Fake co-design threatens the reform agenda
Victoria’s mental health system is undergoing reform at a rapid rate. As someone who has worked across several of these reforms, I can see the hard work Victorian public servants do and the genuine personal investment they make to improve our lives and mental health system.
But there aren’t enough “boots on the ground” to meet these rapid deadlines, all mutually contingent on one another. This shortage necessitates one of two responses: expand the public sector to meet the demand, or enlist external consultants to assist them to deliver the reforms.
The government has pursued the latter, with various elements of the reform agenda, including consultations, being run by external consultancy agencies. Some contracts go to the “big four”, some to the “mid-tier” firms, and some to smaller-scale consultants such as myself.
This brings flexibility and agility to government departments, as well as expert knowledge and community connections. However, it also brings challenges.
Of late, I have witnessed the use, and predominantly misuse, of “co-design” terms to describe activities by external consultancies in the reform agenda. These include tokenistic practices, the failure to engage with lived experience voices meaningfully, poor methodology (from a co-design perspective), significant unchecked power imbalances, and a general lack of awareness of the complexities of mental health policies.
The Royal Commission was intended to provide a broad framework for a mental health system, with government and civil society to flesh this out in greater depth and detail. And yet, when you hear the findings from many consultancy agencies, its as if they are tourists in long-standing and complex policy debates.
These failures, which run on the back of significant and lucrative contracts for some consultancy firms, threaten the making the reform process a “tick box” rather than a transformational piece of social and policy change.
It prompts me to highlight 3 things that government should do to address these issues:
Publish expectations on “co-design” – the contracting processes by the Victorian government should clearly articulate the minimum expectations of what constitutes co-design, and these should be reflected in contract management processes. This should have personnel (clearly having lived experience worker members of the team) as well as methodological requirements about what differentiates co-design from consultation and other methods.
Greater transparency over selection – there is usually limited publicly available information about why some vendors/consultancies have been selected for mental health reform pieces, when this should be public.
Publish consultancy products or reports – the consultation, co-design or evaluation reports from consultancy firms should be published. This allows external community members, particularly those who have been consulted or part of the “co-design”, to assess whether their views have in fact been adequately reflected. These are, after all, amenable to applications under Freedom of Information.
It also prompts me to highlight 5 things that providers should do to address these issues:
Conduct an external audit – have external co-design and lived experience experts conduct an audit of your recent work (selected by them, not by you) to assess whether your methodology does in fact meet the standards you are articulating.
Ensure you have the right team – the people impacted by the policy issue you are reflected on your team for the contract. It is inappropriate to do this work without that representation at a minimum. This process needs to draw on people who have previously worked in consumer-designated roles (and carer roles where necessary/appropriate).
Deep Dialogue – one or two hour consultations as the basis for your “co-design” are inappropriate. You should aim to have a mixture of broad and deep dialogue processes.
Address power and decision-making – many consultancies are forgetting the “co” part of co-design. Power imbalances between designers and the people they consult (or “design” with) are significant, particularly those with lived experience. If you don’t have rules that allow for collaborative decision-making, then I don’t think you can call this co-design.
Budget for co-design – if you are driven by the public interest rather than private profit, budget for co-design at the beginning of the process. This requires allowing the personnel from the relevant community and the time for deep dialogue.
This is a non-exhaustive list, with other important considerations ensuring that voices often unheard or marginalised (e.g. First Peoples) are elevated.
In the absence of this, many design processes will continue to be lucrative market research processes detached from the liberatory intent behind true co-designers.
Resources:
McKercher, K. A. (2020). Beyond sticky notes. Doing co-design for Real: Mindsets, Methods, and Movements, 1st Edn. Sydney, NSW: Beyond Sticky Notes.
Roper, C. Grey, F. and Cadogan, E., 2018. Co-production: Putting principles into practice in mental health contexts. Melbourne: University of Melbourne.
Conflict of interest note: I have worked with consultancies such as Cube Group. I have had positive experiences and relationships with these teams and do not direct criticisms to those teams in this piece. I also have contracts with the Victorian Government on different reform agenda pieces, some performing leading and others performing supporting roles.
