Webwatch: Streetwise – Helping people discharged from secure mental health services into community

Researchers from City, University of London have developed a serious game in collaboration with mental health service users to support and prepare people being discharged from secure mental health services into the community.

The study, which is published in the journal of Psychiatric and Mental Health Nursing, shows how such games can have therapeutic value and help service users to begin to develop skills for community living and consider self-management in risky situations which they may encounter once discharged, such as joining in social situations or being offered illegal drugs.

In the UK Forensic Mental Health (FMH) services are tasked with ensuring public safety whilst supporting service user recovery and reintegration into wider society.  Due to past histories of offending behaviour, FMH service users are often detained under the Mental Health Act (2007) within secure settings where they are monitored and their freedom and self-governance is limited.

As a result, such restricted community access makes risk assessment and skill development for community living problematic and also poses a challenge to social integration and recovery. Additionally, detention in secure services leads to isolation from the community which adds risk and stigma to the complexity of the service users’ journey of recovery.

To help counteract this and aid rehabilitation from such services, the game – which is called StreetWise – was developed by mental health researchers and colleagues along with service users from forensic mental health services.

Recruiting service users from a low security forensic hospital in an inner London location, the participants included eight producers who went on to help make the game and six service user testers. Experience with computer games varied from having no experience to being an experienced gamer. Eight service providers were also interviewed to get their views on the game, and three of these had managerial roles while five were clinicians (nurses, psychiatrists, psychologists, and therapists).

The game itself features realistic environment and dialogue developed from the experiences shared by the service users in the development group. The setting is in an urban park and allows the player to interact with four different characters, through a first person view. Scenarios in the game include encouragement to engage in work, being offered illegal drugs or invitations to join in social activities such as having a coffee.

Within the game, the characters make positive, negative and neutral suggestions that test the player’s ability and coping skills in the community.

Scoring depends on the player’s choices and the nature of their next interaction will depend on the outcome of the first. If the player scores well, the scenarios progressively become more challenging and complex.

Users highlighted the importance of realistic language and graphics. Talking about the language used, one tester said: “Even the lingo, like the action, was correct. The slang terms, everything was correct, that’s how they’re going to approach you.” Another user also commented on the potential for the game to support him to develop skills to manage temptations, such as being offered drugs or money to engage in illegal activities, with the majority of service users felling that the game would be useful for their rehabilitation.

Dr Lisa Reynolds, Divisional Lead for the Nursing Division at City, University of London and lead author of the study, said: “We developed this new and innovative serious game in collaboration with service users to help prepare them for the realities of being discharged and found that the game gives the users a safe platform to begin to rehearse and explore their responses to situations in the community. In game the service users are afforded autonomy to make choices, and consider how to address problem situations without some of the risks encountered with independent living.

“As a result, the game demonstrates the potential for serious gaming to be used by health care providers to proactively support service users to become more independent and work towards their recovery. This was seen by our results, as service users and professional staff praised the game for helping people get to grips with the skills they need to reintegrate effectively into the community once discharged.”