Designing for Stigma

Filmed on March 16, 2017 in San Francisco
Part 1 of 3 from our Health x Design series.

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Dan Miller
Digital Health Entrepreneur
Dan founded Level Therapy, an online platform for accessing mental health care. Before Level Therapy, he founded the world's first marketplace that helped musicians book studio time anywhere. He was early at SurveyMonkey, managed all of the market research at Salesforce, and Business Insider has named him one of the top 46 African-Americans in Tech. When he is not working, you can catch him making up his own jingles, or on a dance floor somewhere.


My name is Dan Miller. I'm the CEO and founder of Level Therapy. Level Therapy is a telemedicine app that provides video access to psychotherapists, as well as treatment tools. I want to talk a little bit about designing for stigma. Not specifically designing to excite stigma, but designing when stigma is inherent in your user base.

We've learned that Americans in the United States do not access therapy as much as they should. The main reason is because of stigma. Costs and access are reasons as well, but stigma is the major barrier.

I want to talk a little bit about designing for that. Who should be involved in the design process, why it's an important design goal from our perspective (especially working with behavior health), and how to go about this. First, I want to talk about who should be involved. To do so, I want to tell a little story. Level Therapy was born out of a problem that I had myself. I was wrapping up my first startup at the end of 2014, and going through some major life changes: a rough breakup and a rough start-up end, and wanted to get back to some sort of baseline.

At the beginning of 2015, I wanted to speak to a therapist, because there was just too much going on in my life, and I needed to make sense of it all. I tried one of our competitors, and just had a really off-putting experience.

The pricing model was off. I had to buy a bundle of sessions before I spoke to anyone, the branding was off, and I left feeling more like a number than an actual person. So I was really close to the pain point that all of our consumers actually feel.

Instead of actually booking that second session, I put together a team, and started working on this company. My co-founder in the company, Coley Williams, is a licensed therapist.

Coley, we found out, was actually experiencing a lot of the same pain points on her side of the market. She had her own private practice in Los Angeles. She wasn't trained to know how to start a business. She didn't know how to market to individual patients, manage billing, or do any of that. She just felt a little bit helpless. We found that she had experienced a lot of the same pain points from her side of the market that I did around the same time period.

This was extremely important for us to figure out how to design an amazing experience from the clinical standpoint, as well as from an actual patient's standpoint.

Secondly, why is designing for stigma an important goal?

For one reason, because the state of mental health the in the United States is terrible.

This is the largest reason that 26 million Americans don't access treatment each year. The others were costs and accesses. Workplace stress contributes 120 thousand deaths per year and approximately $190 billion in health care costs.

This is not just an issue that affects individuals. It affects us aggregately, and it also affects our economic output. Serious mental illness causes over a hundred billion dollars approximately in lost earnings. So there's a tangible dollar amount that mental illness affects in our economies, our employers, and ourselves.

Also, it limits our potential. This is definitely all in the air when our users are downloading our app or using our experience.

So we thought really critically about all of this while we were designing. Lastly, how do you go about this? What does the process look like?

This is a quote from one of our first meetings.

After my experience, I said, "We're not going to design anything that looks sterile, or looks like it was designed by a hospital. I wanted to stay away from blues, and gradients, and turquoise colors as much as possible, but we did not do a good job of this.

Finally, the control ended up performing the best. We tried palettes and colors that you find in nature, plus other analogous kinds of industries that had to deal with stigma. However, this was the one that our users and patients responded to the best.

Our goal at a high level was to focus on evoking trust and professionalism. We still wanted to push the industry forward somewhat, so we wanted to be partly progressive. We took some risks, and the gradient is part of that. Here is the on-boarding experience, and again we thought really critically about all the copy, every single thing that we did, initially that our users experience.

So the tone is really conversational with all of our copy. We explain that we're here to help, that you can talk from anywhere, and that we really care about you. We were really focusing on the trust aspect here, because in on-boarding experience we have a couple of seconds. A couple of swipes can really build some trust with the patient. This is tending to work. We provide a 20 minute free consultation to all of our users, as well. This is to build a lot of trust. We lower the barriers of entry as low as possible, to get a patient that wants to talk to a therapist to talk to one. So after you answer your home page, and get your free consultation, we connect you with one of our license intake specialists. Here, we ask you four questions to get a sense of what you're experiencing. In my experience, I noticed that none of our competitors are leading with a learning approach. They only show a directory of clinicians, and they leave it up to all of us to understand how to discern one therapist from the next, and who to work with. It doesn't work like that in reality. So, we ask a couple of questions just to get a sense of what you're experiencing, as well as if you have any preferences for the type of clinician you like to work with. This can include gender, whether they're in the city base, and more.

After you go through the intake process, we recommend three clinicians based upon what you're experiencing, and the state that you're located in. After you choose your therapist, and you engage in the consultation, if you want to continue to work with that individual you can work with them, or choose any other clinicians in our practice. Afterwards, to make sure that we're building trust and getting a sense of whether we're doing a good job with matching the experience to technology, we ask every patient how their session went. Comparible to uber or another kind of rating system, with three stars or below, we have a couple of pop-up questions, to get down to specifics.

That's it. Thank you very much. Lastly I want to say that if anyone out here is experiencing anything difficult in their lives, and have thought about speaking to a therapist, definitely consider it. It empirically and scientifically works. You never know what's on the other end of that.

I would say, there are some tools out there to help you. Thank you.