Contexts enabling effective codesign by people with lived experience of the mental healthcare system in the Canterbury and West Coast regions of New Zealand

The inclusion of people with lived experience of mental healthcare, their families and communities in the design, delivery and evaluation of mental and physical healthcare is necessary to improve healthcare in Aotearoa New Zealand. This study investigates the material, symbolic, relational, and wider social contexts that enable People with Lived Experience (PWLE) to participate in codesign of mental healthcare in the Canterbury and West Coast regions. We interviewed twenty-nine people working or engaged in organisations across the health system in both regions as part of this study and analysed the results using reflexive thematic analysis, using both Māori and non-Māori foci. We found the degree of participation by PWLE in the codesign of mental healthcare varied and codesign occurred to a greater extent in community organisations and in Māori organisations compared to other parts of the health system. Participants identified material, physical, symbolic and wider social factors that contributed to codesign and areas where improvements could be made. These factors related to remuneration of workers, the need to reduce stigma associated with PWLE, a need for the balance of power within the health system to change and increased inclusion of PWLE in the evaluation of services. These findings have implications across the health system in regard to the material, physical, symbolic and wider social contexts. • The effective codesign of mental healthcare requires changes in many contexts. • Material changes required include review of funding, salaries and resources. • Symbolic changes are required to reduce stigma and address power imbalances. • Lived experience requires building of relationships and trust over time. • Contexts enabling lived experience participation require attention to power relations.