Towards the conceptualisation of co-production and value in mental health services

This project will explore the concept of co-production with relation to mental health services, and examine the frameworks for assessing the value of those services. It asks:
Does co-production in mental health services offer greater value, and in what way?
How can people with mental health issues best be involved in the services they use?
What are the implications of co-production for the provision of mental health services?

The project is informed by the increasing emphasis across public services on co-production as a key strategy to ensure their effective provision (Needham and Carr, 2009), and indications that co-production in mental health services increases their intrinsic value for individuals; their capacity and impact; and their monetary value (Slay and Stephens, 2013:16-18). This may be denoted as 'public value', where there is not only a benefit to service users but the meeting of broader societal objectives and the enhancement of social cohesion (Osborne et al, 2016). These goals are enshrined in commissioning processes by the Public Services (Social Value) Act 2012, although the Act's implementation has been limited, and definitions and measurement of 'value' are undeveloped (White, 2017). Furthermore, there is a need to provide much stronger empirical evidence for constructions of public value (Hartley et al, 2017), not least in how co-production generates these (Alford, 2011).

The overarching theme is the tension between differing understandings of co-production, between the perception of service users as individual 'consumers' as opposed to community groups seeking collective action towards democracy and empowerment (Beresford, 2010). This relates closely to how value is understood; as Fawcett et al (2018) explain, co-production in mental health has been driven by the need to work within economic constraints, yet co-production should be concerned with how it can best provide equality and the delivery of justice (Barnes et al, 2010). My twenty-year career in social care has provided deep insight into these issues.

Considering the broad scale of possibilities for co-production and the complexity of how value is constructed, a diverse range of research methodologies are encouraged (Hartley et al, 2017). Fundamentally, any research into co-production should involve the service users themselves to avoid reinforcing existing exclusions and barriers (Beresford, 2007). Therefore, Participatory Action Research is appropriate, offering ways to evaluate services through the meaningful engagement of communities which in turn leads to creative action (Baum et al, 2006). Alongside this, elements of critical discourse analysis will be used to assess the rhetoric of value creation, using its potential for revealing underlying inequalities in social relationships (Fairclough et al, 2011), typified by the discourse around mental health (Barnes and Bowl, 2001).

The research methods will include interviews and focus groups with service users and practitioners. This will involve approaching mental health recovery colleges, key sites of co-production and rich sources of value to both service users, communities and commissioners (Meddings et al 2014), and engaging with networks online, exploring these discursive arenas to allow critical analysis of the rhetoric around social movements (Unger et al, 2016). Capturing the contestation of value may also involve mapping stakeholders' interactions in gaming events or simulations (Hartley et al, 2017). Comparative analysis of cross-cultural, country-wide and international case studies will further support proposals for policy formation (ibid). The research design itself should be a participatory process and as such retain initial open-endedness (Barnes and Cotterell, 2012).