Design Thinking for Global Mental Health

Teresa Chahine: Welcome to Impact & Innovation. I’m Teresa Chahine, and I’m inviting you inside my classroom at Yale School of Management as we grapple with questions on social entrepreneurship and impact.

Okay, great. All right. Welcome back, everyone. This is our first episode of the new spring semester. I’m so excited to have Daisy Rosales here with me. Daisy, you’re an alum of the program. You are my mentee in the program on entrepreneurship, and you’re back to talk to my students. We’re so grateful to you for flying all the way out from the West Coast. Thank you for being here.

Daisy Rosales: It’s so nice to be here with you.

Teresa Chahine: So let’s start by, tell us a little bit about Brio, your startup. I know this is your fifth year working on it. Tell us what you do and what are the main ways it’s grown over the years.

Daisy Rosales: Sure. So Brio is a nonprofit that works with local organizations and communities to design mental health promotion initiatives. We partner with organizations that are already working in education or workforce development or leadership, particularly in vulnerable or marginalized communities. And we help them design programs that help people to build psychological skills. And the vision for these initiatives is that they are centered in the community’s experiences and values and also that they are scalable so that they can be replicated or adopted by ecosystem partners or even local government or rolled out in a large organization.

Teresa Chahine: Okay, so you just said a lot there. So the vision is mental health, but it’s not about clinical diagnosis and treatment. It’s about finding community-based organizations working in education, wellness, and what was the third thing you said?

Daisy Rosales: And workforce development and leadership.

Teresa Chahine: Workforce development and leadership and thinking about how they serve their communities and building psychological outcomes. And so a lot of what you do applies design thinking, and that’s what we’re talking about today in class. And it seems that my students really resonated with the way you kind of have this process of applying design thinking in a community to pilot new ideas and then think about how you might scale that. Can you tell us more about that design process?

Daisy Rosales: Sure. So when you’re looking at creating a program, there are a number of things that you want to achieve. I think one is thematically that it resonates and from a content perspective that it’s creating some of those skills and outcomes that you’re hoping for. And also that it works contextually, just even on a logistical basis. Can people show up to this program? Is it the right length? Are the activities accessible? And so the design process is very useful to evaluate all of those things. To zoom out a little bit, we work with organizations that want to do this. They see mental health and wellbeing as critical to their mission, even if it is not kind of their headliner. They might be working in government schools or they may be working with refugee populations on workforce development, on helping them to get work, even if it’s not legal for them to work in these other settings.

And they see this as important to the thriving of not just their organization but their participants and the community at large. And so typically when we start working with them, they already kind of have a vision or at least a theory about how mental health will actually amplify their work. And what we do is we help to build that scaffolding around, okay, what would a program look like? What are some of the visions of flourishing that you do have where people are experiencing some of that agency and freedom that mental health can bring to move them in the direction of what matters most to them? And so when we’re designing the programs, we start with the participants, and we start with the leaders of the organization as well. Sometimes in the same room, sometimes separately. And we’re asking questions around values. We’re asking questions like, what does it mean to live a good life in this community?

What is most important to you? And what would it look like for you to move in that direction to really prioritize those values? Now, values, it’s a language that some people are comfortable with and others are not. And so just to clarify, they’re not goals or feelings; they’re ways of being, they’re ways of showing up in the world. They’re kind of like an orientation, like a direction on a compass. And so it helps us to understand in the creation of the content, how do we integrate personal and communal values into this content so that people are actually building skills that help them be more of that.

Teresa Chahine: So this is really interesting because it sounds like the organizations you work with may not necessarily self-identify as mental health organizations. They’re community development organizations, and they feel like they can’t achieve their mission, whether it’s education, workforce, leadership development without addressing mental health. How did you or they come across this realization? How did this work start?

Daisy Rosales: Yeah, so my co-founder and I had some good friends who were community leaders in Ecuador, the founder of that organization, Alicia, is in Ecuador, and she grew up there and she wanted to serve that community. And at a certain point we were visiting her and she said, “One of the challenges that keeps coming up is around mental health and wellbeing and just overall sort of this sense of suffering. Life is really hard here. It’s painful. And people come to us with these questions all the time of how do I deal with this? This is really hard for me.” And it was already clear that a traditional sort of mental health professional model that we have here in the U.S. that is working to varying degrees of success, as we know, was not something that her community could access. And she felt like she almost had to single-handedly respond to this. And so she invited us to think about it with her. And early on we thought it was just access to capital. Let’s help organizations and leaders like Alicia get access to funding so that they can roll out a program.

Teresa Chahine: That’s how Brio started out?

Daisy Rosales: That’s how we started. But then we realized she was like, “No, no, no, I want you to do this with me. I want you to—”

Teresa Chahine: “We don’t have the answers. Help us find the answers.”

Daisy Rosales: Yes. “Help us find out how does this emerge? How do we learn from our participants and our community members as to how to really address this in a way that resonates with their lived experience?” And that’s essentially how we started the partnership program. That is the primary way that we operate. It was this invitation to a company, this journey. And over time, what we realized is that there are certain kinds of processes and areas of expertise and tools and stories and activities that we can bring into this co-creation process to help leaders and their communities actually visualize what would it look like if we were to come together and build psychological skills together.

Teresa Chahine: Okay. So it sounds like the process is the same in each scenario, but then the outcome is totally different. So you’re asking the question of what does flourishing look like, what psychological skills do we need to build in order to achieve our mission, and then you immerse yourself in each community to understand what are the pain points, what are the sources of oppression and pain they’re experiencing. What might it look like to be different, and what programs might you implement to get there? Am I understanding correctly?

Daisy Rosales: Yeah.

Teresa Chahine: And then you pilot that idea, you come up with a program, you pilot it, and then you mentioned at the beginning you always want to be able to scale it. So what does that look like? It must be different, I’m guessing, for each setting.

Daisy Rosales: Yeah. And the gap we’re trying to bridge is that a lot of things that kind of are being scaled have a certain sort of linear way about them. There’s a process that many very large interventions use. And what gets kind of overlooked in that process is one, community organizations that are already responding to these needs, whether or not they have these tools because it just shows up at their doorstep. But two, being able to really bring local participants’ lived experiences and values and their vision of wellbeing into the program itself. So working very much at that grassroots level. And then when it’s validated there, when there are enough people who’ve been through this and said, “Yes, this has really helped me. I’m moving toward what matters to me. I want all of my friends and my family to come to this program.” When that happens, that’s when we feel that it’s ready to go to scale.

Teresa Chahine: More people need this.

Daisy Rosales: Yeah. And so what that looks like depends on how the partner is positioned. We do choose to work with partners that have either that ambition or that motivation, that sense that this is not just something they need within their organization and the communities they work with but even more broadly in their region or their country or the state that they’re working in, that it’s needed more broadly. And so the partner’s positioning informs the pathway to scale. If they are already engaged with working with government, which in some cases they are, they’re looking for pathways to roll out a program that a government could implement. If they are really well networked with other activist organizations, social change organizations in their space, they’re maybe a trusted authority in their local region, then we’ll look at creating something with them that they can share with those partners, share with their network.

There are a couple other options. One is, in some spaces there are social sector professionals, young people who are interested in wellbeing, they’re interested in working for social change, and they see this as important, and there isn’t necessarily a way for them to build those skills. And so we do it through sort of like a fellowship training model where they’re learning some of the basic skills. They’re learning about the program that’s been created, and then they go and implement it on their own. So there are a lot of different ways to share these programs, and we can do it confidently after this really thoughtful and thorough design process that involves the community.

Teresa Chahine: So I’m thinking, you mentioned that you’re a nonprofit. I’m putting myself in the shoes of a funder. I’m imagining once you’ve piloted an innovation and your community partner is saying, “Okay, yeah, we want to partner with this government agency or this multilateral or this NGO,” it’s probably easy to get funding for that, right? We have a proven intervention or at least a tested intervention, and now we want to reach more people. So I can imagine how that gets funded, but from the global health or international development community, but then the actual innovation process, the design thinking process where you’re partnering with the community to figure out what they can do, how do you communicate that to stakeholders? And do you ever get the question of, “Well, why can’t they do this without you? Why should we be paying you and them or funding you and them to do it?”

Daisy Rosales: Yeah. I think it’s a really tough question because first of all, when we started this organization, we were very aware that we are based in the United States. There is a narrative and a very real history around what it means for people from the West to work with people in other parts of the world, whether we call them the Global South or just areas where it’s developing economies. And we were really conscious of that power dynamic to begin with. And I think one of the things that we are really insistent upon is that what we’re doing is working behind the scenes, strengthening the leadership and the capacity of these organizations in this particular way, in the area of mental health because they see it as important to advance the flourishing that they want to see. And so it is challenging. I think from an institutional funding perspective, it’s a lot more comfortable.

It’s less risky if someone is coming to you and they’re saying hundreds of people have already participated in this program. It’s been tested. They were part of the design process. It has all of the values that we all say we want to be about, but none of the risk because it’s already been done. And so what you’re funding is just getting it out to more people, and that feels really comfortable. I think the way that we talk about the design process is that it’s co-creation. We want people to be a part of this process that is different. It’s disrupting a lot of the way that this work has been done in the past. It’s getting it in the communities. It’s getting communities to respond and contribute and actually be a part of this conversation from the beginning. And so I think that people who get excited about this work are driven by those values, are driven by a collective vision of creating things that isn’t just tested in a lab and then rolled out.

It’s something that is validated along the way. And I think it’s also changing a bit of what it means to tackle mental health. A lot of mental health narratives kind of have this mechanistic framework that they’re coming at it where, “Oh, this thing is broken, and we just need the right tool or the right thing to fix it. And once we tweak it right, you’ll be on your way.” Whereas the construct that we use around, it’s called psychological flexibility, is much more process-oriented. It’s helping people to build new mental processes to relate to their experiences in new ways. And so in that way, our design process is also a process. It’s not just coming in, solving a problem, and leaving. It’s about co-creating that, and that is actually part of the intervention itself.

Teresa Chahine: Okay. I want to ask you more about psychological flexibility, but first, just to follow up on my previous question. So the team of this community development organization gets it. They want to apply design thinking, they meet you through a common acquaintance or reach out to you one way or the other and ask you to help facilitate that. What about their constituents? They’re seeing this outsider coming in and trying to connect with them on the most painful things in their life. Tell us a little bit more about your experience in connecting with people across different settings. How are you able to really go deep with them in order to figure out what it might look like to understand their pain and to understand what it might look like to flourish and to design programs to flourish?

Daisy Rosales: Yeah. And every context can be different with regard to how they feel about people coming from outside. But I will say that when we first started this, I was really worried about that. And there is ways, as we’ve discussed, that these interviews can be extractive, especially when it’s just for the good of research or something. You’re just trying to gather information.

Teresa Chahine: Or a donor who wants heads, I get this much money, I reached this many people.

Daisy Rosales: Yes. Yes. In which case then the temptation to compulsion is really strong because you got to deliver on that. First of all, it’s an invitation. I think a lot of times the organizations, they don’t force anyone to come to these things. They’re sort of saying, “Look, we have selected this partner. We want to work on this and we want to hear from you. We’re going to be facilitating some conversations around what’s important to you and what’s hard for you. Do you want to be a part of this?” And more often than not, people actually want to come and talk about this. The responses that we’ve gotten have not been like, “Wow, that was so invasive. I felt so uncomfortable,” which is a valid response to this, but instead it was particularly with a refugee population, it was, “We didn’t know that people outside of our context were even thinking about us.”

And the other thing they said was, “No one has ever asked us these questions before, and we never thought anyone cared about what we thought about our lives.” And so I think when you create a space that it’s open invitation, you can come if you would like, and the questions are asked in a way that is empathetic, that is open, that is sort of saying, “We’re curious to hear this from you.” People actually really enjoy that. That’s what I found. And it’s been a pleasant surprise.

Teresa Chahine: And I think the example you’re sharing might be the one we discussed in class about the Rohingya Women Development Network, correct?

Daisy Rosales: Yeah.

Teresa Chahine: So what I’m hearing is that the constituents trust the team, the community leaders, and the community leaders trust you, and it’s really based on that trust that you’re able to connect across contexts. So with that background and place, let’s talk about the actual mental health construct. So you mentioned one construct that you use is psychological flexibility. Where does this come from? How did you learn about it or did you come up with it based on your experiences and how does this play into your model?

Daisy Rosales: Yeah, so psychological flexibility is a pretty well-researched construct, and it essentially is about the way that we respond to the painful experiences in our lives, trying to create more spaciousness and openness so that we can choose to move in the direction of our values, even in the presence of hardship. And so what that really looks like is depending on our lived experiences, there might be certain things that have been painful for us or that are painful for us in the present. Those could be thoughts or feelings or sensations. And the way that we are evolutionarily programmed to respond to pain is to fight it, to avoid it, or to maybe freeze, right? And that’s helpful when we run into a predator in the forest but not that helpful in the way that we want to move about our lives. And so what psychological flexibility helps us do is to change the way that we relate to our pain so that we can continue to engage in the way that we want to.

Even if it’s hard, even if it means that pain will show up sometimes, even if it means that we’re not always comfortable, but it does mean that we can, one, fully contact and be a part of the whole human experience, which is painful sometimes. And other times it’s joyful and exhilarating. And it also means that we can participate in the liberation of ourselves and each other. And that’s the thing that is really important to us, ultimately, is not just mental health for mental health’s sake. I mean, yes, that’s really important. And we actually think that it is an important resource for individuals and communities to draw from in order to see and make the change that they want to make. And so psychological flexibility is a way to kind of overcome some of those internal barriers and to hold those with a little bit more gentleness, openness, looseness. Then we can continue to move through life even when things are hard but going in the direction that we want to go.

Teresa Chahine: So it’s really about mental health with psychological flexibility is one specific example as being not just the goal and the outcome but also the process. It’s a key ingredient in any community development and moving a society forward, almost like the elephant in the room, let’s address mental health first and then we can address this community’s goals.

Okay, thank you so much for sharing that, Daisy. I’d like to end with the question of what else would you like for us to know about this work? I’m sure that our listeners would like to learn so much more about what you do. What else do you think is important to share, and where can they learn more?

Daisy Rosales: Yeah, I think for a long time I felt unsure of where I belonged in social change. As you know, ever since I was a little girl, I wanted to be a part of making the world better in sort of a vague way, but I wasn’t sure how to find my way. And what I love about the work that we do and the way that we do it is that it’s accompaniment and it’s mutuality. I feel healed by this work in a lot of ways. I’m doing it not just for people out there who are not me, but it is myself as well. And so that self-inclusion piece is really important, I think, in social change. Many of us feel like we should be excluded, somehow my life is to serve other people.

Teresa Chahine: “We’re the privileged ones!”

Daisy Rosales: Right. Either that, it’s either “I am not included in this because I haven’t suffered enough,” or maybe “I have access to resources, I have to pass them out.” And it comes from a place of truly desiring to serve. And I think that a lot of the work does require sacrifice, but ultimately it’s important to include ourselves. And that’s not just to prevent burnout or to not be hypocritical about it but to actually see that this vision is whole and it is not whole without us.

Teresa Chahine: It is not whole without us. And each community has its own pain points and its own oppression. But I think one thing we were talking about earlier was if you’re trying to say one thing that the human condition has in common is that all humans suffer, and that’s a way for humans to connect with each other. I think you were saying that either you were worried or that someone else was saying, “Oh, but you could get pushback about you’re eliminating diversity.” It’s like no, sharing suffering isn’t eliminating diversity. It’s not saying we’re the same. It’s saying we all suffer in one way or the other, and maybe that can bring us together.

Daisy Rosales: Yeah. I think that it does feel almost dangerous sometimes to say there’s a common humanity here because people have used that as a weapon to erase distinctive experiences of particularly marginalized identities. And that is important to name. And yet there’s a solidarity that is required in all work that is going to really make a difference. And that comes back to some of that self-inclusion of sort of saying, “Okay, pain is pain. It is inevitable in life. Life is hard, and it’s hard to know what to expect next. We’re surprised by it sometimes.” And so maybe there’s a way that we can come together across difference, naming what needs to be named but also saying there’s something that we share here.

And I’m really inspired by leaders who have come before us, long before us, who have named that our liberation is bound up with each other’s. Right? And it’s one of those things that really motivates me in realizing it’s not just that I would love to see others to experience some of that freedom and agency, but they actually want it for me as well. And so some of that has informed the way that we’ve been able to have these conversations across difference, across borders, across different kinds of lived experiences, but still be able to connect and make meaningful differences together.

Teresa Chahine: And it wasn’t your idea, it was this woman in Ecuador’s idea. It’s not like you’re trying to take Western concepts and transfer them to someone else. In fact, these are actually not Western concepts at all, they’re universal. Can you share some of those leaders that you mentioned have inspired your work?

Daisy Rosales: Yeah. There’s a quote by Lilla Watson, who I believe is an indigenous woman from Australia, and she essentially says, “If you’ve come here to help me, you are wasting your time. But if you’re here because your liberation is bound up with mine, then let’s work together.” So that is a big piece that is attributed to her, and it really moves me because I think that there’s this global sense of solidarity that we can experience around how do we turn toward those painful places in our lives and care for them.

Teresa Chahine: And solidarity that does not eliminate diversity. It’s not saying that we’re all the same, it’s just saying we stand together. Thank you so much, Daisy. I’m really grateful to you for sharing this with us. I hope our audience will visit Brio. Is that—

Daisy Rosales: It’s startbrio.org.

Teresa Chahine: Startbrio.org and @startbrio on social media. I know you just published your annual report, and they can read about more case studies and follow your work. And we hope you’ll be back to talk to us again soon.

Daisy Rosales: That would be great.

Teresa Chahine: Thank you so much.

Daisy Rosales: Thanks, Teresa.

Teresa Chahine: I’m Teresa Chahine and you’ve been listening to Impact & Innovation. Subscribe to stay tuned and follow us at Teresa Chahine and SOM Ventures. Special thanks to the broadcast center at Yale School of Management.