How does giving up power transform mental health systems? Let's look at real co-production

In the mental health space, we often hear people talking about the use of co-production in relation to practice. What takes more commitment, however, is the leadership and courage to weave co-production into the fabric of a system.



At Living Well, we place co-production at the heart of our programmes - and when we say co-production, we mean co-production - with each stakeholders’ experience and ideas sought and given equal weight as we design new systems for everyone who benefits from, or works in, them.


For some people experiencing poor mental health, it’s the first chance they’ve had to have their voice truly heard; for some professionals and system leaders, it’s the first time they’ve had to give up power. For everyone involved, the unwavering commitment and courage to listen, share and then co-produce is hard - yet the rewards in transforming systems for the long-term are already being reaped.


What is co-production?

Our Living Well programme started some 10 years ago in Lambeth, south London and over the past four years, thanks to The National Lottery Community Fund, we’ve been creating new systems of community mental health in Living Well sites across the UK including Edinburgh, Salford and Tameside and Glossop.


So far the programme has supported some 2,500 people who might not otherwise have been helped and generated over five million pounds of additional investment in local mental health systems - and we’ve recently expanded into Greater Manchester and Derbyshire.


Our depth of experience and expertise in the mental health space means we have significant knowledge of, and capability to manage, the power dynamics at play in co-production.


As a metaphor, to understand the powers at play let’s look at who is on the co-production dance floor and the different tunes being danced to.


You have people and professionals. People, or ‘service users’ are often seen as just that, users of a service with no real power over the service they are experiencing. Professionals can often dance to the tune of rescuers - ‘we are here to help, you have needs and we have expertise’, a compassionate ballad but one that can remove the agency of people to believe they can take action to improve their wellbeing. Added to this is the constant hum of the stigma attached to mental illness.


For professionals, however, the mental health landscape is yet more complicated. Mental Health Trusts bang a loud drum, they are large and have many resources dedicated to this work. In comparison, for the Local Authority, mental health services are only a small percentage of their overall responsibility. And the voluntary sector, a large but fragmented orchestra made up of many small organisations with limited capacity, can find it hard to play in symphony.


From what we’ve learned in Living Well, anyone who wants real co-production needs to help all these people and organisations to play in harmony, on an equal footing.


What is co-production in Living Well?

We know that the process you use to create the future world determines the world you end up in. With commitment and courage, co-production can change relationships, hierarchies and power dynamics - which means there needs to be a congruence between the way that professionals engage with people and the way they engage with each other.


In Living Well the redistribution of power starts with a commitment to honouring and amplifying the voice of lived experience, fostering collaboration and imagination, and supporting professionals to iterate and improve ideas based on real feedback and learning.


Specifically, the shift in professional ‘power’ has been achieved by:


  • Moving staff from being fixers who focus on problems to catalysts that focus on working with people, using their abilities and agency to create solutions - and having the courage to know that such reframing could potentially threaten professional experience and expertise

  • Embedding agency into the model in every way, for example managing risk with people rather than for them; meeting people where they want to meet; exploring what resources people have to draw upon

  • Creating person-centred documentation that defines people by their strengths and needs, rather than their deficits

  • Giving people the courage to self-author their care plans so they are in control of their support

  • Paying attention to language - ‘people’ not ‘service user’, ‘work with’ not ‘help people to’

  • Leaders committing to model an approach which carefully listens to the messages from below, even when they are difficult to hear and genuinely sharing power with each other

So what does co-production look like in practice?


  • In Salford, professionals from across the system actively gathered and listened to stories of lived experience then used ‘prototyping labs’ to co-design new ideas with people

  • In Lambeth, experts by experience sat alongside system leaders at a local pub at monthly collaborative meetings to make decisions about the future of their mental health system.

  • In Edinburgh, there are robust processes to support peer workers who use their lived experience to support others and enable them to develop in their careers


And what can a system look like when people have the permission to work outside of existing power dynamics and professional roles?


  • A support meeting between a professional and a person took place while toasting marshmallows around a bonfire

  • A mental health nurse fetched their toolbox to help someone fix their fence, because that is what the person needed in that moment

  • Grassroots initiatives and lived experience support groups grew after a collaborative decided how grants might be distributed in the local area

Of course, a commitment to co-production must continue in order for change to thrive. Living Well sites have embedded co-production values and mindsets into structures and spaces:

  • Bringing different voices together in collaborative spaces to make joint decisions, and where communities have a say over the support that is delivered in their area

  • Flattening hierarchies through multidisciplinary teams where staff understand each others’ skills and expand each others’ practice

  • Dissolving boundaries between primary and secondary care and voluntary and statutory services through iIntegrated leadership and decision making groups

We’ve learned a great deal from our 10 years in Living Well. Our sites have sought to use co-production to share power, reconfigure permissions and democratise the system, so that staff and citizens are collectively responsible for holding each other to account for a better bolder vision for mental health.


No matter where we work, our starting point remains the same - that a serious commitment to transformation needs the courage to embed co-production in a way that continuously gives power back to those who usually have none.


 

If you’d like to talk to us about Living Well, including developing a programme in your area, then please email lwuk@innovationunit.org and we’d be delighted to start a conversation.

Living Well UK Programme is funded by The National Lottery Community Fund, the largest funder of community activity in the UK.





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