# In-Depth Co-Design of Mental Health Monitoring Technologies by People with Lived Experience
### Why Co-Design Digital Mental Health Monitoring Interventions? Despite the technology's potential value for consumers, public engagement is lacking [19; 20]. Many technology-enabled mental health programs have failed [21; 22; 23]. This may, in part, be driven by the lack of consultation with mental health consumers during the design and development of digital mental health interventions, as a result of which they are not well-designed for mental health consumers and integrate poorly into their daily lives [24; 25; 26]. Examples of misfires include daily self-monitoring activities that might be easy to achieve in a single usability session but are time-consuming and hard to remember over longer periods [25]. Daily lifestyle tips that are not necessarily relevant to the consumer's own lived experience are another concern [25]. Problem areas include low usability, poor fit, lack of engagement, lack of knowledge, and the need for more implementation support [25]. Patient health-monitoring experiences are under-studied across public health care [7]. A scoping review of mobile post-operative self-monitoring interventions, for example, found that the most common outcome measure associated with patient experience was patient satisfaction, and only three out of thirty-four studies reported any sort of patient involvement in the design and development of the intervention [24]. Without a grounded understanding of the consumer's lived experience, as well as the barriers and enablers of consumer engagement that emerge from this experience, there is a risk that consumer needs will not be served, or worse, that the consumer experience will be further challenged as a result of such implementations [27; 28]. Monitoring technologies necessarily implicate issues regarding power and agency, raising concerns that when health systems involve forms of data surveillance, or \"Dataveillance\" [2; 29], they objectify consumers by framing them as a form of data and transforming treatment into a form of data analysis. Consumers who engage with monitoring technologies do not necessarily do so because they believe that they are harmless. Instead, they are more likely to have weighed up the perceived benefits of monitoring technologies versus the potential risks of monitoring technologies and have judged the former to outweigh the latter [30]. Consumer agency is key to optimizing the benefits, as well as mitigating the risks, supported by co-design efforts. Agency is dependent upon the ability to make choices that have meaningful consequences or impacts, whereas co-design can support that capacity by ensuring that consumer \"desire(s) are among those they can take\" [1; 31]. As yet, there are minimal extant legal requirements regarding the monitoring of consumer mental health and well-being at this granular level. While the number of studies into the consumer acceptance of health monitoring technologies is growing [9; 17; 30; 32; 33; 34; 35; 36; 37], nevertheless, these attitudinal surveys and interviews do not encompass the full range of consumer experience of digital health processes, and few studies consider the specific considerations of mental health lived experience. Digital mental health care processes may feature digital tools, but they also encompass broader contextual concerns and service delivery considerations that can profoundly influence the consumer's lived experience of care [25]. A systematic review of studies that explored consumer engagement with digital mental health interventions found numerous issues that hamper engagement. Barriers include severe mental health challenges, as well as technical issues. Some apps were difficult to use or else failed to work as expected. In this regard, a lack of personalization options in some mental health apps and the inclusion of app content that is not directly relevant to the consumer's lived experience can be off-putting. For example, people who spend most of their time indoors are unlikely to be interested in exercise programs.