Developing an eClinic for Youth Mental Health: A Participatory Design Approach

The article addresses a critical issue in Australia: many young people aged 16 to 25 experience mental health disorders, yet a small proportion access services, and even fewer receive timely and evidence-based treatments. Traditional barriers such as geographical, economical, and human resource limitations, along with stigma, often hinder access to quality mental health care, particularly for disadvantaged and vulnerable populations. The authors highlight the promising potential of the internet and technology to provide 24/7 access to mental health support.

The objective of this study was to leverage participatory design (PD) methodologies by involving end users (young people aged 16-25 and youth health professionals) and the research team. This collaborative approach aimed to codesign and build the Mental Health eClinic (MHeC), a web-based platform intended to enhance timely access and improve the quality of mental health care for young people across Australia. Participatory design, originating in the late 1960s and early 1970s, is emphasized for its role in ensuring the final product meets stakeholder needs, improves usability, and increases user engagement by involving all parties—end users, developers, and researchers—equally in all stages of development.

The research utilized a research and development (R&D) cycle that included several iterative PD phases. These phases involved PD workshops, where knowledge and ideas were generated and translated into mockups (hand-drawn sketches or wireframes), followed by rapid prototyping and one-on-one consultations with end users to assess the usability of the alpha build of the MHeC. Various design activities, such as propositions and end-user sketching, were employed to facilitate discussions and design.

The iterative R&D cycle led to the identification and development of five key components for the alpha build of the MHeC:

1. A welcoming home page with a visible triage system for those requiring urgent help, which users suggested should include testimonials, reliable mental health information, frequently asked questions, and a “need help now” button visible before login.
2. A comprehensive online physical and mental health assessment, which young people preferred to be about 15 minutes but understood the need for a longer, more comprehensive assessment (up to 1 hour) with a “pause and resume later” feature.
3. A detailed dashboard of results and progress, providing immediate, accurate feedback through simple bar graphs, colored icons, traffic light representations, and line graphs for tracking changes over time.
4. A booking and video visit system, including a “waiting room” feature with activities like breathing exercises before the video visit, and a chat box for sensitive conversations or connection issues. The system also includes a “share” functionality to display relevant information during video visits.
5. The generation of a personalized well-being plan that includes tailored, automatic recommendations and links to evidence-based, health professional-recommended apps and etools, with categories such as sleep, mood, anxiety, and physical health.

The study concluded that the MHeC offers a technologically advanced and clinically efficient system that incorporates health promotion, triage protocols, screening, assessment, video visits, personalized well-being plans, and self-directed mental health support. By breaking down traditional barriers, the MHeC aims to make best-practice clinical services more personalized, accessible, affordable, and available to all young people, particularly those in regional, rural, and remote areas, or those unwilling to engage with face-to-face services. The project is now informing the development of the Synergy Online System, a web-based modular platform that links integrated and interoperable resources to transform Australian mental health services.

How the eClinic was co-designed

Ospina-Pinillos and colleagues used participatory design to build the Mental Health eClinic, a web-based service intended to give young Australians aged 16 to 25 faster access to better-quality mental health care. Their research and development cycle had four iterative phases: participatory design workshops, translation of workshop ideas into hand-drawn sketches and wireframes, rapid prototyping, and one-on-one consultations to test the usability of the alpha build.

Who took part

Four workshops were held with 28 end users, 18 young people and 10 youth health professionals, together with eight members of the research team. Each workshop was followed by a knowledge translation session. After the alpha prototype was built, six new participants (four young people and two professionals) took part in one-on-one usability sessions.

What the process achieved

The authors report that participatory design gave end users active and equal involvement at every stage. Combining several design activities, such as propositions, sketches and mock-ups, with different methods, such as workshops and individual consultations, improved feedback, generated new ideas and accelerated refinement of the prototype. The process helped balance what young people and clinicians expected from the service with what was technically feasible and what is known to be effective in mental health care.

Lessons for digital health services

Many earlier eHealth tools addressed single problems or replaced one part of traditional care and relied on people finding them online. The eClinic aimed instead at an integrated service designed with its users. For health managers planning digital services, the study shows a practical, staged way to involve patients and professionals from the start rather than testing a finished product at the end.

APA Reference:

Ospina-Pinillos, L., Davenport, T. A., Ricci, C. S., Milton, A. C., Scott, E. M., & Hickie, I. B. (2018). Developing a Mental Health eClinic to Improve Access to and Quality of Mental Health Care for Young People: Using Participatory Design as Research Methodologies. Journal of Medical Internet Research, 20(5), e188. https://doi.org/10.2196/jmir.9716