Desk research

In my desk research and orientation phase, I delved into the development of a smartwatch application designed for suicide prevention with Miles, a foundation dedicated to supporting individuals with mental health challenges. I explored the current capabilities of smartwatch technology, which uses various sensors to track patient data and provide real-time updates to caregivers. I also investigated several therapeutic approaches, including Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and Art Therapy, focusing on their effectiveness in activating brain areas affected by suicidal thoughts and improving emotional regulation. This research guided the creation of an application that integrates technological and therapeutic elements to support patients and caregivers in managing mental health crises and preventing suicides.

Research aim and research questions

My aim is to understand the suicidal experience from both the patient’s and caregiver’s perspectives and explore solutions to reduce suicidal risks. I want to study emotions, behaviors, triggers, and routines of patients, and how they connect with caregivers. Additionally, I aim to find solutions that promote healing, coping skills, personal growth, and better communication.

1. How do patients experience suicidal thoughts and behaviors? I want to understand the mental and emotional processes behind suicidal thoughts, how patients cope, communicate, and how their perspectives and relationships change.

2. What do patients need to reduce suicidal thoughts? I aim to explore therapies, technologies, and strategies that help patients heal, develop coping skills, and manage suicidal thoughts before, during, and after crises.

3. What are the needs and challenges of caregivers? I want to understand caregivers' roles, how they support patients, and the unique needs of both formal and informal caregivers in suicide prevention.

Research methods

1. Expert interview: This method helps answer my research question by providing insights into the experience of a patient with suicidal thoughts and behaviors.

2. Interview with trigger: Interviewing a sound therapist offers valuable insights into how sound therapy aids relaxation and self-awareness, similar to how healthcare professionals help patients with mental health issues.

3. Qualitative survey: This method helps me understand how individuals with mental health challenges express and manage their emotions. With 9 participants, it offers insights applicable to suicidal patients, helping inform future design choices to encourage emotional expression.

Data analysis

After audio-recording and transcribing both the Expert interview and Interview with trigger, I structured the survey data based on responses to each question to compare different perspectives. I then created data cards from the transcripts and survey answers, combining them with data cards from other Expert interviews. This resulted in a comprehensive set of data cards covering various topics. I clustered the cards into 25 groups, divided into four main categories: struggles, therapy, caregivers, and technology. Within each category, I created more specific clusters, such as emotional needs, stages, and crisis under "struggles." This approach streamlined the clustering process and kept it organized.

Insights

1. Early support is crucial: Suicidal patients need to feel seen, heard, and accepted before their condition worsens to prevent isolation.

2. Five stages of suicidal episodes: Suicidal episodes involve five stages, each requiring different interventions, though relaxation is vital throughout.

3. Multiple contributing factors: Suicidal episodes result from the buildup of various factors, making it hard to predict when they will escalate.

4. Altered perception of reality: Suicidal individuals often experience a distorted view of reality, feeling detached, self-hating, and finding peace in thoughts of death.

5. Crisis vs. suicidal planning: Emotional crises need immediate support, while suicidal states involve planning and emotional numbness.

6. Fluctuating suicide risks: Suicide risk factors are constantly changing, making it difficult to assess, but patients can identify personal risks.

7. Unresolved trauma impacts mental health: Unaddressed trauma and emotional imbalance increase mental health struggles, but expression helps relieve distress.

8. Creative expression aids emotional processing: Engaging in activities like music, writing, and art helps patients process emotions and feel understood.

9. Self-prevention strategies: Personalized safety plans, coping skills, and support networks help patients prevent suicidal episodes.

10. Various therapies support recovery: Recovery methods like EMDR, CBT, and art therapy offer essential tools for healing and self-regulation.

11. Challenges in suicide prevention: Barriers include patients' reluctance to open up, caregivers' lack of understanding, and limited access to mental health resources.

12. Caregivers must be informed: Caregivers should be aware of patients' needs at each stage and provide support during crises.

13. Listening without judgment is key: Patients need caregivers to listen without judgment and support them through all stages.

14. Community involvement aids prevention: Patients benefit from being part of a safe, supportive community that fosters connection and autonomy.

15. Autonomy in using support tools: Patients need to develop their own coping skills while using tools like apps for support, rather than relying solely on them.

16. Minimalist app design for calmness: The app should have a calming, minimalist design with reassuring words and interactive features.

17. The app should empower patients: The app should help patients express emotions, monitor progress, access support, and use therapy techniques to relax.

Design direction

I want the patient to feel cared for and confident that they can ask for help and express themselves by using the application’s tools for safety and recovery.

How Might We questions

1. HMW help the patient feel connected during high-risk situations?
Insight 5: Emotional crises need immediate support, while suicidal states involve planning and emotional numbness.

2. HMW provide reminders that make outpatients feel safe and loved?
Insight 14: Patients benefit from being part of a safe, supportive community that fosters connection and autonomy.

3. HMW encourage activities between informal caregivers and outpatients?
Insight 13: Patients need caregivers to listen without judgment and support them through all stages.

4. HMW let the caregiver know the stage of the patient?
Insight 2: Suicidal episodes involve five stages, each requiring different interventions, though relaxation is vital throughout.

5. HMW incorporate grounding techniques in the patient’s daily routine?
Insight 10: Recovery methods like EMDR, CBT, and art therapy offer essential tools for healing and self-regulation.

8. HMW include a voice journal within the app to encourage patients to express their emotions?
Insight 7: Unaddressed trauma and emotional imbalance increase mental health struggles, but expression helps relieve distress.

9. HMW encourage caregivers to listen without judgment?
Insight 1: Suicidal patients need to feel seen, heard, and accepted before their condition worsens to prevent isolation.

10. HMW use music to allow patients to express their emotions within the app?
Insight 8: Engaging in activities like music, writing, and art helps patients process emotions and feel understood.

11. HMW provide support for the caregiver through the app?

Diverging

I chose two diverging techniques: crazy 8 and brain dump. For my first 5 HMW questions I used the Crazy 8 technique to create quick sketches of my ideas, because I wanted to visualise them. For my last 4 HMW questions I did Brain dump techniques because I wanted to have more concepts of how to implement it, since I want to focus in detail on how it will look after choosing one concept.

Converging

To converge my ideas, I chose all the functions that fit the most with the needs of the patient. For each function, I filled 3 columns: what will happen on the patient’s smartwatch, patient’s smartphone and caregiver’s phone.

Concept

Based on this list of functions and how it will show on each device, I made a concept map for each device. I decided I need 4 devices in order to provide the patient and the caregiver with the support they need. The smartwatch will be a helping tool easily accessible at all times. I chose to design the patient’s smartphone as well, because I want it to be an extension of the smartwatch app that encourages the patient to self-reflect on their progress. For the caregiver’s device, I decided to have 2 different interfaces because I believe the formal caregiver has different needs that the informal caregiver, such as working with more patient.

Sketches

I started sketching the homepage for the patient’s smartwatch and smartphone. On the smartwatch, I included the following buttons:
- Emergency (for quick access at all times)
- Safety Plan (to help patients familiarize themselves with it outside of emergencies)
- Back-up Cards (to provide frequent reminders of things that bring hope and comfort)
- Breathing Techniques (grounding exercises to help calm and center the patient)
- Voice Journaling (for healthy emotional expression)
- Listening Ear (encouraging the patient to seek support, even outside of crises)
- Community (to foster a sense of belonging and consistent support)

The smartphone interface will feature the same buttons, plus statistics. I plan to display the buttons as flowers on the homepage, as I learned from an expert interview that flowers are relaxing. Flowers will grow as patients engage with each function, shrinking if they don’t. For example, regular use of breathing exercises will cause its flower to grow.

Listening ear:

When the patient presses this button, they can choose from three options: solution, vent, or hug. These options help patients express their needs in difficult moments and guide caregivers in offering the right support.
Once the patient requests a "listening ear," the caregiver receives a notification and can choose if they’re available. If they are, they’ll see the patient's specific need and guidance on how to respond. I included this feature because my research showed caregivers also need support to better assist the patient.

Journaling:

When the patient opens the journaling page, they will be able to record their text rather than write, because it s difficult to write on the watch. To make the experience more relaxing and allow them to focus on something while speaking about what’s on their mind, I decided to add an interactive screen during recording. I made this decision because I learned during the expert interview that having a fidget helps the patient relax. I chose the interactive element to be water circles, because I know water is relaxing, and I wanted them to see water circles spreading when they tap on the screen.

Emergency screen:

During emergency, the patient will see a moving circle in the middle that will guide their breathing and 4 buttons:
- 113 (quick access to call or send their information to 113)
- call (easily call other caregivers during the emergency)
- safety plan (the patient will be able to easily access their safety plan during the emergency)
- advice from caregivers (the patient can press on the caregiver button to hear recordings of their advice and pictures of the caregivers, that they chose/recorded for the application set-up).

Homepage for formal/informal caregiver:

The informal caregiver's homepage shows daily patient statistics and allows them to send activity requests, photos, and questions. It also includes an emergency button and a navigation menu with a community map, home, and info page for support and resources.
The formal caregiver's homepage lists all patients, with a filter for high/low heart rate to efficiently monitor well-being. Their navigation menu includes knowledge, home, and patient list buttons, plus an emergency button.
I differentiated the homepages since informal caregivers focus on one patient and connection, while formal caregivers manage multiple patients. Both share knowledge, support, and emergency functions, as both caregivers need similar tools to ensure patient well-being.

Iteration patient's homepage:

The app's first screen will be minimalistic and calming, based on peer feedback and research. I reduced the buttons to four: Emergency, Safety Plan, Grounding/Calming Techniques, and Community. The central interactive square will display backup cards or reminders from caregivers.
Pressing Safety Plan shows both the safety plan and backup cards. Pressing the flower button opens grounding techniques—breathing, journaling, and listening ear—using the same flower interface as the phone app. The Community button shows a map of caregivers, friends, or family who have shared their location.

During my university course, I had two weeks to design the low fidelity prototype based on my research and ideation.

1. Patient's smartwatch

Homescreen

The homescreen has an interactive back up card in the center, that changes. There are 4 buttons: Safety plan, Grounding exercises, Community and Emergency.

Grounding techniques

The grounding techniques screen is relaxing and has the following buttons: Journaling, Breathing techniques and Request a listening ear.

Emergency screen

When the patient first gets the app or later in the settings, they will create together with the caregiver a safety plan. The patient will record the steps in the safety plan, and they will be played when they press on the emergency button. Another emergency recording will be from the caregiver(s). They will record short messages beforehand, and they will be played during the emergency.

Steps: The patient presses on the emergency button.
The smartwatch uses the sensors to detect their heart rate and if their breathing is too high/low; the smartwatch will know the optimal breathing rate of the patient, or 6 breaths per minute on average.
The first screen the patient will see during the emergency is four buttons and a circle in the middle. The four buttons provide 2 quick actions for the patient (113 and call the caregiver) and 2 actions for more recordings.
If they press or swipe up, they will listen another recording from their safety plan steps; if they press or swipe to the right, they will listen to more recordings from the caregivers. It can be short recordings that continue each time the patient presses, but they shouldn’t continue automatically as a long recording so the patient is not overwhelmed.
The circle in the middle is supposed to guide the patient to relax. At first it shows as breathing circles. This will help the patient regulate their breathing by following the movement of the circles to inhale and exhale. The design is minimalistic in order to not overwhelm the patient. The user can follow the breathing guide while they listen to the first automated recording, which is from their safety plan.
If the patient presses on the recordings from the caregiver, the circle in the centre becomes a picture of the caregiver, chosen beforehand.
If the patient presses on the recordings from their safety plan, the circle shows an image related to their step. For example, if the step is “I go to the cafe .. to calm down”, the picture can be with that cafe, chosen beforehand so they are available during the emergency situation.

Peer feedback:
“I like it, but it is difficult to figure out how to go back to breathing, in case the patient wants help to keep doing grounding exercises”

Emergency screen - Iteration

After testing with one of my mental health survey candidates, I decided that I need make it easier for the patient to return to breathing exercises. As a result, I decided to combine both calling and 113 buttons into one calling button, that should later ask if they want to call 113 as well.

At the bottom of the screen will be a button for grounding techniques to help the patient gain control in the moment. If the patient presses or swipes down, they will see the breathing technique they were at the last time, and if they press again they continue to the next one. The same process is for the other buttons, if they listened to the next step from the safety plan and they press on the advice from the caregiver, they will see the advice they saw the previous time. Then they will press again to see the next one. It works as if the first time they press on a button it returns to where the user left it, then they need to press again to continue. This will ensure they remember the last step and make them pay more attention.

So when they press on the arrow of each button, they should continue to the next step. I didn’t make them yet, but for the safety plan it should be the next step of their plan and the sound of the step recorded by the patient before; on the caregiver advice it should be the next part of their advice or the advice of another caregiver (short, the patient can click to listen more); on the grounding techniques (green button), they will press to go back to breathing and if they press again they will see other grounding techniques.

For now, the patient will be able to choose in the settings what they want to see during the emergency situation, so there they can choose if the backup cards or the grounding techniques are more important. If the patient doesn’t want grounding techniques but wants to get back to breathing, they can swipe back in the circle.

Breathing Music

The patient can use the music feature to relax. When they open the music feature, they get two options:

1. Breathing
In this function, the user will be guided through breathing exercises using sound. The sound will give inhaling and exhaling cues in order to help patients breath 6 times per minute on average.

With extensive functions, the smartwatch can use the heart rate variability sensor to detect the optimal breathing rate - so that the patient can breath at the optimal breathing rate - which will result in optimised heart rate variability - which means a rest-and-digest state (rather than fight-or-flight)

2. Songs
Patients can find songs that support them to breath 6 times per minute, and which can be adjusted by the app to fit with their optimal breathing rate. It can be songs from music libraries from any genre, random or the patient can make a playlist. But most importantly, it should contain songs that encourage RFB - resonance frequency breathing.

Additonal research:

Based on the research presented in the article "Music for breathing – An innovative research application," (https://uasjournal.fi/1-2023/music-for-breathing-an-innovative-research-application/) I identified features that can be benefic in the patient’s daily routine for stress management using breathing techniques combined with music:
music with clear inhaling/exhaling cues makes it easier to keep an optimal breathing rate and to promote relaxation
send reminders for patients to breathe fully, not just in the chest
help patients identify their optimal breathing rate (usually between 4.5 and 7, on average 6 breaths per minute), where heart rate and respiratory rate are synchronized
during breathing techniques provide sounds that encourage them to breath at their optimal rate
find songs that fit with their breathing rate
breathing exercises combined with music relax both the patient and the caregiver - good anytime + before medical appointment
it is accessible - can use music designed for REB (resonance frequency breathing) to guide their breathing, no need for special equipment

Journaling

The journaling feature offers the patient different types of prompts to guide them and encourage them to be self-aware and learn who they are.

If the patient wants to journal freely, without prompts, the app includes a tap on water interactive feature. While he speaks, the patient can tap on the screen to create water circles where they press. To be extended, the water circles can also appear based on the voice tone. It is a good idea because it provides a “fidgety feature”, something I learned from the experience expert interview to be a good idea to include, because it helps them relax. As a result, I want to include the interactive circles because water is relaxing, and they can fidget while speaking, so they have something to focus on.

Listening ear

When the patient requests a listening ear, they will be able to choose their needs. If they don’t want to choose, they can tap on the “next” arrow to send the request to the caregivers.

The first row is for the patient’s needs regarding feeling heard. I learned from the expert interviews that the most important cause of suicide is not feeling heard or seen by others. I want to make sure patients using this app will be able to say (and also think about their needs) and let others know before they listen to them, to ensure everyone is aware of the patient’s needs.

The next row contains the means of communication preferred to the patient. The reason I chose to add these needs is because I want to make sure that the patient is comfortable. For example, a patient might choose they want to vent, and maybe a caregiver replies that they are available. Without establishing a means of communication, the caregiver might offer the right support, but the wrong way, such as via chat when the patient wants to talk physically.

Community

The patient will be able to see all the community functions on a separate screen when they press on the community button. The first screen they will see is the map, in order to see whether caregivers (friends and family) are close to them, so it would be easier for them to meet. If a caregiver wants to turn off their location, they can do that in the settings.

This is important because by being able to see each other’s location in real time, spontaneous meetings will be more likely to happen, because there is no need to talk or plan before. The map feature will just make spontaneous meetings easier. Maybe they could also get a notification if there is a certain distance between them, to let them know they are in the same area.

The second screen will be sending and invitation. They can choose who they are going to send the invitation to, or they can send it to everyone. First, they need to choose an activity and press send, then the app will recommend a day and time when all the members of the community (or those who it is sent to) are available, by syncing their schedules before. Besides sending invites, they can also send quick pictures, quotes or songs to each other. These will appear in their group chat in another app probably, but the last one will also appear on the patient’s smartwatch home screen.

When the patient receives an activity, they will receive a pop-up. If they don’t reply, the unanswered invites should be stored somewhere visible.

2. Patient's phone

Homescreen

The homescreen on the patient's phone is relaxing, offering easy access to breathing exercises and the emergency button.

Mood pop-up question

The patient will receive regularly pop-ups to say how they are feeling. This can be 3 times per day (morning, noon, evening), but it can also be depending on the preferences/relevance of the patient.

I chose 3 main categories, good, medium and bad, because I don’t want the patient to be overwhelmed. I want to help them analyse their emotions slowly, firstly by being aware of them, and later thinking about them in details in the text box. If they see the pop-up on the smartwatch, they can write in the boxes using voice recording.

Their replies will be store and analysed in the mood calendar page of the statistics.

Statistics

I want the patient to be able to think critically about their behaviour. As a result, I want the statistics that the user sees to be about their health first. Each section (heart, mood, sleep) health is measured on a scale of 1 to 100.

The heart health is measured with the HRV sensor of the smartwatch. If the sensor detects good results, it will show the green colour and a number between 80-100. If the results are medium, then the colour will be yellow, and it will be between 40 - 80. Anything under 40 means the patient’s heart health is bad. These are not the numbers detected by the sensor, but this is the output based on the results, because the HRV detects more things about the heart health to generate an overall score.

I believe this is more effective than showing their heart rate, because it is more “tactile” information, since the patient might not know the effect their heart rate has on their health.

In the stress health analysis, it will get the results from the stress sensor. If the patient is stressed, the mood will be low, if they are not stressed, the mood will be high. This can be combined with mood calendar of the patient for more accurate results.

The sleep score is shown from the watch sensor based on the sleep quality of the patient.

After the patient sees their health statistics, they will see their heart rate in the moment and the daily average. By pressing on the arrow, they will see a page with their heart rate graphic and calendar.

By choosing breathing statistics, the patient will go to a page where they will see their breathing techniques progress, their average breathing rate and how it affects their health.

By pressing on the mood calendar, the patient will see the statistics of their daily mood input. They can also get insights such as “your mood is usually lower when you sleep less”.

Emergency

When the patient presses on the emergency button on their mobile phone, they will see the same functions as the smartwatch, with a few more buttons: a button for back up cards, so if they press on the left they will see interactive back up cards in the circle. For example, their favourite song will appear as a backup card, and since it is interactive they can press on it to play it. To return to breathing, they can swipe back in the circle, or they can press on the grounding techniques.

If the patient has other needs during an emergency situation, they can change it in the settings.

I took out the hamburger menu and the homepage button so the patient will remain on the emergency page until the caregiver gives the confirmation that the patient is safe.

I added the call button instead of the home button in the bottom navigation menu. I felt the community and statistics buttons because I think it would be helpful for the patient to see where the caregiver/friends and family are, and also to visualise their health statistics to understand why they are feeling this way, in order to be more critical.

Journal

On their phone, patient's can see their past journals, including how they felt and details about the context of the journaling exercise (time, location, etc).

Since journaling should be a way to express themselves, patients can choose if they want to journal using prompts or without any prompt.

If they want prompts, they have 3 options:

Interesting subject
This is for creativity, they get a topic that they can express their opinion. It is helpful because it will promote critical thinking and feel like their opinion matters.

Reflect on statistics
This is to help them think about their process, their surroundings. For the process, they will get results from the statistics and they can reflect on them. For example, a statistic from journaling could be: A recurring topic in your journal is sadness, and it happens on Monday afternoon usually, at this specific location. Then patients can reflect on this result and try to understand the process behind the result. This is helpful because it encourages patients to be analytical of their emotion patterns.

Story time suggestions
This encourages patients to think about their memories. If the app has access to data from the patient’s phone (pictures, etc), they will generate prompts with pictures, location, and more data about the event that can spark memories for the patient. This is helpful because they will reflect on their memories and feel grateful for their loved ones.

Journaling statistics

Based on their journal, the patient gathers data in the statistics page.

Steps:

1. The patient writes/records pages in their journal.

2. On this page, they can write/record, add title, images, add music they are listening to, choose an emotion between 3: positive, negative, neutral.

3. AI will analyse the content to search for the main topic and find people mentioned.

4. In the statistics page the patient can see the summary of their journals, and for each journal they can see: the emotion, the title, pictures, location, time, people and the activity they were doing. By pressing on the arrow they can open the page to read it.

5. By pressing on “See more” they will go to the page where they see the full journal, so all their pages.

6. In the “Patterns” section, AI will generate a summary for each of the 3 emotions. This summary will include top 3 locations, times, people and activities for this emotions. It will find them by looking for the most frequently mentioned during the journal based on the emotion they chose. For example, if the patient has 10 pages with the positive emotion where they speak about a sport they do, AI will recognise the location/activity when the patient feels positive.

7. It is important because the patient can see in which contexts they are feeling positive or negative. This way the patient can become aware of patterns that they might not have been aware of. For example, maybe a location they go to frequently gives them negative emotions. They will see the location in the negative emotions average and think about why it is negative for them.

Community

Patients can choose at the beginning of opening the community page who is going to have access to their community. They need to connect with other members of their community, so they need to install the app as well, logging in as informal caregivers.

The patient can manage in the settings who will have access to their details. Some informal caregivers might have access to their statistics, others might only have access to he community or a listening ear.

Within the community, friends and family will be able to sync schedules to plan events together more easily. They will also be able to easily send an activity request to each other. Whoever says yes, they will be asked to confirm if a specific time slot in their schedule is good for this activity, or they can choose it manually. By syncing schedules, they can get recommendations of when the other persons are free.

By joining the community, members can also share their location with each other. This is useful for spontaneous meeting when they are close to each other, but also to keep each other updated. The share location feature can be turned on/off in the settings.

The community can also send pictures, videos and quotes to each other. As a result, the patient will get updates from his community on the main screen of the smartwatch. Pictures sent between the community will be stored in a community folder accessible within the app.

The patient can see activities related to their community on the community page. This is important because the patient needs to feel part of the community and be reminded of the activities going on. By showing patient’s upcoming events first, they will be motivated to look forward to events they enjoy.

Seeing their calendar (when pressing on “see more”), adding events and requesting events with others will make them feel busy and create a stable routine within their community.

3. Informal caregiver

Homescreen

The caregiver will see the patient’s main 4 statistics at the moment, so they know the heart rate of the patient, if they are stressed (on a scale from 1 to 100), if they slept well (on a scale of 1 to 100), and the stage they are in. The stage will be monitored by the guidelines they chose together, such as low/high heart rate and creating a checklist. The caregiver can press on any of them to see more details, or go to the statistics page to see more.

This is useful because the patient will know the current state of the patient, and they would know if they need to interfere.

The flower shows 3 main actions for the informal caregiver to get quick information and reminders about the patient: Safety plan, backup cards and questions.

If they press on the safety plan, they can see the safety plan of the patient. If they press on the backup cards, they can see their backup cards. If they press on the questions button, they can see information about the patient, details about their communication preferences, advice how to listen to the patient, and support for the caregiver.

Patient's statistics

The patient will see the statistics of the patient the same as the patient sees them or depending on how much access they have. The difference is that the caregiver will see the heart rate of the patient and not the heart health, since it is more important for the caregiver to determine whether the patient is in danger or not. The patient can choose in the settings who has access to their data.

The interface looks more minimalistic, so the caregiver can easily check the status of the patient and more information. When they press on an arrow, a popup appears with a graphic.

Emergency

The caregiver will have support information to help the patient during the emergency, such as the location, communication preferences, safety plan and backup cards. They can also press on 113 to call and send the patient’s details. They can press on call to call the patient, or they can press on the question button to get information about how to give support.

Listening ear

If patients request a listening ear, the caregivers will be notified with a popup. Patients can choose before or in the settings which people should be notified when they click on the listening ear button. This is helpful because the patient doesn’t need to ask for help by thinking about what they need to say, or worry if someone is not available. This way, the caregiver who is available will select yes and see what is the need of the patient (what type of being heard - solution, vent, hug, call, message) and a few reminders (communication style preference, how to listen without judgment, what to do in case of emergency). After reading the information, they can proceed to contact the patient.

In the first wireframe I only included that the patient requested a listening ear and a question if the caregiver is available or not. I thought that if they choose “yes”, they will get the specific needs of the user, such as to be heard, call, meet, etc.

However, I thought that the patient should know before the need of the patient to make sure they are fully available. For example, they could choose yes because they are available to chat, but maybe the patient wants to talk or meet. As a result, I decided to add the needs selected by the patient before the caregiver decides if they are available or not.

Then I decided there is too much information inside the pop-up frame, so I made put the title of the pop-up outside the rectangle to make it easier for caregivers to see the information and make a decision.

4. Formal caregiver

Homescreen

The formal caregiver has many patients, so they will see a list of all the patients on the homepage. The first patients shown are the ones in the worst conditions, showing 3 red statistics. Next is everyone with something red. Then it will be patients with yellow statistics, and lastly green statistics, which are patients who are doing good.

In the navigation menu, the formal caregiver will see the same buttons as the formal caregiver. The community page will be used if the informal caregiver wants to keep close contact with its patients/outpatients. This can result in 2 things: 1) the caregiver sees all patients who also agree, or 2) there is a separate community with the formal caregiver and the patients, so outpatients can also see where they are, communicate and keep in touch. This would result in a close community of people giving support to each other, which is also monitored by the formal caregiver. This is something important that I learned from the expert interview, that the social circle of the patient needs to be regulated to make sure they are safe. As a result, I think if the patient has two communities, 1 with their informal caregivers, friends and family, and 1 with their formal caregiver and other patient, it would provide 2 close and safe communities for the patient.

On the statistics page, they can see the same statistics as the informal caregiver, but they can change between the patients on the left and right arrows.

The rest of the features are the same as the informal caregiver's features, but adapted to the list of patients. The fornal patient will see the same information for every patient depending on what they have access to, while the informal caregiver only sees the information for one patient.

Clustering all the features from the university course

After the university course where I focused on research and wireframes, I started working on the hi-fi prototype during my internship. My internship task is to combine the features from my colleagues and design the final application.

I started by clustering all the features that me and my classmates designed during the course. For the application for the patient, I grouped the features into 4 categories:
1. Safety plan, emergency and check-up
2. Connecting the patient and the caregiver
3. Data analysis from the smartwatch sensors
4. Self-help tools

Expert Meetings

I organized meetings with experts in suicide prevention that also work with Miles to get their feedback on the features and to select together what should be included in the application for the patient and for the caregiver. Based on the expert meetings, I analyzed the information gathered and planned how each feature could work in a way that is benefic for both patient’s autonomy and for providing more insights for the clinical sessions with the caregiver. Additionally, I thought about how to set up the patient’s account together with the caregiver, to ensure the application is personalized and tailored to the specific needs of the patient. And lastly, I thought about how the sensors of the smartwatch could provide valuable information for a caregiver or institution (113) that want to reach out if the patient might have an emergency.

Selected features

While the patient will set up their account with their caregiver, they will choose what tools and features are useful for the patient. These are all the features that will be included in the patient’s account:

1. Emotion check-in
The patient can select how they feel and where in the body they feel it, then journal about it. The emotions are recorded in an emotions calendar, which can be helpful to discuss during the clinical sessions with the caregiver. The patient can do the check-in at any time, as many times per day as they want. If they don’t check-in themselves, they can get a daily reminder to do it if they want to.

2. Emergency button
After pressing on the emergency button, the patient will be asked if they can manage on their own: if they can manage on their own, they can use the safety plan and self-help tools. If they can’t manage on their own, the patient can contact 113/emergency contact. The patient can decide at any time who should be notified and have access to their location in case of an emergency.

3. Information
The patient has access to categories and subject to learn, and afterwards the patient can journal about what they learned or just select how they feel after learning about a subject. If the patient learns about a topic and they say how they felt afterwards, that information can be saved in the emotional journal and discussed with the caregiver if wanted. The categories and subjects are chosen together with the caregiver and can be updated based on the needs of the patient.

4. Journaling
The patient will choose together with the caregiver what journaling tools and exercises to use, as well as the difficulty level of the prompts. The preexisting journaling tools can be: Free journaling, CBT journaling, Art therapy journaling, Gratitude journaling, Future self journaling, Intention setting journaling, Self reflection journaling, Dream journaling. The tools can be renamed, and the caregiver and patient can always create new tools, exercises and prompts. After doing a journaling exercise (for example an art therapy journaling exercise), the patient is asked if they want to reflect on the process and how they feel after journaling. The journals are saved in an archive where they can be discussed during the sessions with the caregiver. The app could also analyze the journals and identify possible patterns that could offer insights to discuss during the sessions.

5. Sound meditation
There will be sound meditation playlists in the app, and the patient will add them together with the caregiver, based on preference and needs of the patient. The preexisting playlists can be: Breathing exercises, Morning routine, Night routine, Meditation, Immersive narrative, Body scan technique, Safe space visualisation. The patient can decide if they want guided or not guided sounds. I want to research beneficial ways to use sound for suicide prevention and make personalised sounds, without taking them from the internet.

6. Hobbies
The patient can have a list of hobbies, check ✅ when they complete a hobby, then journal about the experience. Checking hobbies and journaling about them is not a daily mandatory practice, the patient can use the hobbies list for inspiration, keep track of how often they do what they love, and reflect on how their hobbies make them feel.

7. Unhelpful thoughts
The patient can write or record their thought, personalize how the thought looks like, listen to the thought in a weird sound while seeing the visualization of it, then release the unpleasant thought. This can help the patient feel that they are not their thoughts. If the patient wants to reflect on the experience or on the thought, they can journal about it afterwards.

8. Five senses exercise
The patient is guided through the 5 senses exercise. Instead of using the 5-4-3-2-1 technique, I thought to go through each sense and let the patient identify as many things as they want. The guidance can be short and visual on the smartwatch, and more detailed in the smartphone app (depends on the patient’s preferences).

Setup and plans

The app can have 4 accounts:

1. Patient account - set up with the formal caregiver
2. Informal caregiver account - set up with the patient’s formal caregiver
3. Formal caregiver account
4. Institution account - could be for 113. If the patient gives permission, 113 can be notified when the patient is in a high risk situation, even if the patient doesn’t call 113.

The patient can set up their account during the sessions with the caregiver. I thought of the following plans that the patient can fill in together with the caregiver during the sessions:

1. Safety plan (6 steps, like 113)

2. Emergency plan
I thought that the patient can discuss with the caregiver what happens in case of 2 emergency situations:

a) Emergency = when the patient presses on the emergency button/says that they are not ok and they can’t manage on their own.
Within the emergency plan, they can decide who will be notified in case of an emergency and who will have access to their location. If there would be an account for 113, the patient could decide if they want 113 to have access to their emergency statistics and location in case it is an emergency.

b) Potential emergency = when the patient might be in an emergency based on their statistics, but the patient is not responding.
The patient and caregiver can set a timer for how long it can take to not respond before the emergency contact is notified of the potential emergency. If there is an account for 113, they could also be notified in case of a potential emergency, and the patient can decide if they want 113 to have access to their statistics and location in case of a potential emergency. This could be helpful if the patient doesn’t want to call for help when they are in a crisis, but the patient needs to decide with their caregiver if they need this kind of help or not.
If the patient agrees to be helped during potential emergencies, the smartwatch app needs more information from the patient, in order to avoid mistakes. For example, it should recognize when the patient is sleeping, the smartwatch charging, etc.

3. Risks
The patient and caregiver can decide if there are any risk locations or if the patient is sensitive to loud/quiet environments, or if there are any specific times when the patient feels more at risk (for example, having dinner alone). These risks can be detected by the smartwatch and ask the patient if they are ok or taken into account if the patient is not responding, resulting in a potential emergency.

4. Reasons to live
The patient can write with the caregiver their reasons to live, write why and personalize it (with pictures maybe).

5. Needs
The patient can think about how they need to be supported by others. This can be helpful for the informal caregiver to know how to be there and help the patient, but also for the patient to understand what they need.

Statistics from smartwatch sensors

1. Patient’s account:
The data for statistics comes from: 1) Biodata from sensors, 2) Location and sound from sensors and 3) Patient’s personal input.
When one of the sensors detech a risk, the patient is asked if they are ok. If they are not ok, they are asked if they can manage on their own, the same as pressing the emergency button.

2. Formal/Informal caregiver’s account:
If the patient and the caregiver both agree, the caregiver can be notified in case the statistics show that the patient might be in distress. In case of a potential emergency, the caregiver is asked if they need help and support by using the patient’s safety plan, library resources, patient’s needs and journaling for the caregiver.

3. Institution account:
Could be for 113 and other institutions that want to offer emergency help. If the patient agrees that the institution can have access to their statistics and location during potential emergencies (when the patient’s statistics show distress for a set amount of time and the patient hasn’t reached out or answered that he is ok), then the institution is notified that the patient is having a potential emergency and they can contact or go to the patient’s location.

Flowcharts