Future of Mental Health - Reverse Archaeology Event Report

EVENT REPORT 1
2040
2030
2020
2010
2000
2050
1990
EXPERIMENT IN
REVERSE
ARCHAEOLOGY:
EXPLORING THE
FUTURE OF
MENTAL HEALTH
SERVICES
MAY 23RD
, 2014
EVENT REPORT

EXPERIMENT IN REVERSE ARCHAEOLOGY: EXPLORING THE FUTURE OF MENTAL HEALTH SERVICES2
WORKSHOP OVERVIEW
Experiment in Reverse Archaeology: Exploring the Future of Mental Health Services was a hands-on workshop co-hosted by MaRS and CAMH
(Centre for Addiction and Mental Health) on May 23rd
, 2013. This session was held as a part of a series of meet-ups of health innovation
centres, engaging forty health system innovators, service providers, and individuals with lived experience of mental health needs from
across Southern Ontario.
The purpose of the workshop was two-fold:
• To explore the value of scenarios and artifacts to spark new thinking around the future of health; and
• To test out an emerging method that could build momentum and interest in health innovation.
The session was built on the understanding that the health care system can’t just focus on doing ‘the same old better’. While working to
improve the current system, we also need to invest in new services and new systems that will help us prepare for the future and guide it in
a positive direction. With this in mind, workshop participants rolled up their sleeves to fill bathroom cabinets with artifacts from the future
using an emerging method called reverse archaeology.
In this case, the method was intended to spark imagination about the spectrum of possibilities for innovation in mental health and help
participants meaningfully experience alternative futures. Testing out this method was part of a larger vision of coming together to create
polished museum-like exhibit that sparks greater in interest and investment in the future of health.
Reverse archaeology is a new technique, coined by futurist Stuart Candy, where participants tell stories
about future possibilities by creating objects from the future – just as archaeologists use historical
fragments found to uncover the story of our past. This process bridges abstract thoughts about what
could be with concrete objects to keep it real.

EVENT REPORT 3
THE VISION
This workshop was designed to test the reverse archaeology method to inform a larger, more strategic collaborative project. The overall
project vision is to bring together visionaries and game changers interested in influencing the future of health to collectively create an
exhibit that would inject imagination into the health care industry and provoke investment in innovation for the future. The intention was
to offer thinkers and makers a playful opportunity to get outside of current system constraints and create powerful tangible, solutions for
the future. The session held in May 2014 offered important lessons to guide the larger goal of creating a exhibit that could be exhibited a
well-known gallery. The overall process for the larger project is described below.
CROWDSOURCE
TREND ANALYSIS
COLLABORATE ON
FUTURE WORLDS
SHARE THE
SCENARIOS
DESIGN SERVICES
FOR 2040
EXHIBIT
ARTIFACTS
Thinkers from inside
and outside the
health care space are
invited to identify
trends influencing
health services.
Using the trends
identified, the
collective will work
together through a
series of foresight and
strategy methods to
develop scenarios for
2040.
The future scenarios
will brought to life
through thoughtful
and creative
illustrations and
distributed to
interested thinkers
and makers to provide
context and inspiration
for their service
innovations.
Creators will
collaborate to imagine
mental health services
relevant to one of the
2040 scenarios. Each
participating team will
build a remarkable
object from 2040 that
will allow others to
discover the essence of
their imagined future
service.
These artifacts will
be curated into a
rousing exhibit in a
setting that mimics
a museum from the
future. Health system
stakeholders and the
general public will be
inspired to rethink
the trajectory of the
mental health system.

WORKSHOP PROCESS
To test out this process in an afternoon, a small segment of the overall vision was brought to life. Participant were placed in diverse groups
and each group received a scenario of mental health services in 2034 and a bathroom cabinet. They were asked to fill the cabinet with
artifacts that someone might find in the future world outlined in their scenario.
This process involved the following four steps:
1. Visit the Future: Groups reviewed their scenarios and by imagining themselves in this future world, discussed what this world might
mean for people’s mental health needs.
2. Capture the Essence: Participants worked together to identify the most compelling discoveries about mental health services in this
future and sketched objects that reflected these discoveries.
3. Craft the Artifacts: The groups then identified compelling objects to bring to life, built them quickly using craft supplies, and placed
them in their group’s bathroom cabinet.
4. Showtime: All participants came back together to view the mini-exhibit of bathroom cabinets from the future, with brief
explanations from each group.
GUIDING PRINCIPLES
• Understand that useful insights about
the future at first appear ridiculous.
• Challenge present assumptions and play
with the possibilities.
• Rigorously imagine the future -
stretching plausibility, but not breaking
it.
• Make things from the future, not about
it.
• Leave something for the audience to
imagine – the cabinet is a hook, not the
full story.

EVENT REPORT 5
SCENARIOS The following are the four scenarios of future worlds
utilized by each small group.
TALE OF TWO WORLDS
FORCES OF CHANGE
SYSTEMS INTEGRATION
PEOPLE POWERED HEALTH
VALUE-BASED CARE
SOCIAL DISTANCING
After a yo-yoing of government priorities and spending in the 20s, there are
significant cuts to mental health and social services in the 30s leaving the desperate
population with little government support and unimaginable waitlists.
While mental health has emerged from the twilight of people’s lives, formal services
are irrelevant for most. With a large population of very old, low-income boomers,
marginalized and segregated minority groups in urban areas, immigrants with unmet
health needs, and First Nation, Inuit and Métis communities that have been long
neglected, mental health issues are reaching unprecedented levels, especially related
to chronic stress. Still, meeting the basic necessities of life are a much higher priority
for the majority of the population.
Trained police officers are the front-line responders for mental health crises,
sometimes partnering with medical personnel or peer supporters. Segregated
population groups are highly networked using simple technological advances that
allow for monitoring and instant virtual connection between individuals anywhere.
Caregivers rarely stay at home with the individuals they are caring for, instead they
connect with them regularly while at work or elsewhere. Social enterprises are
creatively working to fill the government void by addressing environmental factors
of health and meeting the needs of targeted population groups, making exciting
progress at a small scale.
On the other hand, the small group of elite in Ontario are finding ways to take
advantage of exciting medical advances through private practice, personal
connections or international purchasing. They are obtaining the newest technology,
medications and interventions that enable real time adjustment of medications and
reminders based on body and mood tracking, ensuring that mental health issues
rarely interfere with functional abilities.
Illustration by: Ken Orvidas
TIME LINE
2014 204420342024
INCREASING GOVERNMENT DEBT DRAMATIC CUTS TO SERVICES
STRENGTHENING OF TWO-TIERED SYSTEM
Mismanaged govern-
ment spending on
economic stimulus
Prime minister speaks
publicly about mental
health struggles
20 year wait list to
see a publicly-fund-
ed psychiatrist
20 jails built in
Ontario in last
decade years
50% of the population
in Ontario identifies as
having a MH issue

CONNECTED COMMONS
FORCES OF CHANGE
SYSTEMS INTEGRATION
VALUE-BASED CARE
SOCIAL DISTANCING
With early legislation to unlock electronic health records and provide open access to
these records, Ontario experienced a digital health boom in the 20s that resulted in
a variety of tools to support communication and collaboration between clinicians,
peers and patients. What emerged from this era was a platform or commons in
which almost all health information, communication and knowledge is linked,
creating a virtual one-stop shop for big data and specific patient information, despite
disparate applications and devices. This infrastructure enables distributed, informed
collaboration between highly-linked providers, empowering all providers as well as
caregivers and peers with specialized support to address mental health needs.
With advanced monitoring and communication techniques, outpatient visits are a
thing of the past. Most patients and caregivers connect with providers and peers
through cloud medicine channels. When individuals with mental health needs do
connect directly in with providers, the continuity of this relationship is less important
because all providers have an instant comprehensive overview of the individual’s
history and preferences, and can make informed decisions with specialized support.
Ontario mental health services have become a web of networked health care
providers and social service providers with protocol for instant and ongoing
collaboration, reducing issues around location and strengthening service at
every access point. Specialized mental providers become easily accessible
knowledge supports for primary providers and informal supporters. Organizational
collaboration across the health sector is incentivized, especially for individuals with
complex mental health needs, through reimbursement structures that creates shared
responsibility and pooled funding.
TIME LINE
2014 204420342024
DIGITAL HEALTH BOOM
ORGANIZATIONAL LINKAGES AND MERGERS
Ontario makes
it mandatory to
unlock EHRs
Pooled funding
for complex
patients
Patients access EHR &
open access to anony-
mized information
Emergence of
common cloud
medicine platform
All health care providers
connected to special-
ized mental health

EVENT REPORT 7
THE PEOPLE ASSEMBLE
FORCES OF CHANGE
SYSTEMS INTEGRATION
VALUE-BASED CARE
SOCIAL DISTANCING
As a response to the overburdened, perpetually underfunded mental health system,
people affected have mobilized to support each other and enhance their power
within services. Through greater access to health and medical information, patients
and caregivers are increasingly informed about health choices and connect to each
other for support and knowledge.
Instead of stifling this emerging movement, funders and formal mental health service
providers recognized the assets of the community and the economic benefits of a
‘peer positive’ approach. They responded through a shift to client-directed services,
the creation of many paid peer support positions over time, a focus on group visits,
connection to non-medical alternatives, and seed funding for the development
of advanced community support networks. Through this recovery orientation,
individuals are encouraged to build capacity for long-term self-management with
support from tools and advanced social monitoring techniques.
Still, individuals with complex and severe mental health issues are neglected
resulting in a rise in homelessness and significant caregiver burden. The system of
services remains fragmented, but individuals cope through social connection, peer
navigator roles and offerings from curatorial health enterprises.
TIME LINE
2014 204420342024
UNDERFUNDED MENTAL HEALTH SERVICES
WIDESPREAD ACTIVISM AND CITIZEN ACTION
Legal case sets presi-
dent for requirement of
shared care planning
LHIN invest in
peer and patient
engagement
Most of patients
seen regularly in
group visits
Mental health
riots in 6 major
cities
Global MH
network reaches
100 M members
25% of staff in
mental health
services are peers

COLLECTIVE IMPACT
FORCES OF CHANGE
SYSTEMS INTEGRATION
VALUE-BASED CARE
SOCIAL DISTANCING
Supported by inter-ministerial collaboration and aggressive funding models, Ontario
becomes a leader in holistic mental health care. Through the creation of individual
“endowments” for individuals with complex mental health needs, funding enables
extreme flexibility of goods and services to support mental health and wellbeing.
Increased ability to monitor health outcomes and shared accountability for
population health has enhanced the integration of services and comprehensive client
outcome tracking. Financial incentives for effective, low-cost interventions have
encouraged health care providers to connect patients to a spectrum of alternative
services, tools and supports including, physical activity interventions and peer
networks. Most services provided are reimbursed based on short and medium-term
health outcome measures.
Many mental health service providers establish a focus on a specific patient
population to improve efficiency and outcomes. This leaves some diagnostic
populations, such as those with obsessive compulsive disorder, significantly under-
resourced in Ontario. While providers support individual medical and lifestyle-based
interventions and governments work at environmental interventions to support
health and ensure that all new policies encourage health equity.
TIME LINE
2014 204420342024
ENHANCED MEASUREMENT OF HEALTH OUTCOMES
ALLIANCES WITH SHARED TARGETS AND ACCOUNTABILITY
Interministerial
mental health com-
mittee established
“PopCan” partner-
ship of Stats Can
and Health Canada
Performance pay-
ments are 15% of
MH funding
Release of
‘Health in
All Policies’
“Endowments” for
individuals with
complex MH needs
“Operation Out-
comes” changes
payments

EVENT REPORT 9
FUTURE BATHROOM CABINETS
The bathroom cabinets that resulted from this process were thought-provoking, inspiring, and eerie. The cabinets were filled with future
objects like:
• The next generation mood ring that instantly communicates your every emotion
• Social communication platforms to reduce isolation
• Monitoring devices linked to peer support
• Built-in mindfulness activities
• Positive affirmations based on the owner’s current state
• Bio-feedback toothbrushes
• Monitoring chips that signal to others for support in times of need

DIS/CONNECTED COMMONS
This public bathroom cabinet in 2034 is a ubiquitous portal into
personalized mental health services. High tech and high touch has become
interchangeable. With personal health and social records thoroughly
integrated and stored in the cloud, most services can now be accessed in
many public places and at home (for those who can afford it). Touching the
mirror activates the portal for a personalized mental health journey. The
cabinet senses and collects multiple bio signals and markers. The mirror
doubles as a virtual conferencing console with realistic tactile feedback, to
meet with a mental health professional or friend. The cabinet also dispense
tools (e.g. stress balls) and medications.
COLLECTIVE IMPACT
This cabinet belongs to a man named John who, in the year 2034, lives with
mental health in a world characterized by “collective impact”. The stigma
and shame associated with having mental illness is a thing of the past, and
people are able to live “normal” lives (see John’s Rolling Stones ticket,
assuming they’re still rockin’). With the push of a button on the cabinet
mirror, people are able to alert employers if they’re having a bad day and
there is no problem whatsoever with staying home. Built-in monitoring
devices call up friends for peer support then the situation requires. The
cabinet is relatively empty on the inside, with an expired pill bottle,
reflecting the relatively good state of mental health in this future world.

EVENT REPORT 11
THE PEOPLE ASSEMBLE
This cabinet offers real-time analysis and intervention. A “quantified”
toothbrush measures and tracks the exact levels of stessors and drugs via
an onboard lab chip. That in turns triggers the home pharmacy to churn
out the appropriate drugs in the specific amounts needed for that day. The
cabinet is connects to social networks in various ways, including immediate
access to a loved one to support messages from an extended social circle.
TALE OF TWO WORLDS
This bathroom cabinet is owned by a young man who lives in the shadows
of the wealthy and must deal with the stress of his everyday life in
an ongoing way. Despite his low-income, he has access to some old
technologies that help him assess his needs and cope with stress, including
a mood ring that senses his every emotion, a screen that provides personal,
targeted positive affirmations, as well as mindfullness and art-based
therapy tools.

REFLECTIONS & NEXT STEPS
While the workshop lasted no more than two hours and the new objects created were only made of construction paper, popsicle sticks and
plasticine, the process was incredibly fruitful and energizing.
Despite rich discussions and ideas, the results were raw, somewhat superficial and for the most very focused on technology, likely because
of the time and material constraints of the workshop. Engaging participants right from the beginning in scenario development and
allowing significantly more time for artifact design and creation will help to make future worlds more robust, build understanding among
artefact creators, and produce more provocative, polished pieces.
Still these prototype bathroom cabinets cannot be ignored. They spark emotion, ignite new thinking, generate questions, and invite
conversation about the future. The cabinets speak to the need for more investment in exploring the future of health and the value of co-
creating the possibilities together with people from all walks of life. Also, a number of participants were inspired to find ways of bringing
this method and future thinking back into their organizations, building on the momentum of this short experiment.
Following the workshop both MaRS & CAMH put up a blog post summarizing the event. Workshop organizers are also working to set up a
mini-exhibit to display these cabinets publicly within MaRS as means of building engagement and interest in the larger project vision to
collectively create a polished museum exhibit exploring the future of health. In Fall 2014, a working group will begin meeting to commence
the planning for the larger reverse archaeology project.
If you are interested in getting involved in the working group or want to find out more information, contact:
Josina Vink at josina.vink@camh.ca.

EVENT REPORT 13
EXPERIMENT COLLABORATORS
Workshop facilitators included:
• Chris McCarthy, Kaiser Permanente/Innovation Learning Network
• Tai Huynh, Centre for Innovation in Complex Care
• Jerry Koh, MaRS
• Josina Vink, Centre for Addiction and Mental Health
The organizing team consisted of:
• Zayna Khayat, MaRS
• Jerry Koh, MaRS
• Josina Vink, MaRS
Workshop participants included representatives from the following organizations:
• York University
• Bridgepoint Collaboratory
• Cancer Care Ontario
• Center for Addiction and Mental Health (CAMH)
• Centre for Innovation in Complex care (CICC)
• Coalition of Mental Health Latino-Hipano People
• Ethnovation
• OCADU
• LOFT Community Services
• London Health Sciences Centre
• Mackenzie Health
• Mental Health International
• Saint Elizabeth
• Sick Kids
• Southlake Hospital
• Techna, UHN
• Toronto East General Hospital
• TransForm SSO
• Trillium Health Partners
• University Health Network (UHN)
• University of Toronto

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