Piñata: A Personalized App to Support People at Risk of Self-Harm and Suicide

How Experiences as a Crisis Hotline Counselor Inspired Innovation at the HackMentalHealth 2019 Hackathon.

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Piñata is an application that offers personalized, trackable crisis intervention and stress management techniques.

Currently, there is a lack of standardized resources for people who practice self-harm; much of the information is exchanged through forums and word-of-mouth. And of the existing emotional health apps (think mood diaries), most of them have poor UI/UX and do not provide mechanisms to track the effectiveness of an activity/intervention over another.

Piñata will provide a more personalized application of tried and tested Dialectical Behavioral Therapy (DBT) techniques and learn alongside our users over time to help them recognize which techniques work best for them.

The Inspiration

During my time as a crisis line counselor, I’ve interacted with many young adults who struggle with mental health issues and suicide — and often they use self-harm (ex. cutting, scratching, hitting oneself) as a coping mechanism.

Navigating the conversation about self-harm can be very tricky — on one hand, we recognize that self-harm is not a sustainable, long-term coping mechanism; on the other, we also have to acknowledge that it can, in fact, be a transient salve for people in distress, who may be considering suicide.

From these tough conversations, however, I’ve also come to realize that there was a lack of centralized and standardized resources for people who self-harm; much of the information is exchanged through forums and word-of-mouth. It is estimated that somewhere between 15% — 40% of people have practiced some form of self-harm behavior throughout their life — that is a huge proportion of people who have not been adequately supported.

Hence, we wanted to create a clinically sound, evidence-based, and aesthetically pleasing application for young adults in distress.

Why the name Piñata…?

The idea of the app was to offer alternatives to self-harm behavior — either healthier coping mechanisms, or distress tolerance techniques (borrowing from the Dialectical Behavioral Therapy paradigm). By pressing the Piñata button in the middle, the user is offered another set of 8 actionable alternatives.

Sample Piñata User Interface

Sample Piñata User Interface

In addition, we also wanted the app to be uplifting and whimsical to contrast to the user’s distressed mood/state.

And if all else fails, whacking your frustrations/agitations out on a Piñata is also a viable option. At least you’ll get to enjoy some candy!

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The Piñata Team

By a stroke of pure serendipity, it was our first meeting at the Hack Mental Health Hackathon — and our first hackathons ever!

By a stroke of pure serendipity, it was our first meeting at the Hack Mental Health Hackathon — and our first hackathons ever!

Bora Kim (left, Program Manager at Google) Ideation and Business Model

Yiu Ho Au (center, Clinical Researcher at UCSF) Concept and Design

Dena Burd (right, Apprentice at Techtonica) Coding and Prototype


How does Piñata work?

Assessment

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“I’m feeling ________ today.”

When the user first signs in, Piñata does a quick assessment of their mood — sad, frustrated, melancholic, disgusted, etc. The available emotions (an autocomplete field) is based off The Atlas of Emotions developed by pioneering psychologists Paul Ekman and Eve Ekman (think Inside Out!).

The intent is that users, over time, will not only develop a greater awareness for their mood, but also vocabulary to better describe what they might be going through.

We were also very intentional with the wording regarding the initial assessment; we wanted to convey a sense of transience, by qualifying it with “today.” So often in English, we unintentionally personalize our emotions (ex. “I’m sad.” or “I’m hopeless”).

Elevated Mood

In conjunction with understanding their mood state, we want to get a gauge of how elevated their mood is — the intensity of their current emotion helps inform us how to best support the user.

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For example, if a user rates themselves as a 5 or below, that gives us an idea that they may be upset, but not in crisis — and we can continue with providing healthier coping mechanisms.

Distraction techniques for moderately elevated moods.

Distraction techniques for moderately elevated moods.

However, if a user rates themselves as a 6 or above, then we would want to first get clarification on whether they were thinking of killing themselves, and also offer more involved distress tolerance skills instead.

Distress tolerance techniques for highly elevated moods.

Distress tolerance techniques for highly elevated moods.

Trackability, Re-Assessment & Personalization

After each activity, we want to reassess their mood state to not only check-in on their well-being, but also to quantify how effective the activity was in providing relief.

Over time, Piñata will be able to track the effectiveness of each chosen activity by measuring the before and after mood state. From that, it can infer what worked best for each user, and these insights will power future personalized recommendations.

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Example changes in mood after activities/interventions over a month.

Example changes in mood after activities/interventions over a month.

Accomplishments

We were very fortunate to be recognized for one of the prizes at Hack Mental Health 2019! Joyable, a sponsor of the event, identified us as the winner of the Joyable Challenge, for hacking a solution to provide more integrated options for those in need of crisis support!

Piñata at this point is still very much in its infancy — and we look forward to further refining the idea and developing Piñata as an iOS app.

Written by Yiu Ho Au