Self-fulfilling Prophecies in Service Design: Strategies to Address Virtuous and Vicious Circles for Mental Healthcare Transformation

The self-fulfilling prophecy can be best described as an assumption that, only because of the fact of being believed, provokes certain expectations and patterns of behavior that eventually make the initial assumption come true. This phenomenon has been long studied in a variety of applied settings, including the one of mental health care: in this regard, the concepts of stigma and self-stigma have been proven to be, in part, self-fulfilling. Service design has been working in the field of mental health care to address these issues by promoting service co-production and a recovery-oriented approach. However, shared beliefs and norms within organizations, rooted in unquestioned and taken-for-granted ways of operating, may hinder this transformational process. In fact, these shared beliefs and norms may result in unconscious self-fulfilling prophecies, that are, positive and negative feedback loops of thinking and acting in the form of virtuous and vicious circles. Recent studies in service design identify institutional theory at the macro-level and mental models’ theory at the micro-level as promising practices to prompt individual and collective reflexivity to overcome these barriers. This chapter aims to further develop this research stream to address both virtuous and vicious circles at the micro-level, in order to reveal, question, and transform them if necessary to foster change at the macro-level, too. Through an experimental work within a Northern-Italy department of mental health care, this chapter reflects on which kinds of service design reflexivity tools can help to enable transformational processes across service systems.