— Case studies / Research
Documented case studies and co-design and co-production research.
Summary
Purpose: This paper explores how users and providers cocreate value through interacting with online peer support mental health forum technology and offers insights into service ecosystem innovation.
Design/methodology/approach: The authors employed digital ethnography and interviews and analysed data to identify themes about user practices, provider adaptations and cocreated value outcomes.
Findings: The study shows how users engage with technology affordances to develop a community that supports their engagement in value cocreation and helps them access support. In turn, providers engage with user data generated through forum use and other sources to influence changes to forum institutions. By analysing a dataset of user interviews, value outcomes realised for forum users are identified. Using a diagram to illustrate how users and providers interact with technology to generate an evolving service ecosystem, the study also offers insights about a service ecosystem perspective of innovation.
Research limitations/implications: The research shows the value of using mixed datasets to access granular, multi-actor data. Direct feedback loops between user practices and changes to institutions are implied rather than directly observable.
Practical implications: The authors provide a worked example highlighting how consumers and providers interacting with forum technology supports value cocreation that contributes to problem-solving for consumers and service ecosystem innovation, and fills healthcare ecosystem gaps.
Originality/value: The study provides novel empirical evidence about multi-actor interactions with technology in value cocreation and informs theory about a service ecosystem perspective of innovation by illustrating technological and market innovation. It extends knowledge about healthcare value cocreation in mental health.
Summary
Consumer workers play an important role in mental health service provision by providing support and advocacy in a way that draws on their lived experience of being a consumer of these services. The past two decades has seen a groundswell of interest from policy makers and service providers about incorporating consumer workers within the mental health system.
Consumer workers occupy a variety of roles, but all seek to embed a consumer perspective on service provision within the mental health sector. This perspective drives a particular approach to supporting consumers, one that is built on core values such as self-determination, mutuality, authenticity, and transparency (Victorian Mental Illness Awareness Council et al., 2018). Consumer perspective work also necessitates a focus on systemic change within the mental health system with a focus on creating a more humane, rights focused sector.
The findings of this project indicate that there is a pressing need for significant improvement in the inclusion and use of consumer workers within mental health care services funded by the Victorian Government. Participants detailed a lack of clear organisational support for consumer worker roles, a high rate of discrimination and bullying, and a clash of values between consumer work and the mental health system. Participants also highlighted several ways to improve the safety and inclusivity of mental health workplaces for consumer workers. What is evident is that the implementation of consumer work within the current mental health system requires a systemic approach to change that targets organisational and individual support alongside mental health sector reform.
Abstract
Experience-based co-design (EBCD) is a quality improvement approach that is being used internationally to bring service users and health professionals together to improve healthcare experiences, systems and processes. Early evaluations and case studies of EBCD have shown promise in terms of improvements to experience and organisational processes, however challenges remain in participation around shared power and decision making, mobilisation for implementation, sustainment of improvements and measurement of outcomes.
The objective of this case study was to explore the emergent issues in EBCD participation and implementation in six quality improvement projects conducted in mental health, rehabilitation, blood and bone marrow transplant, brain injury rehabilitation, urinary incontinence and intellectual disability settings by the Agency for Clinical Innovation (ACI), New South Wales, Australia (2015-2018).
Summary
In the light of the declaration “Nothing about us without us”, interest in co-production, and coproduced research is expanding. Good work has been done establishing principles for co-production and for good quality involvement and describing how this works in practice in mental health research. In the published literature, co-production has worked well in qualitative research projects in which there is often methodological flexibility.
However, to change treatment guidelines in the UK, e.g., the National Institute for Health and Care Excellence guidelines, and influence service commissioning, high quality quantitative research is also needed. This type of research is characterized by formal methodological rules, which pose challenges for the scope of co-production. In this paper we describe the significant challenges and solutions we adopted to design and deliver a coproduced randomized controlled trial of mental health peer support. Given the methodological rigidity of a randomized controlled trial, establishing clearly which methodological and practical decisions and processes can be coproduced, by whom, and how, has been vital to our ongoing co-production as the project has progressed and the team has expanded. Creating and maintaining space for the supported dialogue, reflection, and culture that co-production requires has been vital. This paper aims to make our learning accessible to a wide audience of people developing co-production of knowledge in this field.
Abstract
Increasingly, experts as deemed by personal experience or mental health service use, are involved in the education of nurses; however, accompanying research is limited and focuses primarily on opinions of nurse educators and students. The aim of this study was to develop an understanding of the potential contribution to mental health nursing education by those with experience of mental health service use.
The research was part of the international COMMUNE (Co-production of Mental Health Nursing Education) project, established to develop and evaluate co-produced mental health content for undergraduate nursing students. A qualitative descriptive design was adopted with data collected through focus group interviews in seven sites across Europe and Australia. Experts by experience (people with experience of distress, service use, and recovery) co-produced the project in partnership with nursing academics. Co-production enriched the process of data collection and facilitated the analysis of data from multiple perspectives. Two themes are presented in this paper. The first focuses on how experts by experience can enhance students’ understanding of recovery by seeing the strengths inherent in the ‘human’ behind the diagnostic label. The second highlights the importance of communication and self-reflection on personal values, where students can explore their own thoughts and feelings about mental distress alongside those with lived experience. Interacting with experts by experience in the classroom can assist in challenging stigmatizing attitudes prior to nursing placements. These findings can be used to inform international nursing curricula by increasing the focus on nursing skills valued by those who use the services.