Participant, Facilitator, Clinician, Researcher: Reflecting on personal and professional experiences of co-production at the outset of researching co-production in youth mental health.

“critical questions need to be asked when those in power claim to be empowering those without power through forms of co-production” (Bevir, Needham and Waring, 2018)

 WHAT?

My first experiences of co-production were in the national youth charity Woodcraft Folk (WCF). An organisation founded on principles of co-operation and youth empowerment whose trustee board has included a majority of young people for more than 20 years [1] [2] [3]. From joining, age 8, I was given responsibilities which contributed to collective aims. Co-producing events and campaigns with my peers in the self-organising 16-20 year old section were formative experiences [4]. Age 22, I began working at the head office as a youth empowerment development officer. My role was to support a steering group of young(er) people to run leadership training, improve representation in the organisation, and to have fun (allegedly then the only big lottery funded youth programme using ‘fun’ as an outcome measure!). Of course, it wasn’t perfect co-production - the holy grail – but, in these roles I witnessed the ‘magic’ and ‘electricity’ often spoken about in relation to co-production.

 

Moving to working in inpatient mental health, I encountered a contrast between those well-established roots of co-operation I was used to in youth work and the seedlings of participation seeking sunlight in statutory services. Hospital staff are very (very) busy and good co-production takes time. Although co-production initiatives in healthcare are on the rise, results are not straightforwardly positive and power plays a big role. One commonplace example of aspiring co-production is patients attending their weekly ‘ward round’ meeting. The intention is to give the patient a voice in designing their healthcare. That said, I think if we are honest with ourselves as healthcare professionals, there is often unspoken ‘right’ and ‘wrong’ answers to the questions we ask in these contexts and the hospital hierarchy frequently prevents the person whose healthcare is under review from making real choices. Similar dynamics can be found in ward community meetings, collaborative goal-setting and organisational expectations for paid expert-by-experience staff. Nevertheless, individuals reported feeling empowered through participating.

 

I have recently begun researching co-production in youth mental health for a PhD. The broad research question itself came from a stakeholder group of young people with lived experience of mental illness [5], gifting the project a co-produced element from before I applied. Through this research we are trying to address the question those young people want answered: Does co-production work in youth mental health, for whom does it work and in what circumstances?


SO WHAT?

What went well?

In my experiences of being the ‘stakeholder’ in a co-production project as a young person, success was those youth-led projects bearing fruit. This was also seen for the young stakeholders in the WCF steering group who went on to take greater roles of responsibility such as becoming trustees, running large international camps or taking these skills beyond the organisation. Within the hospital setting, success was seen in increased patient attendance at ward round and in how different methods were introduced to involve those who were less confident speaking in a meeting (e.g. bringing an advocate or writing their suggestions).

 

What went not so well?

Co-production often takes a ‘professionalised’ form, requiring skills such as speaking in a meeting, writing or brainstorming ideas for service improvement. In these forms it is an activity which suits those with confidence in public speaking and with high levels of literacy, excluding others from participation. In a frenetic hospital environment, it is also hard to ascertain when the changes made following participation work meaningfully altered the material conditions for those living in these institutions and when changes were ‘tokenistic’.

 

NOW WHAT?

Some suggest that co-production has been irrevocably co-opted, and will now always be at the behest of other forces of power at play (e.g. involuntary incarceration or capitalism [6]). Critics suggest that co-production:

  • lacks an agreed definition [7] [8] [9] [10]

  • privileges certain perspectives [11]

  • is used for public services to dump responsibility onto stakeholders [12]

  • perpetuates unequal power dynamics rather than challenging them [13]

  • is not possible in locked environments like mental health hospitals [14]

On the other hand, systematic and scoping reviews consistently find that the research supports giving it a go [15] [16] [17] [18] [19]. What’s more, many (including service user activists) argue that co-production is an equalising force that emancipates those with less power and therefore is an essential part of any service improvement. With this contested backdrop it can feel uncomfortable to take a view on co-production, which can in turn lead to inaction.

 To avoid such inertia, the next step will be to return to the youth advisory group and ask for their views on involvement plans and suggested sub-questions for this project which seeks to identify the ingredients of successful co-production whilst paying attention to these ongoing debates.

Verity Jones is a PhD student at the University of Birmingham, if you want to get in touch to hear more about her research then please e-mail: vrj299@student.bham.ac.uk 

FOOTNOTE

The structure of this reflection is based on the Model of Professional Thinking, a reflective practice model that integrates evidence-based practice into the reflective process [20]. The authors argue it is important to draw on the evidence base and consider alternative perspectives, as practitioners often rely heavily on their existing knowledge during reflection, cementing poor practice and limiting possible learning [21],[20],[22].

REFERENCES

1.           Woodcraft Folk’s Trustee Board welcomes two new members. 2022; Available from: https://woodcraft.org.uk/woodcraft-folks-trustee-board-welcomes-two-new-members/.

2.           Our Aims & Principles. 2022; Available from: https://woodcraft.org.uk/about-woodcraft-folk/our-aims-principles/.

3.           Our Trustees. 2022; Available from: https://woodcraft.org.uk/about-woodcraft-folk/how-we-work/our-trustees/.

4.           Span That World: About Us. 2022; Available from: https://spanthat.world/about/.

5.           Institute for Mental Health Youth Advisory Group. 2022; Available from: https://www.birmingham.ac.uk/research/mental-health/youth-advisory-group.aspx#:~:text=In%20'Institute%20for%20Mental%20Health'&text=The%20YAG%20is%20made%20up,and%20taking%20part%20in%20training.

6.           Táíwò, O.O., Elite Capture: How the Powerful Took Over Identity Politics (And Everything Else). 2022, Chicago: Haymarket Books.

7.           Oliver, K., A. Kothari, and N. Mays, The dark side of coproduction: do the costs outweigh the benefits for health research? Health Res Policy Syst, 2019. 17(33): p. 1-10.

8.           Boyle, D. and M. Harris, The Challenge of co-production. 2009: New Economics Foundation.

9.           Dudau, A., R. Glennon, and B. Verschuere, Following the yellow brick road? (Dis)enchantment with co-design, co-production and value co-creation in public services. Public Management Review, 2019. 21(11): p. 1577-1594.

10.        Ewert, B. and A. Evers, An Ambiguous Concept: On the Meanings of Co-production for Health Care Users and User Organizations? VOLUNTAS: International Journal of Voluntary and Nonprofit Organizations, 2012. 25(2): p. 425-442.

11.        Bevir, M., C. Needham, and J. Waring, Inside co-production: Ruling, resistance, and practice. Social Policy & Administration, 2019. 53(2): p. 197-202.

12.        Bovaird, T., et al., How far have we come with co-production—and what’s next? Public Money & Management, 2019. 39(4): p. 229-232.

13.        Rose, D. and J. Kalathil, Power, Privilege and Knowledge: the Untenable Promise of Co-production in Mental "Health". Frontiers in Sociology, 2019. 4(57): p. 1-11.

14.        Pilgrim, D., Co-production and involuntary psychiatric settings. Mental Health Review Journal, 2018. 23(4): p. 269-279.

15.        Norton, M.J., Co-Production within Child and Adolescent Mental Health: A Systematic Review. International Journal of Environmental Research and Public Health, 2021. 18: p. 1-22.

16.        Slay, J. and L. Stephens, Co-production in mental health: A literature review. 2013: New Economics Foundation.

17.        Robert, G., et al., Co-Producing and Co-Designing, in Elements of Improving Quality and Safety in Healthcare. 2022, Cambridge University Press.

18.        Yamaguchi, S., et al. Participation of Children and Youth in Mental Health Policymaking: A Scoping Review [Part I]. Administration and Policy in Mental Health and Mental Health Services Research, 2022.  DOI: 10.1007/s10488-022-01223-0.

19.        Norton, M.J., Coproduction and mental health service provision: a protocol for a scoping review. BMJ Open, 2022. 12(5): p. e058428.

20.        Bannigan, K. and A. Moores, A model of professional thinking: Integrating reflective practice and evidence based practice. Canadian journal of occupational therapy (1939), 2009. 76(5): p. 342-350.

21.        Boud, D. and D. Walker, Promoting reflection in professional courses: The challenge of context. Studies in higher education (Dorchester-on-Thames), 1998. 23(2): p. 191-206.

22.        Fish, D., S. Twinn, and B. Purr, Promoting reflection : improving the supervision of practice in health visiting and initial teacher training. 1991, Twickenham: West London Institute of Higher Education.

Creating using evidence, Lived experiencePower to PersuadeLived/consumer experience, co-production, mental health, research