Working in partnership with patients to take control of mental health services
Understanding that co-production between service users and staff in mental health services can be crucial to a successful workforce
Co-production is about people taking equal control of their services (Cahn 2004, Nef and Joseph National Foundation 2012, Ostrom and Whitaker 1973).
There is a philosophy behind co-production which is concerned with democracy, the sharing of power, reciprocity and mutuality, blurring distinctions, and building on people’s skills (Slay and Stephens 2013). In my own doctoral research, I have realised that generally there does not seem to be an understanding of this philosophy.
The idea of co-production is that there are equal amounts of control and power for service users (patients) and healthcare professionals. In service delivery, what actually happens is that there is co-production where there is a genuine working relationship with service users (Arnstein 1969). More often than not, this equality and democracy fizzles away into services being ‘done for’ service users, and ultimately services being ‘done to’ service users. Clearly, the professional has all the power most of the time.
Participants in co-produced services are collaborators. My thought is that as co-production unfolds, there is movement from the polarised roles of being a professional or a service user, towards the middle ground where they meet together as equal ‘people’. How complex that would be, one person working with another?
Thought, reflection and guidance needed
Co-production done properly needs thought, reflection and use of the guidance provided by Social Care Institute for Excellence (2015). It is not quick or easy. Service users may not want to get involved; they may actually prefer the traditional paternalistic ways of mental health services.
It seems to me that organisations are using co-production as a way of legitimising what they do when actually there has been no meaningful change in the way anything is done. Organisations that say they co-produce a service and it is a service that ‘does’ to the service user, where they are never really involved, make them even more invisible in the whole process.
I believe that now is the time to put the brakes on and reclaim the language, the philosophy and services. The concept of co-production is fundamental and integral to how we ought to work together. I worry that co-production is being hijacked to the point where it becomes tokenistic, in the same way that recovery (Collier 2010, Social Perspectives Network 2007) has done. Professionals have been defining recovery for a while and it is no longer really about people with mental health problems. It will be a shame if co-production goes the same way.
- Arnstein SR (1969) A Ladder of Citizen Participation. Journal of the American Institute of Planners. 35, 4, 216-224.
- Cahn ES (2004) No More Throw-Away People: The Co-Production Imperative. Essential Books.
- Collier E (2010) Confusion of recovery: one solution. International Journal of Mental Health Nursing. doi: 10.1111/j.1447-0349.2009.00637.x.
- Nef, Joseph National Foundation (2012) Co-production Critical Friends Group
- Ostrom E, Whitaker G (1973) Does Local Community Control of Police make a Difference? Some Preliminary Findings. American Journal of Political Science. 17, 1, 48-76. doi: 10.2307/2110474.
- Social Care Institute for Excellence (2015) Co-production in social care: What it is and how to do it
- Slay J and Stephens L (2013) Co-production in mental health: A literature review
- Social Care Institue for Excellence (2007) Whose Recovery is it Anyway
About the author
Melvin Bradley is a professional doctorate student at the University of Salford
I would like to acknowledge Elizabeth Collier, lecturer in mental health and professor doctorate supervisor, University of Salford, for her advice on the development of this article.