Co-design or faux-design? Reflections on co-designing safe spaces for people in emotional distress or suicidal crisis in Australia

Background: The past decade has seen an increase in non-clinical ‘safe spaces’ for those experiencing suicidal crisis or distress. Integrating service user perspectives through co-design is increasingly recognised as essential for the design of these services to meet user needs. Operationalising genuine co-design practices involving diverse stakeholders in local contexts remains underdeveloped, and research remains limited. Objective: Drawing on co-design participants' experiences, this study evaluates how co-design processes influenced the design and implementation of safe space models in Australia. Design: A mixed-methods design was used to analyse survey, interview and documentary data for six safe space co-design projects. Thematic synthesis and triangulation were applied to develop overarching themes. Setting and Participants: Key partners, steering committee members and lived experience representatives involved in the co-design and implementation of the six sites participated in surveys and interviews. Results: Power imbalances between health services staff and lived experience representatives were key barriers to genuine engagement, alongside tokenistic co-design, or ‘faux-design’. Despite these challenges, all participants reflected positively on their involvement. Conclusions: Effective co-design requires trust, transparency, power sharing, sufficient resourcing and sustained lived experience engagement throughout the project life cycle. Health service providers must assess their capacity for authentic engagement before attempting co-design. Future co-design initiatives should focus on ensuring that lived experience input is not lost during implementation. Future research should explore how to support and sustain this engagement throughout all project phases. Patient or Public Contribution: People with lived experience of emotional distress and/or suicidal crisis, including academic researchers, health, community service and peer workers, carers, and advocates were involved in this study. All authors identify as people with lived experience, from both academic and non-research backgrounds.