Designing Mental Health Policies That Work

What Nintendo, yes that Nintendo, can teach us

I still remember the first time I played Nintendo. It was Super Mario Bros., and I was instantly hooked. There was something magical about that pixelated fantasy world where a high-jumping plumber led me through dungeons to rescue the one and only Princess Peach (originally Princess Toadstool, for you Nintendo purists).

The gaming world never felt the same after that. New consoles and more advanced games seemed to drop every year; and yes, more Mario, too.

Fast forward to 2017. Nintendo launched the Switch, a handheld gaming device that let you take console-level play with you wherever you wanted to go. It was cool. But a really smart design feature wasn’t just the graphics or the portability it was something almost no one noticed.

Unless they tasted it.

You see, Nintendo coated its new game cartridges with a bittering agent to stop kids from swallowing them. That’s right. No warning label. No lecture. Just smart, human-centered design that anticipated behavior and quietly built safety into the experience.

Original NES cartridges were too big to be a choking hazard. But Switch cartridges? Perfect size for tiny, curious hands and mouths.

I’ve never tried putting a cartridge in my mouth. But I’ve raised kids. I’ve seen that look when they scan the room for the smallest, most dangerous thing they can find. Nintendo didn’t have to solve for that problem but they did. A small act, likely saving lives. A private company thinking about people, not just products.

Thinking ahead.

Accountability.

Ingenuity.

I never imagined I’d write about mental health and policy by starting with Nintendo. But it’s 2025, and I am writing about a lot of things I didn’t expect to be writing about so here we go.

The Mental Health System Is Built on Flawed Assumptions

As many have pointed out in their critique of the current model, much of mental health care treats people as passive recipients. They're not seen as experts in their own experience, but as problems to fix or manage. It’s a model that’s built on countless flawed assumptions.

“Come to me for care.”

“Here’s what you need to do.”

“We don’t do that here - you’ll need to go somewhere else for that.”

The system is fragmented, often separating mental health from physical health, community, culture, and daily life. And the metrics we use to define success? They mostly track volume, which includes how many sessions, how many diagnoses, how many discharges, and not things like quality of life, relationships, long-term resilience or even basic health outcomes.

This is a design failure. Not because the people in the system don’t care. But because the system wasn’t designed with or for the people who live inside it.

But I have said this many times before.

This is a design failure. Not because the people in the system don’t care, but because the system was never built with the people it’s supposed to serve in mind.

I’ve said that before. Many have. But we’re still stuck in the same loop.

So let me ask a different question:

What if we designed mental health policy with the same level of thoughtfulness that Nintendo gave a piece of plastic?

That bitter coating wasn’t a technical breakthrough. It was a behavioral one. It didn’t change the gameplay, it changed the risk to a global company. It wasn’t flashy, but it mattered. It wasn’t reactive, it was proactive.

And it raises the bar for what thoughtful design looks like. Because if a gaming company can anticipate harm and build in safety without anyone even noticing, why can’t our mental health policies do the same?

Why can’t we design systems that meet people before the crisis?

Why can’t we prevent the fall, instead of trying to catch it mid-air?

Right now, we’re doing the opposite.

This month (May 2025), the Department of Health and Human Services began rolling back regulations that protect access to mental health and substance use treatment. These rollbacks weaken parity laws, which posit that mental health should be treated like physical health. At the same time, the “Make America Healthy Again” Commission is pushing discipline-first school strategies, pulling resources away from community-based support.

If the goal is better outcomes, it’s hard to see how these moves get us there.

Even globally, the contrast is clear. The World Health Organization is urging governments to reform their mental health laws around human rights, autonomy, and lived experience. Meanwhile, here in the U.S., we seem to be designing backwards; away from equity, away from integration, away from people.

We don’t need more programs stacked on top of structures that don’t work. We need a new way of thinking where mental health isn’t treated as a privilege for the compliant or the wealthy, but a basic human right.

We need policy designed with the same level of foresight, responsibility, and creativity that Nintendo used on that tiny, bitter cartridge, not because they had to, but because they understood the stakes.

Thinking Ahead

Good design plans for how people actually behave, not how we wish they would. Nintendo didn’t wait for a child to choke, they anticipated the risk and built in protection. Mental health policy should do the same. Proactive and prevention are two words we don’t use a lot, but perhaps should use more.

Instead, we have a predominately reactionary systems that only kick in after a crisis: someone ends up in the ER, arrested in jail, or dead. We underfund prevention, delay early support, and wait until people hit bottom before offering help. That’s not thinking ahead. That’s crisis management disguised as care. And while we need those crisis systems in place, that can’t be what consumes all our focus.

Policy that thinks ahead would fund school-based programs before students are in crisis. It would offer walk-in access and peer support before someone ends up on a psychiatric hold. It would treat housing, food, and connection as foundational mental health supports not just afterthoughts.

Accountability

Nintendo didn’t need a law to force that design choice. They took responsibility for potential harm and made a fix. In mental health, accountability is usually upside down.

We make people accountable to systems: proving eligibility, complying with treatment, checking bureaucratic boxes, while systems face no real accountability for outcomes. If care fails, if someone slips through the cracks, if coverage is denied or access is delayed, it’s the individual and their family who pays the price.

True accountability means policymakers and institutions are responsible for results. Did someone get better? Did they stay connected? Did the system help or hurt? If not, what changed? We need public reporting, feedback loops, and funding tied not to effort or volume but to impact.

Ingenuity

As I said earlier, something as simple as a bitter coating isn’t high-tech, it’s smart. It’s small, cheap, and transformative. That’s the kind of thinking we need in mental health: not just more resources, but more imagination.

What if Medicaid paid for peer support or a new community-based workforce the same way it pays for a hospital stay? What if we designed care that was fun, creative, nonlinear like open mic nights, bike groups, drop in centers, or text-based check-ins so it actually meets people where they are?

Ingenuity is not about expensive fixes. It’s about asking better questions and building systems that reflect real lives, responsive to community need.

We’ve spent decades building a mental health system around institutions, not individuals, around categories, not people. But systems that aren’t designed for real life will always fail in real time. Always.

It’s not radical to ask for care that works before a crisis just like it’s not radical to make a game cartridge taste bad so kids don’t choke on it. It’s not idealistic to expect policies that prioritize human lives over political cycles. And it’s not naive to believe that with enough ingenuity, accountability, and foresight, we could build something better.

We’ve seen what thoughtful design can do, even in something as small as a game cartridge. Imagine what it could do if we aimed that same energy at something as serious as mental health.

The stakes are higher. The solutions should be smarter. Like Mario knowing how to use those turtle shells at just the right time.