Co-production in social care: What it is and how to do it
Practice example: You in Mind
About the project
The You in Mind Mental Health Care Pathway and Recovery Colleges programme in Northern Ireland emerged following a regional survey of the experiences of people who use services and carers.
The main outcome of the survey was to place co-production at the heart of mental health care and to develop a regional framework to guide recovery-orientated person and family-centred practice. The documents that support the programme were co-designed and written by users and carers.
The pathway describes the experience that people with mental health care needs can expect and the key standards directing the delivery of all mental health care across Northern Ireland. The pathway promotes co-production through four core principles:
- Know me
- Decide together
- Work together
- Work towards self-management
In support of the care pathway, Recovery Colleges have been established across Northern Ireland. Recovery Colleges provide a fresh adult learning approach to mental health care through blending ‘expert by experience’ and professional knowledge into the delivery of therapeutic educational programmes.
What has co-production meant to the project
A genuine partnership of equals was at the core of the project. This approach changed relationships and resulted in a pathway which is jointly owned by people with lived experience and professionals.
What has helped in implementing a co-production approach?
- A shared vision of co-production
- An agreed set of values for underpinning the pathway
- A framework for practically embedding the evidence
The approach was very important in establishing credibility and in strengthening the mandate for co-production; it allowed professionals to see how valuable co-production was in supporting recovery and opened up more doors for the approach to flourish within mental health services.
What difficulties were there in implementing co-production?
The language of co-production presented a number of challenges in terms of its meaning and how it would be practised.
At the start, people with lived experience expressed concern about dominant professional perspectives, while on the other hand there was professional anxiety that co-production might undermine clinical expertise. Overcoming this involved detailed conversations with everyone about the practical application of co-production and demonstrating the value of lived experience in shaping services.
It was acknowledged that co-production involves the rebalancing of power in the therapeutic relationship. Sometimes the different perception led to defensive conversations. There was also a concern that an over-emphasis on promoting personal control could give rise to a one-dimensional view of decision-making, particularly when safeguarding interventions were required. The different levels of knowledge and expectations associated with co-design occasionally led to misunderstandings.
This made it important to devote time to building personal and organisational capacity that encouraged everyone to adopt a more reflective approach.
As the process developed there were many challenges regarding the representativeness and balance between professional groupings and those people with lived experience. This was complicated by the lack of an agreed framework for the formal reward of people with lived experience. A challenging resource environment also restricted the development and speed of new services in response to emerging evidence.
What are the main strengths in the approach that has been taken?
Giving equal weight to people’s lived experience with professional expertise was fundamental to promoting co-production. This influenced practice, reform of services and was instrumental in the revision of the Northern Ireland Mental Health Services Framework. The establishment of an expert by experience writing group ensured the pathway remained grounded and real for everyone involved. The group helped translate a complex range of evidence and co-production concepts into an easily understood practical guide.
The establishment of Recovery Colleges created a robust network of people with lived experience who are now actively involved in the design and delivery of a wide range of co-education programmes across Northern Ireland.
What have been the main outcomes of the project?
The pathway and Recovery Colleges have helped to mainstream and embed co-production, and initiated a culture shift across mental health care. Although it is early days the work has already led to the establishment of 18 peer support posts, five Recovery College centres and the appointment of Recovery College peer educators which resulted in over 230 sessions of co-produced education.
The project has also been the catalyst for putting experts by experience at the heart of reform as equal partners. This is leading to renewed confidence that co-production offers a real opportunity for people with lived experience to retain and regain personal control of their lives.
How has the project worked to engage all sections of the community?
The project was inclusive from the outset, involving commissioners, providers, and people with lived experience, their families and carers along with policy leads. There was also extensive consultation with service user/carer forums/groups and professional bodies.
Recovery Colleges were established through the Implementation Recovery and Organisational Change Programme (IMROC). The IMROC implementation team structure was also inclusive of people with lived experience, carers, community and voluntary sector organisations.
The colleges have been designed using a ‘hub and spoke’ model and programmes are delivered within local communities through a wide range of community and voluntary sector venues. A wide range of co-produced courses have been developed in partnership with people with lived experience and with the active involvement of voluntary and community sector professionals.
What advice would you give to others?
In taking forward co-production it is essential:
- The work is governed by a clearly agreed vision, driven by passion and values underpinned by a commitment by everyone involved in the delivery of care; including policy makers, commissioners, providers of care, professionals and people with lived experience
- To be imaginative, inclusive, think big, and create small representative groups that get the work done
- To develop networks and empower people with lived experience to co-lead and champion projects supported by a capacity building programme
- To remain relentlessly positive