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

该项目将探讨与心理健康服务有关的合作制作概念，并审查评估这些服务价值的框架。它的问题是：精神卫生服务的合作是否提供了更大的价值，以及以何种方式提供了更大的价值？有精神健康问题的人如何才能最好地参与到他们所使用的服务中？合作制作对提供精神卫生服务有何影响？该项目的依据是，公共服务部门越来越强调联合制作，将其作为确保有效提供服务的关键战略（Needham和Carr， 2009），并有迹象表明，精神卫生服务的联合制作增加了其对个人的内在价值；他们的能力和影响；以及它们的货币价值（Slay和Stephens， 2013:16-18）。这可以被表示为“公共价值”，其中不仅有服务用户的利益，而且更广泛的社会目标的满足和社会凝聚力的增强（Osborne等人，2016）。尽管《2012年公共服务（社会价值）法》的实施受到限制，而且“价值”的定义和衡量尚未开发，但这些目标已被纳入《2012年公共服务（社会价值）法》的委托流程中（White, 2017）。此外，有必要为公共价值的构建提供更有力的经验证据（Hartley等人，2017），尤其是在合拍片如何产生这些证据（Alford, 2011）。最重要的主题是对合作生产的不同理解之间的紧张关系，以及将服务用户视为个体“消费者”与寻求集体行动以实现民主和赋权的社区团体之间的紧张关系（Beresford, 2010）。这与如何理解价值密切相关；正如Fawcett等人（2018）所解释的那样，精神卫生领域的合作是由经济约束下的工作需求驱动的，但合作应该关注如何才能最好地提供平等和司法公正（Barnes等人，2010）。我从事社会关怀工作二十年，对这些问题有深刻的见解。考虑到合作生产的广泛可能性和价值构建的复杂性，鼓励采用多种研究方法（Hartley et al, 2017）。从根本上说，任何关于合作生产的研究都应该让服务使用者自己参与进来，以避免加强现有的排斥和障碍（贝雷斯福德，2007）。因此，参与式行动研究是合适的，它提供了通过社区有意义的参与来评估服务的方法，从而导致创造性的行动（Baum et al, 2006）。除此之外，批判性话语分析的要素将用于评估价值创造的修辞，利用其揭示社会关系中潜在不平等的潜力（Fairclough等人，2011），以围绕心理健康的话语为代表（Barnes和Bowl， 2001）。研究方法将包括与服务使用者和从业人员进行访谈和焦点小组讨论。这将涉及接近心理健康康复学院，合作生产的关键地点以及对服务用户，社区和专员的丰富价值来源（Meddings等人，2014年），并与在线网络合作，探索这些话语领域，以便对围绕社会运动的修辞进行批判性分析（Unger等人，2016年）。捕捉价值争论还可能涉及映射利益相关者在游戏事件或模拟中的互动（Hartley et al, 2017）。跨文化、全国和国际个案研究的比较分析将进一步支持政策形成的建议（同上）。研究设计本身应该是一个参与性的过程，因此保留最初的开放性（Barnes和Cotterell， 2012）。

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).