Since the publication of A Vision for Change (Department of Health and Children 2006), which sets out the direction for mental health services in Ireland, new approaches to interacting with people who have lived experience of mental ill health have emerged. Co-production is one such approach.
Co-production is a word used to describe the creation of a dialogical space where the service user, family members, carers and service providers enter a collaborative medical partnership to improve their own care and also service provision. Co-production is a cornerstone in the delivery of a recovery-oriented service and when implemented correctly it has the power to achieve positive change. The aim of this article is to provide background information and guidance on how to implement co-production in traditional mental health services. It is in line with the publication and implementation of the Irish recovery guidance document, A National Framework for Recovery in Mental Health.
Author details: Michael Norton, peer support worker and doctoral student, department of nursing and health care, school of health sciences, Waterford Institute of technology, Waterford, Ireland.
This paper will discuss examples of mental health training developed and co-produced in active partnership with two communities, one in Britain and one in Sri Lanka. This work has taken place in community settings, not within the consulting room. The learning had a bi-directional flow; through these partnerships, both partners/groups shared and developed their understanding of different cultures, idioms of distress, explanatory mental health models and ways of dealing with these.
This expanded everyone’s knowledge, understanding, and repertoires of practice. The work in Britain was audited through a range of psychometric tests and that in Sri Lanka through questionnaires. Semi-structured interviews also took place with both groups as did meetings with a range of key informants. Working beyond the clinic can benefit people, who have obliquely been labeled, as ‘hard to reach’ groups and who may find it difficult to access mental health services or who find services inappropriate. Therefore, community groups may be well-positioned to bridge this gap in non-stigmatizing, accessible and culturally appropriate ways. Evidence has begun to emerge suggesting that mental health services developed in conjunction with service users and the wider community may lead to better usage, more appropriate and accessible services, and to an improved sense of inclusivity. The implications of this for the global mental health debate will be briefly considered as will health pluralism and the importance of language and using a mother tongue.
Mental health services are increasingly encouraged to use co-design methodologies to engage individuals and families affected by mental health problems in service design and improvement. This scoping review aimed to identify research that used co-design methods with Culturally and Linguistically Diverse (CALD) communities in mental health services, and to identify methodological considerations for working with this population.
In October 2019, we searched five electronic databases (CINAHL, PsycINFO, EMBASE, MEDLINE, Web of Science) to identify papers published in which people from CALD backgrounds were engaged in the co-design of a mental health service or program. Searches were limited to peer-reviewed articles published in English in the last 25 years (1993–2019). The search identified nine articles that matched the inclusion criteria. Using a scoping review methodology, the first author charted the data using extraction fields and then used qualitative synthesis methods to identify themes. Data were grouped into themes relevant to the research question. The two key themes relate first, to improving the experience for CALD communities when engaging in co-design research and second, to the development of co-design methods themselves. These findings support the need for further research into the transferability of co-design tools with CALD communities, particularly if co-design is to become a best practice method for service design and improvement. This scoping review identified methodological and practical consideration for researchers looking to use co-design with CALD communities for mental health service design, re-design or quality improvement initiatives. Further research is required to explore experiences of co-design methods, including documented protocols such as experience-based co-design, with CALD communities. This review indicates that explanatory models of mental health, community and co-design impact partnerships with CALD communities, and need to be understood to optimise the quality of these relationships when using co-design methods.
Aim: This study aimed to evaluate a pilot cross-sector initiative - bringing together public health, a community group, primary mental health teams and patients - in using co-production approaches to deliver a mental health service to meet the needs of the black and minority ethnic communities.
Background: Black and minority ethnic communities continue to face inequalities in mental health service access and provision. They are under-represented in low-level interventions as they are less likely to be referred, and more likely to disengage from mainstream mental health services. Effective models that lead to improved access and better outcomes are yet to be established. It has long been recognised that to be effective, services need to be more culturally competent, which may be achieved through a co-production approach.
Methods: This study aimed to evaluate the role of co-production in the development of a novel community mental health service for black and minority ethnic service users. Qualitative research methods, including semi-structured interviews and focus groups, were used to collect data to examine the use of co-production methods in designing and delivering an improved mental health service.
Findings: Twenty five patients enrolled into the study; of these, ten were signposted for more intensive psychological support. A 75% retention rate was recorded (higher than is generally the case for black and minority ethnic service users). Early indications are that the project has helped overcome barriers to accessing mental health services. Although small scale, this study highlights an alternative model that, if explored and developed further, could lead to delivery of patient-centred services to improve access and patient experience within mental health services, particularly for black and minority ethnic communities.
Co-design as a participatory method aims to improve health service design and implementation. It is being used more frequently by researchers and practitioners in various health and social care settings. Co-design has the potential for achieving positive outcomes for the end users involved in the process; however, involvement of diverse ethnic minority population in the process remains limited. While the need to engage with diverse voices is identified, there is less information available on how to achieve meaningful engagement with these groups.
Ethnic minorities are super-diverse population and the diversity between and within these groups need consideration for optimising their participation in co-design. Based on our experience of working with diverse ethnic minority groups towards the co-design of consumer engagement strategies to improve patient safety in cancer services as part of the two nationally-funded research projects in Australia, we outline reflections and practical techniques to optimise co-design with people from diverse ethnic backgrounds. We identify three key aspects of the co-design process pertinent to the involvement of this population; 1) starting at the pre-commencement stage to ensure diverse, seldom heard consumers are invited to and included in co-design work, 2) considering logistics and adequate resources to provide appropriate support to address needs before, during and beyond the co-design process, and 3) supporting and enabling a diversity of contributions via the co-design process.
The National Mental Health Consumer and Carer Forum and the National Primary Health Network Mental Health Lived Experience Engagement Network acknowledge the Traditional Custodians of the lands and waters on which we work and live on across Australia. We recognise their continuing connection to land, waters, culture and community. We pay our respects to Elders past and present.
“A lived experience recognises the effects of ongoing negative historical impacts and or specific events on the social and emotional wellbeing of Aboriginal and Torres Strait Islander peoples. It encompasses the cultural, spiritual, physical, emotional and mental wellbeing of the individual, family or community.
“People with lived or living experience of suicide are those who have experienced suicidal thoughts, survived a suicide attempt, cared for someone through a suicidal crisis, been bereaved by suicide or having a loved one who has died by suicide, acknowledging that this experience is significantly different and takes into consideration Aboriginal and Torres Strait Islander peoples ways of understanding social and emotional wellbeing.” - Aboriginal and Torres Strait Islander Lived Experience Centre
We welcome Aboriginal and Torres Strait Islander people to this site and invite them to provide any feedback or items for inclusion.
We also recognise people with lived and living experience of mental ill-health and recovery and the experience of people who are carers, families, kin, or supporters.