Co-Designing Psychiatric Education with Autistic and Intellectual Disability Communities

Health professional and psychiatric training programs rarely incorporate lived experience into curriculum development despite ethical mandates and persistent clinical gaps, according to a primer published in Academic Psychiatry that outlines practical principles for co-designing educational initiatives alongside people with intellectual disability and autistic individuals. The authors emphasize that while the United Nations Convention on the Rights of Persons with Disabilities establishes the fundamental right of individuals to participate in decisions affecting their lives, conventional educational design frequently excludes these populations, risking the reproduction of paternalism and low expectations. A cited survey of psychiatry residency and fellowship program directors in the United States demonstrated that a decade after training gaps were initially identified, programs still reported minimal dedicated teaching hours in intellectual disability and autism. Directors’ ratings of resident competency correlated moderately with the amount of teaching and clinical exposure received, prompting directors to identify online educational resources as an urgent priority while advocates urge general psychiatry to build competency rather than treating these patients as the sole province of subspecialists.

The need for systemic educational reform is further underscored by widespread workforce limitations, diagnostic overshadowing, and inequities documented across healthcare settings. Mainstream healthcare professionals continue to hold stigmatizing attitudes toward people with intellectual disability, and constrained capability across the mental health workforce creates substantial barriers to access and communication. While targeted educational interventions can help resolve these disparities, collaborative design remains exceptionally rare. The authors highlight a systematic review of 34 educational interventions, which revealed that although all 34 initiatives reported gains in healthcare professional knowledge, attitudes, or confidence, most relied on single-group pre-and-post evaluation designs with few validated measures. Crucially, only eight of the 34 reviewed interventions incorporated any degree of co-design or co-delivery with autistic individuals or people with intellectual disability, and merely three involved members of these communities in the direct delivery of education.

Delineating the boundaries between participatory research and curriculum development, the authors note that co-design principles established in disability studies are only beginning to emerge in healthcare education. Unlike research, where contributors shape what questions are investigated, educational co-design allows lived-experience contributors to determine how future clinicians are trained, producing materials that are reused across successive cohorts of learners and elevating critical concerns regarding how these populations are depicted. Furthermore, co-design does not represent a single uniform method, but rather a spectrum of engagement ranging from consultation and review to formal employment and creative collaboration, all operating under the influence of historic power imbalances between patients and healthcare services. To guide residency directors, fellowship coordinators, faculty, and workforce commissioners, the primer sets out seven core principles drawn from the development of the Enhancing Access to Services for Your Health (EASY Health) education program.

As a practical case example, the EASY Health initiative was developed as an online, co-designed educational program for hospital and health service employees, specifically structured for delivery as mandatory education to reach staff who would not otherwise seek out training in this area. Developed over approximately two years, the curriculum comprises four discrete modules lasting 10 to 15 minutes each, totaling around 55 minutes of instruction. The modules systematically cover four primary clinical domains: reasonable adjustments, communication, screening and diagnosis, and physical and mental health management. The instructional format centers on interactive case vignettes featuring paired depictions of clinical encounters conducted poorly and well, first-person accounts of care, patient voiceover narratives, and vignettes accompanied by expert commentary. Built using Articulate Rise 360 and hosted on institutional learning management systems, the modules were evaluated in more than 700 learners with positive findings reported separately, have been completed by over 1,400 professionals, and are currently undergoing arrangements for public web access.

A foundational recommendation in the primer is that co-design must be integrated from project inception rather than treated as a late-stage consultation. The authors identify late consultation as the most common failure in curriculum development, occurring when community members are invited merely to review pre-existing content shaped by academic experts rather than helping determine learning priorities and instructional delivery. In the EASY Health project, partnership began during initial planning and grant application stages through formal collaboration with an inclusive arts theater company and a disability advocacy organization. The advocacy organization provided direct access to a diverse membership, encompassing autistic individuals and people with intellectual disability, including First Nations representatives and individuals of diverse gender and cultural identities, ensuring that core priorities reflected community perspectives from the outset.

Meaningful engagement also demands the deployment of multiple modes of involvement rather than reliance on a single advisory committee. Drawing on the framework by Bigby and colleagues, the primer emphasizes three distinct modes of involvement in inclusive initiatives: advisory oversight, leading and controlling roles, and participation within collaborative groups. The authors stress the necessity of maintaining distinct groups for autistic people and people with intellectual disability to accommodate differing community preferences, as well as maintaining separate groups for individuals versus parents and support persons. Within EASY Health, five collaborative methods operated across all developmental stages: a strategic project advisory group comprising a First Nations representative and a parent advocate, a peer support group run independently by people with intellectual disability that reviewed content during regular meetings, a dedicated focus group for autistic participants, institutional instructional design collaboration, and creative co-production.

To facilitate authentic participation, standard co-design formats must be systematically adapted to meet specific communication and accessibility needs. Conventional focus groups and written surveys often prove insufficient because they fail to account for cognitive, communicative, and sensory requirements. Practical adaptations implemented in the primer include the use of plain-language Easy Read documentation, visual supports, augmentative and alternative communication options, and the advance distribution of meeting agendas and materials. For autistic contributors in particular, receiving meeting content and schedules in advance mitigates anxiety associated with unexpected or ambiguous material. The authors urge educators to embed these adaptations as standard operational procedures rather than exceptional accommodations, allocating generous meeting durations so all contributors can participate meaningfully, while periodically updating practices to align with evolving community expectations.

The primer establishes that fair financial remuneration and realistic project scheduling are both ethical obligations and practical necessities. Providing token honoraria or relying on unpaid goodwill devalues contributor expertise and reinforces historic disparities. Remuneration should be formally costed into external grant applications from the outset; for EASY Health, budgeting for a local advocacy organization enabled them to coordinate recruitment and organize focus groups directly. The authors caution project leaders to navigate government income support regulations prior to engagement, as earned income can jeopardize disability benefit entitlements, requiring proactive consultation with support agencies. In tandem with financial budgeting, project timelines must accommodate the substantial time required for iterative co-design. Video scripts and narrative modules require multiple iterative cycles of drafting, community feedback, revision, and secondary review, which must be protected against timeline compression.

Addressing representation, the authors highlight partnerships with inclusive arts organizations as an essential mechanism for authentic creative content. Educational materials rarely depict individuals with intellectual disability or autism, and when they do, non-disabled actors are frequently cast, inadvertently reinforcing passive, deficit-focused depictions. In EASY Health, partnering with an inclusive arts theater company engaged trained performers with lived experience who co-wrote scripts, blocked clinical scenes, and filmed alongside the clinical research team. The primer also evaluates delivery modalities: while online platforms reduce travel burdens, facilitate geographically dispersed collaboration, and scale training across extensive workforces without exhausting community contributors, they cannot replicate live instructor interaction. The authors recommend combining self-paced online modules with facilitated small-group discussions or interactive workshops to optimize clinical skill acquisition.

Finally, the primer confronts core ethical complexities, warning that genuine co-design requires demonstrable influence over curricular decisions and active mitigation of power imbalances between academic faculty and community members. Educators must acknowledge that self-advocates who communicate without extensive support are often over-represented, while individuals with severe or profound intellectual disability, high support needs, or intersectional backgrounds remain under-represented. Teams must be transparent regarding whose perspectives shaped the curriculum, recognizing that parental accounts cannot substitute for the direct perspectives of individuals with lived experience. Educators must also safeguard against the emotional labor experienced by contributors sharing traumatic or stigmatizing healthcare encounters by offering debriefing and flexible participation. While these structural principles apply broadly across psychiatric training—including modifications for fluctuating capacity in severe mental illness or assent protocols in youth psychiatry—they establish that respectful co-design enhances clinical relevance, workforce engagement, and educational validity.

Subject of Research: Co-design principles for psychiatric education involving autistic people and people with intellectual disability

Article Title: How to Co-design Psychiatric Education with People with Intellectual Disability and Autistic People

Article References: Franklin, C., Culla, C., De Greef, R., Brooker, K., Beck, C., Trollor, J. N., & Heffernan, E. (2026). How to Co-design Psychiatric Education with People with Intellectual Disability and Autistic People. Academic Psychiatry. https://doi.org/10.1007/s40596-026-02465-y

Image Credits: AI Generated

DOI: 10.1007/s40596-026-02465-y

Keywords: Psychiatric Education, Co-Design, Intellectual Disability, Autism, Medical Education, Disability Rights, Curriculum Development, EASY Health, Psychiatric, Education, People, Intellectual