Ideas of and issues in co-design and co-production including overcoming barriers.
In the design of mental health services and facilities, co-design requires that people with lived experience are equal partners with clinicians, staff and other experts and involved at every stage in decision making – from problem identification to design, development, delivery and evaluation.
Co-design is more involved and takes more time than a standard consultation process. Delivering the Mental Health Beds Expansion Program quickly is a priority, due to the critical shortage of hospital-based mental health beds identified by the Royal Commission into Victoria’s Mental Health System. However, taking the time to co-design each of the four facilities was crucial – to both meet the Royal Commission’s recommendation and to ensure the future facilities are innovative, person-centred and responsive to the needs of consumers.
Co-Design Living Labs bring people with technological, industry, policy and research skills together with people who have lived-experience of a service, role, or mental health condition. We brainstorm ways to improve research, policy and practice in mental health and co-develop solutions and new approaches for primary care to respond to mental health needs in the community. Working together, a Living Lab offers the potential for private-public-partnerships to co-create new technologies, solutions and co-design research projects and materials.
In an era of mental health service reform, co-design is emerging as a leading framework to guide the design and implementation of new services. Co-design uses the expertise of clinicians, those with lived experiences of services (both consumers and carers) and provocateurs (curious questioners) to understand a ‘problem’ and develop innovative strategies to address it.
It relies on the creation of a safe environment where power imbalances are acknowledged and mitigated, and decisions are made collaboratively. Understanding how to do this effectively within the mental health sphere, where experiences of uneven power distribution and trauma are common, can feel overwhelming. Building a shared understanding of the opportunities and limitations within co-design is also important to establish its place within broader mental health reform. This paper uses an experiential approach to reflect on a co-design process, offering an opportunity to learn from a specific example. Factors that enhanced co-design included formal, remunerated roles, the allocation of time to establish and maintain an intimate, trusting team culture, and the capacity for all team members to be vulnerable. Equally important, strategies needed to be employed to mitigate the challenges inherent within the process, including the impact of power differences, a push to make fast-paced decisions, and a sense of cynicism remaining from previous projects or experiences. When these factors are attended to, the process of co-design can be dynamic, innovative, and transformational for the people participating in it, the project and the mental health sector.
This paper examines the concept and practice of coproduction in mental health. By analyzing personal experience as well as the historical antecedents of coproduction, we argue that the site of coproduction is defined by the legacy of the Enlightenment and its notions of “reason” and “the cognitive subject.”
We show the enduring impact of these notions in producing and perpetuating the power dynamics between professionals, researchers, policy makers and service users within privileged sites of knowledge production, whereby those deemed to lack reason—the mad and the racialized mad in particular—and their knowledge are radically inferiorised. Articulating problems in what is considered knowledge and methods of knowing, we argue that modern “psy” sciences instantiates the privilege of reason as well as of whiteness. We then examine how the survivor movement, and the emergent survivor/mad knowledge base, duplicates white privilege even as it interrogates privileges of reason and cognition. Describing how we grapple with these issues in an ongoing project—EURIKHA—which aims to map the knowledge produced by service users, survivors and persons with psychosocial disabilities globally, we offer some suggestions. Coproduction between researchers, policy makers and those of us positioned as mad, particularly as mad people of color, we argue, cannot happen in knowledge production environments continuing to operate within assumptions and philosophies that privilege reason as well as white, Eurocentric thinking. We seek not to coproduce but to challenge and change thinking and support for psychosocial suffering in contexts local to people's lives.
Publications from 2020 confirm that interest in co-production is gathering pace. But from some perspectives, this approach to research is unwanted, unhelpful, or unrealistic. In this review, Rory takes a critical look at co-production and the new frontiers we can look forward to as it continues to develop.
This year, researchers of the University of Edinburgh and the University of Strathclyde brought us a book (The Impact Agenda) that discusses a great many issues around the role of research and the UK Research Excellence Framework (REF). For anyone involved in co-production, the book’s focus on research impact is very useful, as are the discussions in it. Is it still true, as the traditional view suggests, that impact is the benefit of research to society? Are there alternative methods for research to serve society, and if so, how do individual academics feel about those alternatives?
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.