A Critical History of Co-Production in the Design and Delivery of UK Mental Health Services.

BACKGROUND

The term co-production is now very common and risks losing its original egalitarian and emancipatory meaning. Questions about what the term means relate to how the concept developed historically. We conduct a critical history of the concept to shed some light on this and inform contemporary practice.

OBJECTIVES

To chart the history of co-production focusing on co-production in the design and delivery of mental health services; critically examining the extent to which the original egalitarian promise has been realised.

METHODS

We draw on early foundational texts, key UK policy frameworks and legislation, mental health service user/survivor movement accounts and more recent guidelines, using illustrative cases to critically examine the concept.

RESULTS

Early accounts from the US stressing reciprocity, shared power, and active citizenship directly influenced approaches to UK mental health services. Further accounts from the user/survivor movement stressed the importance of power sharing and a critique of medical models of mental distress. UK policy frameworks and legislation have since brought co-production from the margins to the mainstream, introducing a tension between a mainstream concept of co-production influencing services through collaboration and a service user/survivor concept of co-production as equal power sharing.

CONCLUSION

Historically there have been a range of conceptions of co-production with different notions of what power sharing means for service users working alongside professionals.

LIVED EXPERIENCE OR PUBLIC CONTRIBUTION: Both authors have past lived experience of using psychiatric services. The manuscript was also shared with a small group of user/survivors with a particular interest in co-production and their feedback incorporated in the final draft.