Abstract

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Mental Forest is a board game developed as part of a practice-led research project exploring how creative health approaches can make conversations about mental health more open, accessible, and normalized. The project builds on my lived experience with anxiety but is not limited to that condition; instead, it asks how playful, metaphor-driven methods can encourage dialogue around mental health more broadly.

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Grounded in an autoethnographic and reflexive methodology, this research uses the creative process itself as inquiry. Iterative design, playtesting, and reflection formed cycles of learning, revealing how game mechanics can mirror emotional states while also opening spaces for connection.

Findings suggest that balancing challenge with moments of support within the game reflects real mental health journeys, while the familiar format of a board game helps reduce stigma and makes engagement feel natural. The project also draws on gamification theory, showing how challenge, reward, and collaboration can be reframed not to measure or control behaviour, but to normalize mental health as part of everyday life. In doing so, it contributes to arts-in-health discourse by offering an alternative to clinical or didactic interventions.

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Introduction

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Conversations about mental health remain difficult for many people. Stigma, misunderstanding, and the weight of clinical language often make it harder to talk openly about struggles that are in fact common and shared. I wanted my final project to ask a simple but powerful question: What if talking about mental health could feel as normal as playing a game with friends?

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Mental Forest grew from this idea. It is a handmade board game that uses metaphor, colour, and storytelling to create an imaginative journey through a forest. Players collect key fragments, face obstacles, and occasionally receive support from others. The mechanics are designed not to simulate therapy or teach coping strategies, but to create a symbolic environment where people can reflect, laugh, and connect.

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While the project is rooted in my own lived experience with anxiety, it extends beyond that. My autoethnographic perspective shaped the design choices, but the goal was always broader: to normalize mental health as part of everyday conversation, not something siloed into clinical spaces.

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The aims of the project were to:

1. Use creative health approaches to make mental health conversations more accessible.

2. Normalize mental health by embedding it in a playful, culturally familiar format.

3. Explore how metaphor, abstraction, and gamification can represent complex emotional states.

4. Balance individual struggle with collective connection through game design.

5. Reflect autoethnographically on the process of making, testing, and sharing the game.​

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The following sections situate the project within arts-in-health and gamification literature, outline the reflexive methodology, describe the process of development, evaluate the outcomes of play testing, and reflect critically on successes, limitations, and contributions.

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Literature Review

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2.1 Arts-in-Health and Creative Approaches

The arts are increasingly recognized as vital in supporting wellbeing, reducing stigma, and providing new forms of expression (Stuckey & Nobel, 2010; Fancourt & Finn, 2019). Unlike clinical interventions, creative health methods allow ambiguity, emotion, and storytelling to play central roles. For young people in particular, non-clinical creative practices can offer more accessible entry points into mental health dialogue (MIND, 2023).

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2.2 Play and Games as Metaphor

Games are not only entertainment but also cultural forms that embody narrative, metaphor, and interaction (Nicholson, 2015). Play provides a safe, bounded space where difficult ideas can be explored indirectly. In mental health contexts, this allows participants to reflect symbolically without pressure to disclose personal details (Russoniello et al., 2009).Board games in particular carry familiarity and nostalgia, making them effective for reducing barriers. Mechanics like chance, looping pathways, or cooperative goals can map metaphorically onto emotional experiences, from unpredictability to resilience.

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2.3 Gamification and Health

Gamification — the application of game elements in non-game contexts — has become an increasingly popular method for supporting learning, behaviour change, and engagement (Deterding et al., 2011). In health-related fields, gamification has been used to encourage exercise, adherence to treatment, and mental wellbeing, often by making challenging or routine activities more engaging (Johnson et al., 2016).Key gamification elements include points, levels, rewards, challenges, and social collaboration (Werbach & Hunter, 2012). These elements motivate users by tapping into intrinsic drivers like curiosity, mastery, and relatedness (Deci & Ryan, 2000).

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While many digital health apps rely heavily on gamification, its potential in non-digital creative health contexts remains under-explored. Board games, with their tactile and social qualities, offer opportunities to integrate gamification principles in ways that feel immediate and human, rather than abstracted through a screen.Mental Forest contributes to this space by applying gamification not to “fix” or measure health behaviours, but to normalize conversations around mental health through mechanics of play.

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2.4 Reflexivity and Autoethnography

Traditional research often marginalizes personal story in favour of clinical objectivity. Reflexive and autoethnographic methodologies instead place lived experience at the centre, acknowledging that emotions and identity shape both process and outcome (Ellis & Bochner, 2000; Finlay, 2002). In arts-in-health, this approach disrupts hierarchies and allows for more authentic knowledge production (Boydell et al., 2018).For this project, reflexivity was essential. My own experiences with anxiety were not background context but an active lens, influencing everything from visual choices to pacing. This autoethnographic position made the work emotionally demanding but also more truthful.

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2.5 Normalization and Challenging Clinical Aesthetics

Mental health art in clinical settings is often sanitized, neutral, or overly “safe,” which can alienate the very people it aims to support (Stickley, 2012). By contrast, projects like Hospital Rooms show how bold, authentic creative work can transform spaces and normalize emotional honesty.This project aligns with that ethos, using a familiar, playful format to make mental health part of everyday activity. By embedding it in a game, the conversation becomes normalized — not something separate, but part of ordinary social interaction.

Methodology

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This was a practice-led, arts-based project framed through reflexivity, autoethnography, and gamification.

Practice as Research: The act of designing and making the game was the research process itself (Candy & Edmonds, 2018). Iteration, playtesting, and reflection formed cycles of inquiry.

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Autoethnography: My lived experience with anxiety shaped design choices and was documented through journaling, sketches, and process notes.

Reflexivity: I continually reflected on how my feelings, limitations, and identity influenced the work (Finlay, 2002).

Gamification: I drew on gamification theory as a design lens, using mechanics like challenge, reward, and cooperation to shape player experience.

Ethics: Because I did not have formal ethics approval, peers and tutors could only provide feedback on game mechanics. Deeper reflection on metaphors and applications came from consultation with mental health professionals.

Emotional Responsibility: I recognized the emotional labour of working with my own mental health material, and set boundaries around participation to protect my capacity.

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This methodology allowed me to treat both external feedback and internal experience as data, producing layered insights into how games can function in arts-in-health.

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Process and Development

4.1 Sketches and Early Concepts

The project began with sketches of characters that I had created to represent six of the most common forms of mental illnesses.  I knew at the time that I wanted them all to interact in someway, and to be used in some form of creative health project, but I was unsure of how or what.  In my trans disciplinary module I had come up with the idea to build a board game, which originally was going to be about mental health, but instead about energy levels.  I ended up using my characters as testers for this initial idea, and mental forest was born.​

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4.2 First Prototype

A cardboard prototype was built with a simple board and a set of “challenge” cards. This version leaned heavily on obstacles, reflecting struggle but lacking balance.

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4.3 Playtesting

Playtesting was an essential part of refining Mental Forest. Each session had different participants, goals, and ethical boundaries, but together they formed a developmental arc from unbalanced prototype to validated creative health tool.

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Playtest 1: Mechanics with Peers (March 2025)

The first playtest took place with three of my fellow LJMU Art in Science MA students and Professor Mark Roughley. Because I did not have ethical approval, feedback was limited to mechanics — rules, pacing, and flow — and avoided any discussion of metaphors or mental health themes.

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The group found the design approachable and the characters engaging, but noted that the board had too few playable squares, which slowed the game to a crawl. They also suggested adding an element of collaboration between players.

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This feedback showed me that while the aesthetics were promising, the mechanics needed work.

In response, I:

• Added more playable squares to smooth the pacing.

• Introduced Heart cards to encourage interaction.

• Cleaned up the design for visual cohesion.

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Playtest 2: Refining Mechanics (July 2025)

The second playtest again involved peers and Professor Roughley, with the revised version of the game. This included the extra squares, Heart cards, and a more polished design.

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The pacing was noticeably smoother, but new issues emerged. There were too many cards, particularly star cards, which made goblin squares obsolete. Players recommended double-sided illustrations to make characters easier to find on the board, suggested experimenting with thermochromatic materials for hidden elements, and requested a physical rulebook. They also advised changing the skull symbol to a ghost to avoid potentially triggering imagery.

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In response, I:

• Removed a third of the cards and balanced positive and negative outcomes.

• Changed the skull into a ghost and noted in the rulebook that it could be skipped if triggering.

• Redesigned the characters and key pieces.

• Created a detailed physical rulebook.

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​Following Playtest 2, I also explored thermochromatic materials in response to feedback suggesting the use of “unknown” squares. I added thermochromatic paint to certain board spaces so that hidden instructions would appear when rubbed. The effect was striking, reinforcing the metaphor of hidden aspects of mental health becoming visible under different conditions. I attempted to apply the same principle to character pieces, but the black thermochromatic paint muted the colours underneath, limiting the effect. For the purposes of the prototype, I chose not to continue with the character elements, though this remains a feature I would like to revisit in future iterations of the game.

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This playtest reminded me that balance is delicate, and that small symbolic details can carry emotional weight even when feedback is restricted to mechanics.

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Playtest 3: Professional Perspectives (August 2025)

The third playtest was conducted with Professor Dean McShane (Senior Lecturer in Mental Health, LJMU, cohost of Man Hug podcast) and Professor Ian Pierce Hayes (Senior Nursing Lecturer, LJMU, cohost of Man Hug). Unlike my peers, these participants could engage with both mechanics and meaning, and their feedback bridged design with applied practice.

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Professor McShane played through the game, while both offered detailed observations on its potential. They described the game as “incredibly interesting” and unlike anything they had seen before, affirming its originality. They suggested adding objectives and statistics to the outside of the box, including definitions of mental illness on player cards, making outcomes and goals more central, and considering ethical pathways for involving younger audiences in future testing.

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In response, I:

• Added objectives and stats to the game box.

• Revised player cards to include a definition of mental illness.

• Made outcomes and goals more visible and central.

• Began exploring frameworks for ethical approval in future iterations.

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This playtest was a turning point. For the first time, the game was validated not only as mechanically functional but also as conceptually powerful.

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Evaluation

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The evaluation of Mental Forest follows Gibbs’ Reflective Cycle, tying together the three playtests as iterative stages of learning.

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Description: Three playtests were conducted. The first two, with peers and Professor Roughley, focused exclusively on mechanics due to ethical constraints. The third, with Professors McShane and Hayes, allowed reflection on meaning and application.

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Feelings: The first two sessions were both encouraging and frustrating — the game improved mechanically, but I wanted to ask more about how it felt. The third playtest was affirming, showing that the project had originality and potential.

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Evaluation: Each test revealed new insights: Playtest 1 highlighted pacing and collaboration; Playtest 2 refined balance, symbols, and clarity; Playtest 3 confirmed originality, improved presentation, and raised ethical considerations for future development.

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Analysis: Iterative design showed that mechanics cannot be separated from metaphor. From a gamification perspective, Playtest 1 leaned too heavily on challenge without reward; Playtest 2 risked clutter and imbalance; Playtest 3 introduced stronger framing and social cooperation, aligning the game with principles of intrinsic motivation and self-determination (Deci & Ryan, 2000).

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​The thermochromatic experiment also highlighted how materials themselves can act as metaphors. By revealing hidden squares only when touched, the board introduced a mechanic that paralleled the visibility and invisibility of mental health experiences. While not every application worked — the character pieces, for instance, proved impractical — the trial added depth to the symbolic language of the game.

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Conclusion: The project demonstrated that creative health games can normalize mental health conversations when mechanics balance realism (struggle) with optimism (support).

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Action Plan: Future work will require broader ethical approval, wider playtesting with diverse groups, and exploration of dissemination pathways (workshops, publication, or community rollouts).

Discussion

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The project demonstrates how games can serve as hybrid objects: part artwork, part research, part social tool. Unlike clinical interventions, Mental Forest does not prescribe or diagnose. Instead, it normalizes mental health as a topic of everyday play.

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Metaphor allowed for expression without disclosure, while Helping Hand mechanics modelled support in ways that sparked real conversation. This shows the unique potential of games to hold both seriousness and playfulness, reflecting the messy realities of mental health more honestly than overly polished institutional aesthetics.

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Through the lens of gamification, Mental Forest also shows how elements of challenge, reward, and cooperation can be reframed. Instead of motivating behaviour change (as in many digital health apps), these elements normalize dialogue by embedding mental health into an enjoyable, familiar cultural activity. Gamification here is not instrumental but relational: it supports connection, openness, and normality.

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By embedding lived experience reflexively, the project contributes to arts-in-health discourse by highlighting the role of the artist-researcher’s vulnerability and emotional labour.

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Critical Reflection

Successes:

Created a public-facing outcome that normalized mental health conversations.

Balanced metaphor with play, seriousness with accessibility.

Integrated gamification principles in a non-instrumental way.

Engaged participants meaningfully without requiring disclosure.

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Challenges:

Emotional labour of designing from lived experience.

Limited reach of playtesting due to lack of ethical approval.

Difficulty of balancing metaphor with functional mechanics.

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Contribution:
The project offers an example of how creative health methods and gamification can normalize mental health through everyday activities. By framing mental health in a playful, accessible way, it challenges clinical dominance and expands the possibilities for arts-in-health practice.

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Conclusion

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Mental Forest shows that mental health conversations can be normalized through creative, playful methods. By turning lived experience into a board game, the project transformed vulnerability into a public-facing tool for dialogue.

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While rooted in my personal story of anxiety, the game is not just about one condition. It is about mental health as a whole — the challenges, the supports, the cycles, and the connections. Through iterative making, reflexive reflection, and participatory testing, the project demonstrated how creative health approaches and gamification can make mental health conversations more open, engaging, and human.

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Future directions include wider playtesting, community workshops, and possibly publishing the game as an accessible resource. For now, Mental Forest stands as both an artwork and an invitation: to play, to reflect, and to talk about mental health as something we all share.

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References

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MIND (2023) Facts and figures about young people and mental health. Available at: https://www.mind.org.uk/about-us/our-strategy/doing-more-for-young-people/facts-and-figures-about-young-people-and-mental-health/
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