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2040 2030 2020 2010 2000 2050 1990 EXPERIMENT IN REVERSE ARCHAEOLOGY: EXPLORING THE FUTURE OF MENTAL HEALTH SERVICES MAY 23 RD , 2014 EVENT REPORT

Future of Mental Health - Reverse Archaeology Event Report

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EVENT REPORT 1

2040

2030

2020

2010

2000

2050

1990

EXPERIMENT IN REVERSE ARCHAEOLOGY: EXPLORING THE FUTURE OF MENTAL HEALTH SERVICES MAY 23RD, 2014

EVENT REPORT

EXPERIMENT IN REVERSE ARCHAEOLOGY: EXPLORING THE FUTURE OF MENTAL HEALTH SERVICES 2

WORKSHOP OVERVIEWExperiment in Reverse Archaeology: Exploring the Future of Mental Health Services was a hands-on workshop co-hosted by MaRS and CAMH (Centre for Addiction and Mental Health) on May 23rd, 2013. This session was held as a part of a series of meet-ups of health innovation centres, engaging forty health system innovators, service providers, and individuals with lived experience of mental health needs from across Southern Ontario.The purpose of the workshop was two-fold:

• Toexplorethevalueofscenariosandartifactstosparknewthinkingaroundthefutureofhealth;and• Totestoutanemergingmethodthatcouldbuildmomentumandinterestinhealthinnovation.

The session was built on the understanding that the health care system can’t just focus on doing ‘the same old better’. While working to improve the current system, we also need to invest in new services and new systems that will help us prepare for the future and guide it in a positive direction. With this in mind, workshop participants rolled up their sleeves to fill bathroom cabinets with artifacts from the future using an emerging method called reverse archaeology.

In this case, the method was intended to spark imagination about the spectrum of possibilities for innovation in mental health and help participants meaningfully experience alternative futures. Testing out this method was part of a larger vision of coming together to create polished museum-like exhibit that sparks greater in interest and investment in the future of health.

Reverse archaeology is a new technique, coined by futurist Stuart Candy, where participants tell stories about future possibilities by creating objects from the future – just as archaeologists use historical fragments found to uncover the story of our past. This process bridges abstract thoughts about what could be with concrete objects to keep it real.

EVENT REPORT 3

THE VISIONThis workshop was designed to test the reverse archaeology method to inform a larger, more strategic collaborative project. The overall project vision is to bring together visionaries and game changers interested in influencing the future of health to collectively create an exhibit that would inject imagination into the health care industry and provoke investment in innovation for the future. The intention was to offer thinkers and makers a playful opportunity to get outside of current system constraints and create powerful tangible, solutions for the future. The session held in May 2014 offered important lessons to guide the larger goal of creating a exhibit that could be exhibited a well-known gallery. The overall process for the larger project is described below.

CROWDSOURCETREND ANALYSIS

COLLABORATE ONFUTURE WORLDS

SHARE THE SCENARIOS

DESIGN SERVICES FOR 2040

EXHIBITARTIFACTS

Thinkers from inside and outside the health care space are invited to identify trends influencing health services.

Using the trends identified, the collective will work together through a series of foresight and strategy methods to develop scenarios for 2040.

The future scenarios will brought to life through thoughtful and creative illustrations and distributed to interested thinkers and makers to provide context and inspiration for their service innovations.

Creators will collaborate to imagine mental health services relevant to one of the 2040 scenarios. Each participating team will build a remarkable object from 2040 that will allow others to discover the essence of their imagined future service.

These artifacts will be curated into a rousing exhibit in a setting that mimics a museum from the future. Health system stakeholders and the general public will be inspired to rethink the trajectory of the mental health system.

EXPERIMENT IN REVERSE ARCHAEOLOGY: EXPLORING THE FUTURE OF MENTAL HEALTH SERVICES 4

WORKSHOP PROCESSTo test out this process in an afternoon, a small segment of the overall vision was brought to life. Participant were placed in diverse groups and each group received a scenario of mental health services in 2034 and a bathroom cabinet. They were asked to fill the cabinet with artifacts that someone might find in the future world outlined in their scenario.

This process involved the following four steps:

1. Visit the Future: Groups reviewed their scenarios and by imagining themselves in this future world, discussed what this world might mean for people’s mental health needs.

2. Capture the Essence: Participants worked together to identify the most compelling discoveries about mental health services in this future and sketched objects that reflected these discoveries.

3. Craft the Artifacts: The groups then identified compelling objects to bring to life, built them quickly using craft supplies, and placed them in their group’s bathroom cabinet.

4. Showtime: All participants came back together to view the mini-exhibit of bathroom cabinets from the future, with brief explanations from each group.

GUIDING PRINCIPLES• Understand that useful insights about

the future at first appear ridiculous.

• Challenge present assumptions and play with the possibilities.

• Rigorously imagine the future - stretching plausibility, but not breaking it.

• Make things from the future, not about it.

• Leave something for the audience to imagine – the cabinet is a hook, not the full story.

EVENT REPORT 5

SCENARIOS The following are the four scenarios of future worlds utilized by each small group.

TALE OF TWO WORLDS

FORCES OF CHANGE

SYSTEMS INTEGRATION

PEOPLE POWERED HEALTH

VALUE-BASED CARE

SOCIAL DISTANCING

After a yo-yoing of government priorities and spending in the 20s, there are significant cuts to mental health and social services in the 30s leaving the desperate population with little government support and unimaginable waitlists. While mental health has emerged from the twilight of people’s lives, formal services are irrelevant for most. With a large population of very old, low-income boomers, marginalized and segregated minority groups in urban areas, immigrants with unmet health needs, and First Nation, Inuit and Métis communities that have been long neglected, mental health issues are reaching unprecedented levels, especially related to chronic stress. Still, meeting the basic necessities of life are a much higher priority for the majority of the population. Trained police officers are the front-line responders for mental health crises, sometimes partnering with medical personnel or peer supporters. Segregated population groups are highly networked using simple technological advances that allow for monitoring and instant virtual connection between individuals anywhere. Caregivers rarely stay at home with the individuals they are caring for, instead they connect with them regularly while at work or elsewhere. Social enterprises are creatively working to fill the government void by addressing environmental factors of health and meeting the needs of targeted population groups, making exciting progress at a small scale. On the other hand, the small group of elite in Ontario are finding ways to take advantage of exciting medical advances through private practice, personal connections or international purchasing. They are obtaining the newest technology, medications and interventions that enable real time adjustment of medications and reminders based on body and mood tracking, ensuring that mental health issues rarely interfere with functional abilities.

Illustration by: Ken Orvidas

TIME LINE

2014 204420342024INCREASING GOVERNMENT DEBT DRAMATIC CUTS TO SERVICES

STRENGTHENING OF TWO-TIERED SYSTEM

Mismanaged govern-ment spending on economic stimulus

Prime minister speaks publicly about mental health struggles

20 year wait list to see a publicly-fund-ed psychiatrist

20 jails built in Ontario in last decade years

50% of the population in Ontario identifies as having a MH issue

EXPERIMENT IN REVERSE ARCHAEOLOGY: EXPLORING THE FUTURE OF MENTAL HEALTH SERVICES 6

CONNECTED COMMONS

FORCES OF CHANGE

SYSTEMS INTEGRATION

PEOPLE POWERED HEALTH

VALUE-BASED CARE

SOCIAL DISTANCING

With early legislation to unlock electronic health records and provide open access to these records, Ontario experienced a digital health boom in the 20s that resulted in a variety of tools to support communication and collaboration between clinicians, peers and patients. What emerged from this era was a platform or commons in which almost all health information, communication and knowledge is linked, creating a virtual one-stop shop for big data and specific patient information, despite disparate applications and devices. This infrastructure enables distributed, informed collaboration between highly-linked providers, empowering all providers as well as caregivers and peers with specialized support to address mental health needs.With advanced monitoring and communication techniques, outpatient visits are a thing of the past. Most patients and caregivers connect with providers and peers through cloud medicine channels. When individuals with mental health needs do connect directly in with providers, the continuity of this relationship is less important because all providers have an instant comprehensive overview of the individual’s history and preferences, and can make informed decisions with specialized support. Ontario mental health services have become a web of networked health care providers and social service providers with protocol for instant and ongoing collaboration, reducing issues around location and strengthening service at every access point. Specialized mental providers become easily accessible knowledge supports for primary providers and informal supporters. Organizational collaboration across the health sector is incentivized, especially for individuals with complex mental health needs, through reimbursement structures that creates shared responsibility and pooled funding.

Illustration by: Ken Orvidas

TIME LINE

2014 204420342024DIGITAL HEALTH BOOM

ORGANIZATIONAL LINKAGES AND MERGERS

Ontario makes it mandatory to unlock EHRs

Pooled funding for complex patients

Patients access EHR & open access to anony-mized information

Emergence of common cloud medicine platform

All health care providers connected to special-ized mental health

EVENT REPORT 7

THE PEOPLE ASSEMBLE

FORCES OF CHANGE

SYSTEMS INTEGRATION

PEOPLE POWERED HEALTH

VALUE-BASED CARE

SOCIAL DISTANCING

As a response to the overburdened, perpetually underfunded mental health system, people affected have mobilized to support each other and enhance their power within services. Through greater access to health and medical information, patients and caregivers are increasingly informed about health choices and connect to each other for support and knowledge. Instead of stifling this emerging movement, funders and formal mental health service providers recognized the assets of the community and the economic benefits of a ‘peer positive’ approach. They responded through a shift to client-directed services, the creation of many paid peer support positions over time, a focus on group visits, connection to non-medical alternatives, and seed funding for the development of advanced community support networks. Through this recovery orientation, individuals are encouraged to build capacity for long-term self-management with support from tools and advanced social monitoring techniques. Still, individuals with complex and severe mental health issues are neglected resulting in a rise in homelessness and significant caregiver burden. The system of services remains fragmented, but individuals cope through social connection, peer navigator roles and offerings from curatorial health enterprises.

Illustration by: Ken Orvidas

TIME LINE

2014 204420342024UNDERFUNDED MENTAL HEALTH SERVICES

WIDESPREAD ACTIVISM AND CITIZEN ACTION

Legal case sets presi-dent for requirement of shared care planning

LHIN invest in peer and patient engagement

Most of patients seen regularly in group visits

Mental health riots in 6 major cities

Global MH network reaches 100 M members

25% of staff in mental health services are peers

EXPERIMENT IN REVERSE ARCHAEOLOGY: EXPLORING THE FUTURE OF MENTAL HEALTH SERVICES 8

COLLECTIVE IMPACT

FORCES OF CHANGE

SYSTEMS INTEGRATION

PEOPLE POWERED HEALTH

VALUE-BASED CARE

SOCIAL DISTANCING

Supported by inter-ministerial collaboration and aggressive funding models, Ontario becomes a leader in holistic mental health care. Through the creation of individual “endowments” for individuals with complex mental health needs, funding enables extreme flexibility of goods and services to support mental health and wellbeing. Increased ability to monitor health outcomes and shared accountability for population health has enhanced the integration of services and comprehensive client outcome tracking. Financial incentives for effective, low-cost interventions have encouraged health care providers to connect patients to a spectrum of alternative services, tools and supports including, physical activity interventions and peer networks. Most services provided are reimbursed based on short and medium-term health outcome measures. Many mental health service providers establish a focus on a specific patient population to improve efficiency and outcomes. This leaves some diagnostic populations, such as those with obsessive compulsive disorder, significantly under-resourced in Ontario. While providers support individual medical and lifestyle-based interventions and governments work at environmental interventions to support health and ensure that all new policies encourage health equity.

Illustration by: Ken Orvidas

TIME LINE

2014 204420342024ENHANCED MEASUREMENT OF HEALTH OUTCOMES

ALLIANCES WITH SHARED TARGETS AND ACCOUNTABILITY

Interministerial mental health com-mittee established

“PopCan” partner-ship of Stats Can and Health Canada

Performance pay-ments are 15% of MH funding

Release of ‘Health in All Policies’

“Endowments” for individuals with complex MH needs

“Operation Out-comes” changes payments

EVENT REPORT 9

FUTURE BATHROOM CABINETS

The bathroom cabinets that resulted from this process were thought-provoking, inspiring, and eerie. The cabinets were filled with future objects like:

• The next generation mood ring that instantly communicates your every emotion • Social communication platforms to reduce isolation• Monitoring devices linked to peer support• Built-in mindfulness activities• Positive affirmations based on the owner’s current state• Bio-feedback toothbrushes• Monitoring chips that signal to others for support in times of need

EXPERIMENT IN REVERSE ARCHAEOLOGY: EXPLORING THE FUTURE OF MENTAL HEALTH SERVICES 10

DIS/CONNECTED COMMONSThis public bathroom cabinet in 2034 is a ubiquitous portal into personalized mental health services. High tech and high touch has become interchangeable. With personal health and social records thoroughly integrated and stored in the cloud, most services can now be accessed in many public places and at home (for those who can afford it). Touching the mirror activates the portal for a personalized mental health journey. The cabinet senses and collects multiple bio signals and markers. The mirror doubles as a virtual conferencing console with realistic tactile feedback, to meet with a mental health professional or friend. The cabinet also dispense tools (e.g. stress balls) and medications.

COLLECTIVE IMPACTThis cabinet belongs to a man named John who, in the year 2034, lives with mental health in a world characterized by “collective impact”. The stigma and shame associated with having mental illness is a thing of the past, and people are able to live “normal” lives (see John’s Rolling Stones ticket, assuming they’re still rockin’). With the push of a button on the cabinet mirror, people are able to alert employers if they’re having a bad day and there is no problem whatsoever with staying home. Built-in monitoring devices call up friends for peer support then the situation requires. The cabinet is relatively empty on the inside, with an expired pill bottle, reflecting the relatively good state of mental health in this future world.

EVENT REPORT 11

THE PEOPLE ASSEMBLEThis cabinet offers real-time analysis and intervention. A “quantified” toothbrush measures and tracks the exact levels of stessors and drugs via an onboard lab chip. That in turns triggers the home pharmacy to churn out the appropriate drugs in the specific amounts needed for that day. The cabinet is connects to social networks in various ways, including immediate access to a loved one to support messages from an extended social circle.

TALE OF TWO WORLDSThis bathroom cabinet is owned by a young man who lives in the shadows of the wealthy and must deal with the stress of his everyday life in an ongoing way. Despite his low-income, he has access to some old technologies that help him assess his needs and cope with stress, including a mood ring that senses his every emotion, a screen that provides personal, targeted positive affirmations, as well as mindfullness and art-based therapy tools.

EXPERIMENT IN REVERSE ARCHAEOLOGY: EXPLORING THE FUTURE OF MENTAL HEALTH SERVICES 12

REFLECTIONS & NEXT STEPSWhile the workshop lasted no more than two hours and the new objects created were only made of construction paper, popsicle sticks and plasticine, the process was incredibly fruitful and energizing.

Despite rich discussions and ideas, the results were raw, somewhat superficial and for the most very focused on technology, likely because of the time and material constraints of the workshop. Engaging participants right from the beginning in scenario development and allowing significantly more time for artifact design and creation will help to make future worlds more robust, build understanding among artefact creators, and produce more provocative, polished pieces.

Still these prototype bathroom cabinets cannot be ignored. They spark emotion, ignite new thinking, generate questions, and invite conversation about the future. The cabinets speak to the need for more investment in exploring the future of health and the value of co-creating the possibilities together with people from all walks of life. Also, a number of participants were inspired to find ways of bringing this method and future thinking back into their organizations, building on the momentum of this short experiment.

Following the workshop both MaRS & CAMH put up a blog post summarizing the event. Workshop organizers are also working to set up a mini-exhibit to display these cabinets publicly within MaRS as means of building engagement and interest in the larger project vision to collectively create a polished museum exhibit exploring the future of health. In Fall 2014, a working group will begin meeting to commence the planning for the larger reverse archaeology project.

If you are interested in getting involved in the working group or want to find out more information, contact:Josina Vink at [email protected].

EVENT REPORT 13

EXPERIMENT COLLABORATORSWorkshop facilitators included:

• Chris McCarthy, Kaiser Permanente/Innovation Learning Network• Tai Huynh, Centre for Innovation in Complex Care• Jerry Koh, MaRS• Josina Vink, Centre for Addiction and Mental Health

The organizing team consisted of:

• Zayna Khayat, MaRS• Jerry Koh, MaRS• Josina Vink, MaRS

Workshop participants included representatives from the following organizations:

• York University• Bridgepoint Collaboratory• Cancer Care Ontario• Center for Addiction and Mental Health (CAMH)• Centre for Innovation in Complex care (CICC)• Coalition of Mental Health Latino-Hipano People• Ethnovation• OCADU• LOFT Community Services• London Health Sciences Centre• Mackenzie Health• Mental Health International• Saint Elizabeth• Sick Kids• Southlake Hospital• Techna, UHN• Toronto East General Hospital• TransForm SSO• Trillium Health Partners• University Health Network (UHN)• University of Toronto

EXPERIMENT IN REVERSE ARCHAEOLOGY: EXPLORING THE FUTURE OF MENTAL HEALTH SERVICES 14

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