Inclusive design in digital mental health: stakeholders with disabilities must be central to usability testing.

Co-developing digital mental health tools is essential to ensure innovations are usable, engaging and accessible for the target populations. The Web Content Accessibility Guidelines, version 2.2, provide the minimum level of compliance for digital mental health tools and these should be further built on through usability testing. Developing digital tools without following inclusive design principles risks widening the digital divide, especially for individuals with disabilities. The Enhancing Child and Adolescent Mental Health Service (CAMHS) Referrals 2 project funded by the National Institute of Health Research developed a digital referral tool for NHS CAMHS. The tool was co-developed with a Pan-Disability Digital Accessibility Group members of which all had lived experience of disabilities. The group advised on the accessibility of the tool through usability testing workshops. As a direct result of the feedback from the workshops, changes were made to the multi-factor authentication and the wording and navigation throughout the tool. This paper outlines the methods and processes followed to develop the group and facilitate the usability testing workshops to provide guidance for future digital mental health research teams. Engagement from advisory groups with lived experience can ensure accessibility is in-built from the start of development and not included as an afterthought.