Seminar 6: Presentations

As promised, presentations from yesterday’s seminar on co-production in coercive environments.

  • Introduction by Pamela Fisher & Christine Rhodes: download here
  • Co-production of mental health services: the art of the impossible? by David Pilgrim (Keynote): download here
  • Power Sharing Within Coercive Environments? by Charlotte Scott: download here

Thanks to the speakers for providing these materials.

April blog post – some ideas on co-production

Dear All

Below are some bullet point type notes relating to the final discussion at St Catherine’s on 17 February. Do let me know via email if you’d like to add anything or change anything.  It’s great that the seminar has generated much interest. Since February I’ve been contacted by a number of people/organisations who are interested in getting involved in order to take this initiative forward. More on this later.

I want to write a little here about research and co-production because it is very much an emerging paradigm. Generating knowledge co-productively challenges accepted research practices. The researcher no longer defines clear objectives but instead engages with stakeholder groups in a dialogical process. Whilst University researchers normally adopt a linear approach to research, co-production requires an expanded view of research which blurs traditional boundaries whilst being open to uncertainty and ambiguity. While some may see this approach as unfocussed, I see it as a driver for research which is thoroughly interrogated, socially useful, and, crucially, co-productive. A colleague recently expressed the view that I should have started with clearer ideas about co-production at the outset. But, stating clear ideas about what co-production should be at the beginning would in itself be irreconcilable with co-production. The seminar series is about developing a position on co-production whilst at the same time (however imperfectly) enacting co-production. My only non-negotiable when I wrote the proposal for the ESRC was that co-production is not the same as patient and public involvement, it is about power-sharing, and power-sharing requires new approaches to professionalism. Otherwise, for me it’s a journey.  If anyone thinks this sounds like the road to nowhere, I say ‘watch this space’…

Just one other thing, I shall be developing a book proposal for an edited collection. I’ll be circulating more information on this in the summer, but you might want to start thinking about the possibility of contributing a chapter.

Pamela Fisher, April 2016

Key Words: Power – Space – Peer Support

 Research power imbalances

Dichotomy of paid and unpaid work in a context of shrinking budgets

Unpaid service users/researchers               paid professional researchers

Imbalances in the legitimacy/status of different forms of knowledge (experiential, personal, lived experience, and professional)

People are expected to ‘inhabit’ one ‘role’ or another: either service user, volunteer/peer support worker, paid professional

Co-production involves parity of esteem for all type of knowledge/’roles’

This requires external voices to ‘raise hell’. Reform cannot be achieved from the ‘inside’ only

Community

 Asset based approach, based on community wellbeing. Should involve multiple partners across core services/economy working towards the promotion of wellbeing with a focus on the prevention of mental distress and the development of resilience

 Many resources in the community (800 organisations in Kirklees), but recognition that ‘the community’ can be a hostile as well as enabling. More opportunities in community than anything a service can offer.

 More blurring of roles needed: ‘allow people to give back when they are well’. This is a feature of Recovery Colleges.  Peer supporters also need peer support

Investment in education needed in volunteer and peer support ‘roles’. Recovery colleges are harnessing the expertise and skills acquired through lived experience

ZIP (Leanne) and commissioning training for co-production

Flexibility of using services when needed rather than being ‘service user’

Co-production of commissioning is working in some CCG’s – particularly Leeds. The environment needs to be right for this. How can co-production in commissioning be facilitated?

Key questions: How is the ‘right’ environment created? What forms of governance are required to ensure that service user perspectives are incorporated?

Protected/shared ‘recovery’ spaces required in order to develop the capacity for co-production?

Education, Training and Workforce

Accountability requires service user and peer-led governance

“People with power please listen!”

Commensus – Community Engagement and participative process at UCLAN

Education, Training and Workforce

Professional training didactic, little space for critical political thinking

Involvement of service users is tokenistic rather than core to education and training

Professionals are generally reluctant to share power: a need for some ‘unlearning’ before they are able to facilitate co-production.

Collaborative risk training involving service users, peer support workers, professionals is needed

Ian McGonigle and Kim Woodridge and others have developed resources, but these are under-utilised.

More formal representation of service users required as unionised workers, but this also raises risks.

Need to resist power without becoming what you are resisting (need to consider theory on how power reproduces itself in new forms)

Co-production is a methodology applicable to all age groups, including children

Do we need something similar to Schwartz round in mental health?

Ward rounds

Can be overwhelming for service users and professionals

More space for the wards needed for the facilitation of better conversations in order to overcome boundaries between ‘roles’

Space a recurring theme;

  • To talk
  • To feel safe
  • To think
  • To innovate
  • To do things differently
  • To help blur roles/demarcations

A significant body of theoretical perspectives on space

Need to introduce theory on democracy/citizenship into the area of mental health

Project TOGETHER provide training for peer support workers and ward staff.

Drug and alcohol addiction/Recovery

Services have moved from statutory to third sector, and models have been developed which could have wider application in mental health

Values developed around mutual aid and an asset approach

Recovery approaches developed within build on the idea of Patricia Deegan

Co-production in commissioning very important

Use of digital/social media to facilitate co-production

The Voicebox’: simple to use technology which hosts stories

Inappropriate gatekeeping of people’s perspectives

Digital media may mitigate the tendency to find out what people want but only report ‘safe’ ideas

Maybe ‘let go’ of some approaches to defining research questions, and allow themes to ‘emerge’ directly from service user voices. However, difficult to secure funding this way in current context.