(WITHDRAWN) Design Meets Psychiatric Disability: Designing Environments That Do Not Disable

Background and Purpose: A maxim of the disabilities rights movement is that the environment disables, not the individual’s condition. Modifications to the environment, such as sidewalk cuts for people who use wheelchairs, are more readily conceptualized than those for people with psychiatric disabilities. This study investigates what such environmental modifications could look like through the naturalistic study of a unique community of people with serious mental health conditions in Hokkaido, Japan, Bethel no Ie (BnI). This study 1) aims at proof of concept research to demonstrate approaches to environmental modification that improve the lives and mental health outcomes of people with psychiatric disabilities, 2) as well as demonstrating how iterative design thinking can be used to develop different approaches to intervention and support than linear planning approaches such as logic models.

Methods: This is naturalistic research of an existing mental health community in Hokkaido, Japan, embedded in a slightly larger village. It uses ethnographic and participant-observer methods. Research participants are adults with serious mental health conditions and the staffs that support them in their community. The research includes ethnographic visits in 2006, 2007, 2012, and 2016, discussions with the principal designer of this community in 2018. The researcher worked with bilingual Japanese-English research assistants. Data sources include ethnographic notes; participation in group events; photographs and videos produced by the community and a video ethnographer; BnI publications and artifacts; and participation in a BnI community celebration/conference.

Results: The design of this unique community has enhanced the competencies of community members to have social lives, work, interact as equals with the broader community in which it is embedded. 1) BnI assumes that the issues that members face are collective issues that call for collective responses. As an example, they have developed a unique collective approach to assisting members to address distress called Tojisha Kenkyu (self study); 2) They have developed profitable BnI community-owned businesses where members work; 3) they believe that psychiatric symptoms should be expressed, not suppressed, and have found creative and affirming ways to do this, including a yearly community celebration where they award things like “the best delusion of the year.” These and other approaches to design their environment have resulted in a significant lowering of hospital bed use, leadership development, creating profitable businesses that support the community and provide work for members, and a culture of mutual support that enhances the lives community members.

Conclusion/implications: Traditional methods of addressing the community desires and needs of people with psychiatric disabilities are rooted in the limitations of those with serious mental health conditions, typically addressed through linear, top-down planning approaches. This research investigates proof of concept ideas and methods of what is possible in approaching the desires and needs of this population through an iterative design approach. This approach allows considering what is possible, rather than what is not. The paper explores how this approach can be applied to other issues in social work.