Co-production: Who is co-producing what?

MIND recently commissioned a report from NEF (the New Economics Foundation) reviewing the evidence on co-production in ‘mental health’ (1). The NEF’s principles cannot be faulted. Co-production is about being equal partners in designing and delivering services, working in reciprocal relationships with professionals, and removing the distinction between professionals and recipients. They contrast this approach with the traditional one of ‘doing to’, in order to educate and cure them so that they conform to idealised norms and standards.

It is immediately apparent that MIND’s understanding of co-production is at odds with NEF’s principles. However, NEF concedes that the commissioned review helps to position the network of local Minds as market leaders of high quality, recovery focused, personalised services that individuals want to buy. MIND’s foreword refers to ensuring that millions more people are able to access the mental health services that will help them recover and stay well.    

To be cynical, this is rather like a tobacco company investing in e-cigarettes. A citizen who is a service user or buying a service is not engaged in co-production except in the sense that they are an essential element in the production process (as consumer). Of course, a citizen might wish to purchase the services of a professional and this reverse the power differential. The citizen is now in charge, and assuming that they have not been duped, they can end the relationship at will.

In the review, the NEF rows back on its principles somewhat when it refers to ‘doing with’ as a much deeper level of service user involvement that shifts power towards people. In case this is not entirely clear, it means that people’s voices must be heard, valued, debated. It would be foolish to deny that anything more than even a modest shift away from coercion would be welcome, and the evidence reviewed by NEF certainly supports the benefits of so doing. The review is a useful summary and describes 15 different projects. Benefits are seen in improved social networks, social inclusion, skills and employability, prevention, and addressing stigma.

However, what has this to do with ‘mental health’ except for reducing the need for services? According to MIND, one of their objectives is to increase access to services. We want to ensure that millions more people are able to access the mental health services that will help them recover and stay well. Recovery and staying well imply illness. If the outcomes of co-production are defined in this way (in the form of curing disorders as defined by WHO or the American Psychiatric Association), the citizen has already ceded power to the medical professional. The type of service that the citizen is invited to co-produce has already been ordained.  

The NEF’s conceptual framework is one of well-being, with an emphasis on autonomy, relatedness, and competence. Apparently, with the exception of the Richmond Fellowship and up2us, none of the projects used an explicit well-being framework in their evaluations. For MIND, and perhaps for other charitable organisations, the desired outcome is ‘improved mental health’. This latter concept is a convenient dustbin category that leaves power relationships pretty much the same as they have always been.

1. Slay, J. & Stephens, L. (2013). Co-production in mental health: A literature review. London: New Economics Foundation 

 

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