Above Water: Designing Games for Sensitive Topics and Battling Mental Health Stigma (Preprint)

BACKGROUND While in many contexts unsuccessful games targeting learning, social interaction, or behavioural change have few downsides, when covering a sensitive domain such as mental health, care must be taken to avoid harm and stigmatization of people who live with mental health conditions. As a result, evaluation of the game to identify benefits and risks is crucial in understanding the game's success; however, assessment of these applications is often compared to the 'non-game' control condition, resulting in findings specifically regarding entertainment value and user preferences. Research exploring the design process, integrating field experts, and guidelines for designing a successful serious game for sensitive topics is limited. OBJECTIVE Our paper seeks to understand which elements of game design can guide a designer when designing a game for sensitive topics. METHODS To carefully probe the design space of serious games for mental health, we present Above Water, a game targeting the reduction of stigma surrounding mental health, now in its second iteration. This game serves as a research probe to understand the design and evaluation of games in the area of mental health by soliciting expert feedback from experts in domains related to Mental Health and Wellness, Game Design and User Experience (UX). RESULTS By using this deployment as a research probe to gather assessments by domain experts, this paper contributes to a better understanding of how to design specialized games to address sensitive topics. CONCLUSIONS The main contribution of the presented paper is a set of the guidelines for designing games for sensitive subjects. For each guideline, we present an example of how to apply the finding to the sample game (Above Water). Furthermore, we demonstrate the generalizability to other sensitive topics by providing an additional example of a game that could be designed with the presented guidelines. CLINICALTRIAL N/A