Evaluating a Codesign Process in Mental Health: 'Harnessing the Power of Together'

Mental health services often undertake codesign processes to inform and enhance service delivery, however, there continue to be many challenges undertaking codesign activities in mental health.

The aim of this study was to evaluate a codesign process undertaken for a project seeking to enhance consumer choice and satisfaction at one acute mental health inpatient setting in Melbourne, Victoria.

A five-stage codesign process evaluation was undertaken. Data collected at each stage included surveys, feedback and reflections. The data was analysed using basic data analysis and a thematic approach. Data was used for the evaluation of each stage and to inform subsequent stages. This paper describes the various activities undertaken within the codesign process which we sought to examine post hoc using the context, input, process and product (CIPP) framework.

The findings derived from the various data collection stages including the workshops and staff reflections highlighted two main foci, 'direct experience' and 'the bigger picture'. First, the participants from the codesign workshops highlighted their experience including both positive experiences such as feeling heard and seen, and challenges such as having a lack of knowledge. For staff, the focus was on the bigger picture around codesign such as engaging consumers and adapting the approach as needed.

The study highlighted some of the challenges and benefits found undertaking a codesign process. In particular engagement with stakeholders required a higher level of open communication before workshops being undertaken which was important to address a power imbalance. However, the results were limited due to a lack of consumer and staff feedback. The team reflections sought to provide reasons for this limitation which was attributed to a lack of organisational readiness, stakeholder engagement, differing expectations, lack of time, and power differentials. The CIPP framework was used as a tool to undertake a post hoc evaluation of this complex codesign process undertaken.

Codesign processes will continue to grow as the preferred method of ensuring mental health services meet the needs to the community. The CIPP framework is one means of ensuring that codesign processes follow a systematic, iterative approach to appropriately meet those needs. Future projects within mental health settings should consider the inclusion of consumers, carers and non-lived experience staff members, as a project team, to offer differing views. In addition, project success often relies on organisational readiness and the ability to reflect on and address power. We conclude that a restorative practice approach to create more open dialogue and communication before commencement of codesign projects may be a key solution.

The authors would like to thank and acknowledge the consumers with a lived experience, carers, and mental health care staff who participated in the codesign process. This paper was written by consumers, carers, staff and academics who were involved in the project.