are not miraculous cures and I must also re-emphasise that I always refer learners to support services.  My point here is that understanding choice architecture, looking at how it can enable you to make better decisions is a powerful way to increase a sense of ownership and meaning.

 

SIX: Ownership & Symbolic Action

Choice architecture alone isn’t enough.  You can design the building, but you need a few things to help you engage with the process.  For some they can rely on will-power.  However, I like to promote a collaborative approach in implementing the newly designed environment.  I tell learners that all challenges can be resolved, but not always alone.  It’s something that I genuinely believe in and I think is a useful mantra to hold on to.  No matter the problem, there will be a solution and you will certainly play an important part.  But don’t feel as if you must do this in isolation.  Seek out and use any resources that can help you: family, friends, community, books, professionals.  Supporting the choice architecture is just as important as the architecture itself.  To continue the analogy, great choice architecture is built on solid foundations.

 

In the case presented above; the learner’s mother would go into their room and take the phone out (this was agreed to be part of the architecture).  The phone would be put on the kitchen table, meaning that the learner would have to go to the kitchen first thing in the morning.  For the learner who would struggle to leave the house, family members were aware that having a shower first thing was part of the strategy and were supportive of this.  Of course, these are cases where there are supportive structures.  However, my point is for these structures to be identified and utilised.  This ensures that the learner is not the only person who owns the choice architecture, it is shared by the community around it.

 

I like to attach a sense of symbolism to the new choice architecture.  For me, this represents the beginning of a mindset shift that, we can control more of the architecture around us to allow us to make better decisions.  Recently, a learner re-organised their bedroom.  They did so from the perspective of having a clear space to sleep, a space to work and a space to change.  In essence the room is the same, it has the same furniture, however its placement now has a sense of meaning and ownership.  They have designed their bedroom to work for them.

 

In sum:

Mental health needs are becoming more pronounced and I believe will continue to.  I believe that through meaningful conversations we can allow more learners to take greater ownership of their choice architecture as well as educate the surrounding community on how to support this process.

 

 

 

 

 

 

 

 

 

 

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