The realities of co-designing a better mental health system

Many of the Royal Commission into Victoria’s Mental Health System’s recommendations centre around co-design. But doing co-design authentically is a big task – and it will take leaders modeling power sharing, building capability, and letting communities go at their own pace to make it a reality.

By Chris Vanstone, Chief Innovation Officer & Carla Clarence, Principal, Social Health


We read through the 65 recommendations from the Royal Commission into Victoria’s Mental Health System with excitement, because nearly a third of the recommendations explicitly call for co-design (or co-production) between professionals and people with lived experience of mental illness. The commission’s guiding principles for reform include that: 

  • People with lived experience of mental illness or psychological distress, family members, carers and supporters, as well as local communities are central to planning and delivery of mental health treatment, care and support services
  • Mental health and wellbeing services use continuing research, evaluation and innovation to respond to community needs now and into the future

The value of co-design

When the Minister for Health opened Adelaide’s new Urgent Mental Health Care Centre on March 3, he pointed out that two uncommon features – both recommendations that came about through a co-design process – had been adopted: no security guards, and a 50% workforce of people with a lived-experience of mental illness.

We’ve seen what can happen when communities shape culturally specific mental health responses in our work with the South Sudanese Australian Community in Melbourne. We’ve also seen the potential of communities leading local change for mental wellbeing through our work on Our Town, which is supporting rural towns over the next 10 years to self-determine responses to mental wellbeing. 

We were also excited to see a focus on a new collaborative centre to drive exemplary practice including co-design.

Doing co-design authentically is a big task

Co-design is an alluring word. It’s used on the left and right of politics. It’s a word that’s good on the eye; it makes a beautiful promise that’s hard to disagree with. But for such an agreeable word, it smashes together and obfuscates two very disruptive (yet powerful) concepts. 

Doing the ‘co’ means to share power with groups typically marginalised. Doing the ‘design’ means to do practical and iterative innovation. Doing both, together, authentically is a big ask. Especially if you’re not used to either.   

The word co-design should be used authentically. Perhaps not everything that has been promised to be co-designed can be. There may not be time, money or authority, and if that’s the case then it’s important to be transparent about that. Co-design done poorly is a very effective way to break trust with community members.

Professor Megan Davis, a constitutional lawyer and one of the architects of the participatory development of the Uluru Statement from the Heart, recently referred to co-design as “a bureaucratic buzzword void of any real meaning”. 

But we believe that co-design can have meaning – and the Victorian Public Service should give it that meaning. It’s what people with lived experience have been asking for. 

  • If leaders want ‘co’ they will need to model that sharing of power with their teams and with leaders with lived experience.
  • If leaders want innovation (and the commission demands it) they will need to allow time for creativity and by learning through doing.
  • If leaders want communities to lead local change then community members need to be given time to opt-in, get their head around what’s being asked of them, and move at their own pace.

We need approaches in which we deliberately and proactively try to understand issues around power. We need to think consciously about whose voice might be the thinnest or the hardest to hear (and that approach will usually help the consumer)

Royal Commission Witness Statement of Cath Roper, 2 June 2020, para. 90.20

Co-design with authenticity in the real world

Recently, we’ve been developing and delivering a course with the Victorian mental health sector and government called Co-design with Authenticity in the Real World.

The course focuses on co-design as a pragmatic challenge, but also an emotional challenge. The sharing of power demanded by ‘co’ doesn’t come easy; the power dynamics we’re comfortable working in (and perhaps not even aware of) are deeply ingrained in all of us. The ‘design’ asks us to learn through doing, to experiment, to test, to question the assumptions we’ve been operating on, perhaps for decades. That’s not easy either.

Time and safe space need to be created for developing these new behaviours in the implementation of the reforms. Leaders need to show compassion for the change they are asking their staff to embrace, and need to reflect on their own behaviours relating to sharing power and embracing experimentation.

What will it take to lead mental health reform in Australia?

Mental Health Reform Victoria is now faced with the unenviable task of turning these recommendations into actions and outcomes, and to be seen to be doing so efficiently and effectively while under scrutiny from the public, the sector and ministers. Commission chair Penny Armytage is hopeful the recommendations will be a blueprint for reform not just in Victoria, but across the country. 

To make this happen, the Mental Health Reform Victoria and the minister will need to model the kinds of behaviours they want to see in their teams, and provide ongoing development to grow and challenge their teams – and allow time for transformation of cultures of power sharing and experimentation. 

For this kind of reform, one that seeks to shift the power balance toward people with lived experience, success will be as much about how the reforms are led as the milestones and KPIs.