The project started with secondary research that involved processing the most relevant documentation of the field and earlier studies, including the documentation of current situation, development plans, guidelines, frameworks, case studies from other countries, research articles etc. It helped to map existing services, versatility of the service system target group as well as other relevant stakeholders and get the initial overview of the already known issues. The secondary research was used to prepare for the field study.

The field study started with seven group interviews with main stakeholders and relevant interest groups (policy makers, service providers, service user representative organizations, healthcare, education, local municipalities). Altogether 43 persons participated in the group interviews. The group interviews were semi-structured and participants were asked to share their perception of the positive and negative aspects of the AS IS service system.

38 individual interviews and six observations were conducted with the main target group representatives and people in direct contact with them on the daily basis, including primary caregivers, family members, service providers, employers and mental health professionals. Interviews included persons who were already service system users as well as persons not yet using the services (e.g. due to lack of suitable services or motivation to address their mental health issues). Interviews took place in different municipalities in order to achieve geographical inclusion and interview people in their natural environment. The interview questions were semi-structured, and participants were asked about their everyday life, needs, expectations, likes and dislikes, fears, habits and previous experiences in relation to the existing services.

Six observations, lasting up to two hours, were carried out before or after the interviews by different types of existing service providers to gain a better understanding of the service content and overall context.

All interviews and observation notes were transcribed and deductively analyzed using a custom framework composed of life quality domains (from WHO mental health specific life quality measurement instruments: https://www.who.int/substance_abuse/research_tools/whoqolbref/en/) and the main stages of the user journey in the AS IS service system. The motivation behind using the framework was to look at the user needs in a holistic way as the services provided by the service system concern all the life domains of a large part of the target group. The life quality domains according to the WHO framework are physical health, social relationships, psychological well-being, environment, level of independence and personal beliefs. The stages of the user journey in the service system are (1) noticing the need for assistance, (2) entering the service system, (3) using the services, (4) changing the services or leaving the system. The transcribed interviews were coded by four designers during several collaborative data analysis sessions. The coded text excerpts were printed out and affinity diagrammed, grouping similar excerpts as long as sub-themes emerged. The insights from data analysis were formulated as user needs. The main problems in the service system and existing or potential resources were mapped as well.

The field study and secondary research enabled us to prepare a set of design tools for the co-creation workshops. The toolset included personas, user need cards and user journey mapping. We started by dividing the overall target group into five subgroups. The sub-target groups were defined based on the specificity of the target groups’ psychological special needs (i.e. related to intellectual disability or mental disorder) and the level of support needed (less than 8 hours per day and more than 8 hours per day). The five target groups were (1) people with mental disorder who need assistance more than 8 hours per day; (2) people with mental disorder who need assistance less than 8 hours per day; (3) people with intellectual disability who need assistance more than 8 hours per day; (4) people with intellectual disability who need assistance less than 8 hours per day, and (5) people who have been involuntarily assigned to a 24 hour care service based on a court ruling.

Three personas were created to represent each subgroup (altogether 15 personas), based on the field study results. Each persona described his or her current situation and background, most important goals and needs in life, likes and dislikes and some demographical data. We wanted to keep the personas short and easy to read in the context of a workshop (maximum 1 page). Because of the nature of the service that is supposed to assist the target group in almost all life domains, the personas were not enough to sensitize and communicate all the relevant information for the co- creation workshops, as the design team preferred to keep the personas maximum 1-2 pages long.

In addition to the personas, we created a set of user need cards. The cards were two-fold categorized, building on the framework that was used for data analysis in the field study. We differentiated user needs based on the stages of the user journey in the service system (noticing the need for assistance, entering the service system, using the services, changing the services or leaving the system). In each stage, there were user needs divided between the six life quality domains mentioned above (physical health, social relationships, psychological well-being, environment, level of independence and personal beliefs). The cards were intended to represent all the user needs mapped during the field study. The need cards included metadata about the user journey stage and the life quality domain and were color coded. The card content included the description of the need, e.g. "coping at home with the help of sufficient assistance as long as possible to maintain habitual life arrangements" (entering the service system - level of independence). See further examples of user need cards in the gallery. The cards were printed on paper and they were intended to be used for groupwork in co-creation workshops to complement and extend the personas.

In order to involve stakeholders in the process and generate more versatile ideas for the re-design, we conducted ten co-creation workshops. All in all, more than 50 persons attended the ten workshops. In each workshop we had 8-12 participants and three facilitators. The participants were divided into three groups – each group mapping out the ideal user journey of a different persona. The aim of the workshops was to describe future user journeys based on personas defined in the previous phase and to create conditions for fulfilling as many user needs on the way as possible and relevant. The teams mapped the user journeys step by step, describing also relevant resources and other stakeholders in the process as well as their responsibilities. Throughout the mapping activity, they added user need cards into the map, related to the descriptions of how the need will be satisfied. When first iteration of the journey map was completed, the teams went over the user need cards again and discussed the ones that were still not incorporated to the map. This encouraged the teams to iteratively improve their user journeys and discuss viable alternatives to already proposed ideas.

The user journeys and ideas proposed during the workshops provided the design team rich material and insights for developing a new service system concept. All the user journey maps from the workshops were digitalized for better readability and archiving purposes. This enabled us to map and synthesize potential service components and roles of different stakeholders. Several versions on the new service model concept were proposed for another round of discussion. Two additional workshops were conducted to discuss the proposed service models and potential risks with the stakeholders. The models were iteratively improved based on the feedback.

The first iteration of the design project concluded with pilot project to test out one of the service model variations. Namely the model version that focused on providing the care services mainly through local municipality social services specialists. The first pilot was conducted on a small scale over one-year period. In total 40 persons with psychological special needs were included in the pilot project – eight participating municipalities provided services according to the new model to five individuals in their area.

In preparation of the pilot, a series of seminars were conducted for the service providers and organizers from the local municipalities. The seminars focused initially on introducing the principles of the new model and continued as reflective experience sharing meetups to discuss the issues and opportunities that the pilot participants had encountered throughout the year.

In the end of the pilot period, another field study was conducted with the participants to gather feedback for the second iteration of the project. Interviews and observations were conducted in four municipalities out of eight. The remaining four municipalities were asked for feedback in similar topics using a questionnaire.

All the persons who participated in the pilot project and received services according to the new principles, continued receiving same services after the pilot project as there was a specially dedicated budget for covering the additional costs, if any should have occurred.

The first iteration of the project concluded with a final report of the process, including a description of the new service model.