The Cycle of Equitable Codesign' Using Restorative Practice Principles to Address Epistemic Injustice and Advance Codesign in Mental Health.

backgroundCo-design has become a prominent approach in mental health research, policy and service development, aiming to centre lived experience within decision-making processes. Despite its promise, co-design practices often fall short, with reports of tokenism, constrained participation and limited influence. These limitations reflect deeper epistemic and relational inequities within mental health systems. DISCUSSION: This commentary argues that the challenges of co-design can be understood through the lens of epistemic injustice, where certain forms of knowledge, particularly lived experience, are systematically devalued. Drawing on restorative justice principles, the paper proposes a relational and ethical reframing of participation. Restorative approaches-centred on truth-telling, acknowledgement and repair-offer a means to address the relational harms and power imbalances that undermine meaningful participation. Building on this, the Cycle of Equitable Codesign is introduced as a staged framework comprising: (1) acknowledgement and truth-telling, (2) restoration and relational repair and (3) co-design and collective future-making. The model emphasises the importance of timing, power and relational conditions in shaping equitable participation.

conclusionRepositioning co-design within a restorative framework highlights the need to move beyond procedural inclusion towards ethically grounded and relationally just practice. Addressing epistemic injustice is essential for co-design to achieve its transformative potential in mental health systems. PATIENT AND PUBLIC CONTRIBUTION: This commentary is informed by existing literature on co-design and lived experience participation in mental health. It centres and reflects on the reported experiences of people with lived experience of mental health challenges. Although no direct formal patient or public involvement was undertaken in the development of this paper, it was informed following extensive informal communication with those who have a lived experience of mental health challenges and codesign participation over the prior 18 months.