In the spirit of both Mental Health Week and World Accessibility Day being this week, I have put together some musings about designing services for those with mental health issues and how we can make interaction with our designs as easy as possible for them if we just think a little differently to consider their take on our designs.

Whilst awareness of designing for accessibility is increasing, I find there is still a real skew in awareness of considering users with physical issues such as being blind, deaf, or a wheelchair user, whilst consideration of mental or behavioural illnesses (also often referred to as invisible disabilities) hover quietly in the background. As with any other illness or disability, design should not exclude any groups of users. By looking at usability for wide audiences, we make a product more useable for everybody and reduce the stigma and inconvenience for some where this is much needed.

There are many mental illnesses and behavioural issues that can make it equally difficult to interact with a service, due to the impact on concentration and attention spans, comprehension, memory and information processing. Think ADHD, MS, Alzheimers, depression, PTSD, anxiety and more.

Here are 4 simple things for you to consider in your design work to help these user groups.

Remove timers for completing pages.

This is not to do with pages timing out due to inactivity but rather those little tickers you get on some websites. They are usually lurking when booking tickets or flights and you get a lovely page saying the tickets are yours <wahey!>, if you can pass one final Challenge Anneka type situation to enter payment details <groan>. If you are anything like me this situation unfolds as follows:

User need – As a fan of Bears Den, I want to order tickets when they are released today so that I can see them live on tour (because I love my Bears).Go to the website and select the ones I want and submit ‘Buy Tickets’. Everything is swimming along merrily.
Message appears – ’The tickets are being held for you. You have 2:00 to complete this page’. GO!
Waaaah. Does it mean 2 minutes or 2 hours? Oh, who knows. Feck
Frantically run around the house trying to find my handbag and purse, because no, I didn’t think to have that ready and nothing prompted me to. Can’t find it
Shout to the fella to ask him where he’s hidden my handbag
Get abuse back saying it’s where it always is in the middle of the kitchen and why do I always blame him?
Shrug off his chunnering and find the handbag. Got it!
Eek, which is the bank card I want? Where do I have the monies? Hmm. Nowhere. Where do I have the most amount of measly monies for life affirming tickets?
Sod it, use any card, I’ll sort it later
Furiously type in numbers and hope I get it all correct in those precious seconds. Chunner about how I hate numbers
Error message – Card number invalid. Eurgh
Try again. Issue date invalid
Double eurgh. Type type type. Type like a maniac
Hit the submit button
It’s doing something…
Ask the computer whether this time is this counted in my seconds. No answer, so pray it isn’t
Message appears: You are in a queue, do not refresh or click back. Do not breathe. Do not think of blinking. Do not press submit again or you will be charged thousands of monies.
It’s been doing this for ages, ask computer if it is frozen? Strokes computer and begs it to behave. Also pray the 21% of laptop battery left is enough
Success! And breathe. Kiss the computer and cry silent tears of relief into my Bears Den t-shirt

The timer can really heighten anxiety for most of us, especially when tickets for that much needed holiday or your favourite band are at stake, so imagine how someone with anxiety or processing problems may feel such as a dyslexic who is struggling to enter data correctly and validate fields with the numbers ominously ticking down in the top corner. There is sometimes a real case for needing this time function, but where possible we either need to ensure that the time given is either generous for all users or that it is removed.

This function can also be a pain for people who are dealing with a site which is not in their native language. I speak from experience after trying to book a ferry on a Norwegian site, having to use Google translate on every field (my anxiety making me translate them all even if they were obvious what it was asking). It timed out on me 4 times, taking me back to the start every time. On the 5th bout I managed to do it accompanied by a rather loud yelp of relief. Well, I hope it was successful. We haven’t yet gone on the trip – fun could be awaiting us in 2 weeks, I could have booked us to travel in the cargo hold with rats for all I know. Or signed us up to be the ship’s entertainment. I’ll keep you posted.

Only ask necessary information

For example, you are designing a service where a user is buying tickets to a family event – do you really need to know the users age? Gender? Religion? The car they drive? Their pet dog’s name? Their second cousin’s preferred vegetable? Okay, I might be exaggerating slightly, but I do sometimes wonder the legitimacy of many questions being asked.

Some users can find it anxiety inducing to provide personal information, especially if they do not fit neatly into a specified bracket, or are not used to doing so. This can make users feel isolated and worry about the implications of not answering or fitting into the neat tick boxes provided. Are we not going to let their family have tickets if they are over or under a certain age? Do they have to be a specific gender to get in? Is the event only for people of a certain denomination? It is likely that the answer to all of these is no (except for age 18 restricted events and the like) and so it is rare to need the information. If you do need the information, make it clear why you need it.

The new GDPR regulation says we should only ask and retain necessary information for the transaction, but aside from the legal requirement, it is our obligation as a designer to ensure we are not asking information just for the sake of it. If you cannot find a reason to ask for information – push back. Ask the policy makers and business owners as to why they need to ask questions if you feel they are not valid and use your user testing to back up your argument.

Reduce cognitive load

Cognitive load is about making it as easy as possible for a user to read and interpret the information, then transfer it into the memory. This is one that I struggle with myself and there are still many examples where this is just not considered.

The brain can hold approximately 4-5 pieces of information at a time, but this can be significantly reduced by mental illness or even lifestyle factors such as lack of sleep. Often, web pages are totally overloaded with information either due to:Lack of a content designer. Obviously the most important point.
Content not being written by the right person or having content provided from too many people (for example, marketing having a bash and it becoming too much of a sales piece, or legal interfering and it becoming jargonlicious).
Fear of being sued or blamed for something and so putting every single word to cover every eventuality of blame or scenario. This is usually also accompanied by endless terms and conditions.
Not taking to users about what they need to know, and what they understand.
Not having a clear message or voice.
The more information we give at once, the harder it is for a person to interpret the information and understand what they need to do, therefore their cognitive load has increased. This then decreases the chance of a user reading or absorbing any of the information at all. If the content is broken down into just the key information and presented in simple, consumable chunks the load reduces. I think we are all guilty of skipping past terms and conditions, introductory text and long winded descriptions to get to the meat of what we want to know or do. I am the queen of just using search functions to just jump to what I need to know. If the information is not crucial to the purpose right now, link out to it, provide a downloadable file, ask eligibility questions to establish needs or just delete it. Then delete some more.

Again, get a user researcher involved and do some A/B testing with your users to demonstrate to the powers above how being hit with a wall of information actually increases the failure rate of completing a task. It does not reduce problems, it increases them.

Make the next steps clear

So the user has completed their task in your service. What happens next?

Do they need to:wait for an email with details of next steps to complete the process?
wait for an order confirmation?
wait for something to arrive in the post?
ring to arrange an appointment with someone?
do nothing more and crack open the gin? (preferred option in all cases)
Also, tell them when to expect further communication. Is it an immediate confirmation, or will it be within an hour/day/5 working days? Don’t make a user sit anxiously worrying whether everything went through okay and whether they will get their tickets in the post or online to print off themselves. They should not have to work out whether the process is complete or whether something else is needed from them.

If nothing else, it’ll help the lost generation who are trying to start using the internet in their 70s and will reduce SOS calls to the rest of us at all hours of the day asking what they need to do now they’ve ‘pressed the button thingy’ and if their tickets to the Bay City Rollers tribute act are indeed booked.

Make it clear. Please.


This is by no means an exhaustive list, but it is a good starting point to get thinking and these points help all of us in the long term. Take a look at the service or product you are currently building and review whether these points have been taken into consideration or if you can further enhance the experience for a user with a mental health issue.

Note: Cognitive load in particular is an area that I have become very interested in and will be researching and writing more about here. In the meantime if you want to learn more about it, look up cognitive load neurodiversity, reading comprehension in adults and in particular the work of Amy Brann