This graduation project explores how the concept of problem sustaining interaction (PSI) patterns in mental development in adolescence can be used for design. In contrast to the currently used Diagnostic and Statistical Manual of Mental Disorders (DSM), which describes psychiatric disorders from only a psychological perspective, the concept of PSI-patterns describes mental health problems as interaction problems. This new holistic approach incorporates interactions within the individual, but also those between people and their environment. To concretise the concept of PSI-patterns, I used the knowledge of system theory. From the research is concluded that factors on multiple levels influence each other; from biological to cultural. The factors in a system form loops that together reach an equilibrium. PSI-patterns consist of smaller, reinforcing feedback loops of which multiple together cause a system to move towards a problematic state. Changing a system requires effort and outside support. By making the patterns insightful, it becomes clear what strategies can be used to create positive change. The physical, social and psychological changes during adolescence make them particularly vulnerable to develop mental problems. There is a taboo around talking about mental health and society turns a blind eye. This causes adolescents when they struggle mentally to feel abnormal and alone, to lack knowledge and understanding to talk about their struggles and to feel not taken seriously when told that troubles are ‘just part of life’. To support adolescents in their mental development I introduce the design concept “The Bumpy Road”. The Bumpy Road supports adolescents to learn to understand their feelings by recognizing them in others. It is a platform with a variety of podcasts in which adolescents share personal and authentic stories about times in adolescence where they struggled. The problematic patterns of the storyteller are unravelled and explained to listeners in conversation with a pattern expert. The patterns that are discussed in the podcast are linked to other stories on the platform that include their version of the pattern. By making patterns insightful, listeners understand why problems keep occurring and get direction on how to navigate towards a more sustainable situation. The Bumpy Road teaches listeners the language to talk about struggles, normalizes them and provides advice on how to help themselves or support others. This project brings PSI-patterns from a conceptual level towards a concrete and validated design service, and thereby proves that PSI-patterns are a suitable framework for design.

This project’s research question is: How is society able to organize a mental healthcare system, that serves people’s individual care needs and is collectively economically viable? This research question regards a business model on a system level and the hybridity is reflected in the tension between the individual interest of fulfilling a care need and the collective interest of keeping the system economically viable.

In the healthcare system before 2005, care providers had freedom to match their care to the need of clients. The insuring institution, mainly the government, paid for the provided care, based on the care provider’s activities of last year. As the costs for care provision kept on growing, it was decided to put more focus on controlling the costs. Now, insuring institutions can contract care providers and negotiate on “care products”. These care products contain a certain diagnosis and treatment trajectory for a certain price. As care providers must act within the rules of this system in order to cover their expenses, they are less able to match their care provision to the client’s need. Furthermore, the administration that insurers require from care providers result in high system costs.

So what if there would be a stakeholder in the system that intertwines the collective interest of the economic viability of the system and the individual’s interest of fulfilling a mental care need? To embody this role, a new stakeholder is proposed called the “care scout”.

The care scout fulfils a special role. He must understand what a client needs and matches the client with appropriate care. He must not solely act from the client’s care need, but also from the perspective of what that care will cost. So he should independently determine the right price and quality. The care scout is a generalist specialist on mental care. Someone who is able to oversee the full spectrum of mental needs, and even aspects that influence that mental need.

If the care scout thinks help is needed, he will explore what further explore the client’s needs. The care scout will stay involved in the client’s process to adjust the care provision in such a way that the client will have sufficient result of the provided care. Once the care provision ends, the care scout will see that the care provider is being paid for his effort and will document the made match and its result in the learning system. This accumulated knowledge will support care scouts to improve future matchmaking.

The client’s incentive to do his work properly is incentivized through client feedback and through the costs of the called in care provision stated in the digital system. Supervisors will regularly assess the care scout’s performance.

The system is designed to drive sufficient result by dynamically adapting care provision to a client’s unique need and by decreasing ineffective care provision, through ongoing involvement of the care scout. Documenting match results and evaluating the performance of the care scouts, will improve matchmaking and the affordability of care over time.