"Front-load" your co-design-evidence in mental health supports it

Co-design in quality improvement projects is well-established as an effective way of creating more consumer-centred, whānau-centred care, and to shape solutions that work for consumers as well as services. However, in practice, consumers of health services, families and whānau are often consulted after key decisions about project design are made. This can result in tokenism, missed opportunities for improvement and breached obligations to the Māori right to autonomy, self-determination and control of their own destiny as expressed in Article 2 of Te Tiriti o Waitangi. "Front-loaded" co-design was used in selection of project areas and project design in Te Tāhū Hauora - New Zealand Health Quality & Safety Commission's mental health quality improvement work and has been critical to success. With broad sector consultation, one area mental health consumers agreed was a priority for improvement was elimination of seclusion in mental health services, particularly for Māori who experienced significant health inequity in this area. This aim was considered unachievable by many in the sector at the time. However, the zero seclusion project has successfully contributed to reductions in rates of seclusion of all ethnicities, and continues to do so. "Front-loaded" co-design with Māori and consumer guidance is critical to this success. Furthermore, true co-design also ensures the mana motuhake and tino rangatiratanga (self-determination and control over one's own destiny) of Māori, and of all peoples who use our health services.