Co-producing and co-publishing

A letter from our July edition.

Traditional approaches and attitudes within health services, marked by large power differentials between service users and professionals, are currently subject to vast change. This developing revision of attitudes, approaches and narratives has been facilitated and accelerated by the growing involvement and co-production of service design by service user-led groups. Many mental health organisations are taking a lead role in challenging dominant discourses and power relations.

Co-produced research and the dissemination of clinical practice is an important vehicle in the promotion and development of transformative change in the mental health system. At the service in which we work, we are keen to promote this agenda. For a time, we have been working with someone currently detained under the Mental Health Act. Over the past 18 months she has taken a lead role in regaining power and responsibility over her life (having previously experienced this as being taken away from her). The drastic transformation and shift in her role and the empowerment she has created is in stark contrast to the typically marginalised and disenfranchised position some service users experience during detention under the Mental Health Act.

We have been keen to co-produce an article highlighting how collaboration and co-production alongside this service user and her team have enabled and facilitated a shift in the power differential and have enhanced subjective wellbeing. It would not be helpful or appropriate to do this without the person being central to this process, of course. In fact, she is keen to take a lead role and reflect upon her experience and contribute equally to the production of a paper.

There are, however, some ethical dilemmas to consider. Publishing a paper co-produced with a service user raises issues of confidentiality, particularly if details of psychological work are shared. Further, placing the service user in a collaborative position highlights her role as an independent person who is free to decide whether she wishes to share her identity as part of a publication. However, mental health systems introduce complex dynamics through the required use of Mental Health and Mental Capacity Acts and raise concerns around coercion and/or appeasement. Having discussed with editors, we have followed a formal process and have considered these important dilemmas. All of the above considerations have been shared and discussed with the service user involved.

We are keen to hear about other people’s experiences of co-producing research alongside service users who are also named as contributing authors, in order to share thoughts about these dilemmas, particularly within the area of secure mental health care.

Ruth Lewis-Morton
Clinical Psychologist
Andrew Hider
Consultant Clinical and Forensic Psychologist, Clinical Director
Jane Watkins
Chief Operating Officer
Ludlow Street Healthcare

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