The background
Peninsula Health’s hospital outreach post-suicidal engagement (HOPE) team has done vital work in Victoria’s mental health system since its beginnings as a pilot program in 2017.
HOPE fills the gap in services for people needing care, tailoring support to a person’s situation that they may not be able to access through traditional health care channels.
The 90 day program sees teams work collaboratively to create mental health strategies, review medication, assess risks and plan for safety, plus helps to uphold external relationships with providers like general practitioners and psychologists. A family carer works alongside these networks to support the client.
The Royal Commission into Victoria’s mental health system identified a need to expand the service by increasing HOPE’s operating hours and staffing levels through a co-design process, and our challenge was to guide the HOPE team in the next steps of their co-design journey.
Together, we wanted to:
Experience co-design as a new way to make positive decisions at this critical point in the organisation’s growth
Embed co-design principles within the HOPE team, so that it becomes an enduring way of working
Map a sustainable future for the collective good of the organisation, together with the people who use its services
Empower the HOPE team to do co-design moving forward
Our approach
For 16 weeks, TACSI worked alongside the HOPE team within Peninsula Health to support them through the co-design process.
Not only did we help them determine a pathway to expansion, but we also gave them the tools to continue to use co-design in the way they work.
The insights
Co-design is a learn-by-doing activity. Our role as facilitators was to hold the space for people to be vulnerable and find their own way forward, together
There’s no universal framework for co-design. Each organisation (and situation) are influenced by its people, services and power structures
People were surprised that co-design enabled rapid, positive change in a matter of weeks. The slow pace of change in the existing system had often frustrated people pushing to do things differently
The process needed to be prioritised to be successful. Peninsula Health had to commit time and resources to bring people together for co-design
People were surprised by the emotional elements of the work – this was a necessary additional labour
Moments of raw emotion during the sessions could be confronting for participants
Carers took away a different perspective on their role, and who they were at work
Co-design demands dismantled power structures and hierarchies, between healthcare workers, and between consumers and carers. Every participant told us this was a challenge, and required significant courage
It was both confronting and liberating to show up as a person rather than a role
By removing the hierarchy, everyone’s ideas and experiences gained equal stature and made people feel heard, validated and valued
An organisation based on care services can see significant, rapid benefits from a co-design approach. Empathy and relational skills were especially powerful in the process
The process stuck because of its success. The HOPE team is committed to the change and will appoint its own champions to carry the process forward
Here’s what some of the co-design team said about their experience
Kate is the HOPE team manager who’s been there since the beginning of the program
“I think we all felt initially overwhelmed by co-design because none of us had gone through it. We didn't appreciate how mentally fatiguing it might be at the front end because we didn't know you were trying to absorb so much information or gather where the process is going. It's not a tick box, and we're clinical; we come from tick boxes. We've had to change our mindset and change our way of thinking.
It's such a different process. I think co-design is the way of the future regarding any change within organisations, and certainly in the healthcare sector. I’ve borne witness to when changes have not gone well and it's been a top-down approach where the people making the decisions aren't actively involved in what they must do on the ground. I now fully appreciate how powerful co-design work is and how valuable it is.”
A mental health clinician in the HOPE team
“I’ve been involved in organisational change, but not organisational change in this way. This one’s deeper because we're asking people who are our clients.
Our colleagues from TACSI have invited us to be authentic in how we come across, and we have spent time unlearning how we shared opinions and how we juggle that. We had to be brave, and it's not easy to be brave sometimes.
The opinions people give in the sessions are taken on face value as important without bias. There was a sense of equality, with people being able to give their opinions freely. Outside of the co-design, others might have declined to give opinions or repressed them.”
A carer peer support worker at Peninsula Health
“The co-design journey was a bit daunting at the start. I think everybody, including myself, was feeling a bit vulnerable. We weren't sure what would happen, and we weren't used to talking about feelings and emotions with work colleagues and people we had just met.
I think that using co-design across all other areas of the mental health system can create a more humanistic approach. Ultimately, everyone wants to be understood, validated, and valued in their job.”
A person with lived experience of being a HOPE consumer
“Becoming involved with this co-design process, especially with HOPE, taught me that everyone is valuable. I think working in a hospital situation my whole life; you never think you’re included in any of the decisions. I have all this energetic knowledge and things I want to say and share because I've been silent for so long.
Being able to speak as a lived experience person and say what I feel about the service, I get to talk about how the process can be more seamless, talking people through each step. I'm a good yakker. I've been silent for 23 years, and now I won't shut up.
Some of the things that we have discussed are being implemented into everyday clinical life, and the clinicians have taken on board what we think and have said. That wouldn’t have happened before. I learned something every day through the TACSI way of doing things. I even use some of them in my day-to-day life.”
What’s next?
Potential next steps include:
Creating new roles to embed people with lived experience in the way the organisation works, beginning with the new consumer peer role.
Developing concrete ideas about what the expansion might look like, with plans in place to test each component.
Establishing a much more flexible working style, with the capacity to tailor the hours worked and experiment with what will best meet the needs of consumers.
The HOPE team have taken over the process with their key learnings from the co-design workshop. Together, they’ve used co-design to realise the expansion of their organisation.