Design for the psychiatric care in Helsinki
The aim of the 8-weeks collaborative concept design project for psychiatric care in Helsinki was to find opportunities for design intervention to improve the care environments, practices, and image. The project was initiated as a pilot in a more extensive program, 365 Wellbeing, Aalto University’s main project for World Design Capital 2012 (WDC12) Helsinki.
The big AHA! from the research was that there is no such a concept of ex-patient in psychiatric care. Due to various difficulties, patients can always come back to where they were with their mental illnesses, and therefore rehabilitation activities offered by various entities including the so-called 3rd sector are as important as the care offered by health center.
The team worked together with Aurora Psychiatric Hospital and Malmi outpatient clinic both of which belongs to the city of Helsinki Health Center, as well as with many NGOs offering services and activities for psychiatric patients and rehabilitants. The result was two radically different solutions–ADLs Game, Fearless Everyday–in terms of budget, scale, and realization time.
Activities of Daily Living (ADLs) is a widely-used medical term in both somatic and psychiatric care. Some mental patients, especially schizophrenics, may have difficulties in managing Basic ADLs such us brushing their teeth and taking a shower and a patient might not even remember what a toothbrush is, or the patient might be able to say what it is not knowing what to do with it. There are also patients who are in better condition and manage to do those basic things but they might not be able to go outside to buy groceries alone.
ADLs game is designed to help the caregiver evaluate patients’ ability to pull of ADLs and to help patients practice or learn the aforementioned skills. The game consists of many cards related to different activities, and the idea is that a caregiver asks a patient to pick up cards that are relevant to a certain activity, to put them in right order, and to explain each step and how he/she would do it. Patients in better conditions can practice Institutional ADLs: how to use the public transportation step by step starting from determining the items one should have with them before leaving home, how to interact with the bus driver and how to buy a ticket. The game also can help patients be more confident outside of home.
This game also brings value to the caregivers who can use to evaluate patients’ ability to perform ADLs. It makes it easy to monitor the progress of the patient. Playing this game the nurse can naturally pull of much conversation with a patient, which also will help develop verbal skills of a patient.
A prototype of the ADLs game was created and tested with a nurse and a few patients. We got a positive feedback from nurses in Malmi outpatient clinic as both the patients and nurses considered playing the game to be fun and useful. Now other teams in the clinic are demanding them.
We believe ADLs game can easily be an open source, public domain project by incorporating some recent technology and well‐considered logistics. If the card game shall be used in a more rugged working environment just like in the home care team in Malmi outpatient clinic, we believe it shall be printed on a proper paper and cut nicely so that caregivers can use it more easily. The game has a good potential to be developed into a board game or more complex set tasks for rehabilitants. As Professor Keinonen mentioned the ADLs game can be developed further throught a masters thesis by one of the Aalto students.
Peloton Jokapäivä, Fearless Everyday in Finnish, is a branded union for 3rd sector organizations as for psychiatric rehabilitation that is similar to commercial food chain where one easily knows what to expect. The difference is that every 3rd sector organization participating in the brand still keeps activities of their own strength. As to the brand’s promise a standard is to be met such as an open kitchen, a volunteer worker who helps rehabilitants cook for themselves, and two or more professional care givers from different sector.
Peloton Jokapäivä has cooking at the core. Cooking works “carrot and stick” for the psychiatric rehabilitants as the vast majority of them are financially marginalized and live with unhealthy food everyday. Peloton Jokapäivä offers open kitchen area where rehabilitants can come, pay little money, and cook for them selves with helps of volunteers and the NGO staff. Volunteers will eventually be change agents in the society reducing stigma and raising private fund for the brand.
Peloton Jokapäivä is a nation-wide 3rd sector organizations brand that can be adopted by any local NGOs offering rehab activities. The member organization can take part in the brand while keeping the activities of their strength. The open kitchen is right adjacent to the other activity area, so that rehabilitation activities are more easily exposed to all the participants.
There will be also care professionals from different sectors being casually available for patients and also for each other, which is will eventually enhance the care practice in general by having caregivers in different area learn from each other.
Above is the visualization of a typical Peloton Jokapäivä premises. One can see the staff of the local 3rd sector organization on the red sofa talking to a rehabilitant. Behind, a friend of the rehabilitant is coming with a bowl of salad, which she just made with the volunteer in white. The volunteer worker is about to bake buns and a rehabilitant with the rehabilitant in black. There are a social worker from the municipality and a doctor from an in patient clinic talking to each other as all the rehabilitants are having a good time. Finally, there is a knitting activity is going on behind the door which anyone can take part in.
Tools for information
An informative website will be designed for all the stakeholders. Most importantly, any rehabilitant can type in his/her postal number and will be able to find the nearest Peloton Jokapäivä premises. When clicked, the point on the map shows also the other rehabilitation activities by the local organization. Leaflets for local information will also be published every once in a while to help rehabilitants take part in other activities at a little further locations.
As the income of rehabilitants is marginalized the accessibility with the public transportation is critical. All Peloton Jokapäivä branded 3rd sector organizations shall be easily approachable by public transportation, and Peloton Jokapäivä will not only helps the organization have the open kitchen, but also will help their relocation if necessary.
Peloton Jokapäivä is to be built from grass‐root level and up. In the beginning, two third‐sector organizations with already existing kitchens are involved. Two full‐time workers would be needed to get the organization to operate. Volunteers play an important role in Peloton Jokapäivä, especially in the day activity premises. We want to make the participation in voluntary work as easy and fun as possible. Initially twenty volunteers are required if one would spare a couple of hours a month.
In ten years we hope Peloton Jokapäivä will have become a recognized brand nation-‐wide, having roughly 70 premises in over twenty cities, employing some 50 paid staff and recruiting over 2,000 volunteers.
Some 70,000 euros was estimated to be required from the beginning to help participating 3rd sector organizations get proper kitchen, and as Peloton Jokapäivä expands throughout Finland, the budget in 2020 shall be some 2.8 million. The fund comes entirely from RAY and municipality in the beginning. Our goal is, however, to get the majority of fund from private donors. Hopefully by 2020 60% of the funds come from private sector, 20% from RAY, and 20% from the municipalities.
We believe the scenario is probable as many largely branded organizations such as the Red Cross and The Club House succeed to receive help from private sector not only in monetary forms but also in form of products and services.
The future of the Peloton Jokapäivä, however, is in question when the ownership of the problem–the missing middle–is taken into consideration. Mikko Huttunen, one of the rehabilitants working hard for Klubitalo Sörnäinen, has become interested and asked the team to send the presentation material to him.
Collaboration with Ida‐Maria Kivelä(FI), Ilmari Mansikkamäki(FI), Lin Pei(CN)