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

本项目将探讨与精神卫生服务有关的共同制作概念，并研究评估这些服务价值的框架。它问：精神卫生服务中的共同制作是否提供了更大的价值，以及以何种方式？有心理健康问题的人如何最好地参与他们使用的服务？共同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重视共同制作，将其作为确保有效提供服务的一项关键战略（Needham和卡尔，2009年），有迹象表明，精神卫生服务的共同制作增加了其对个人的内在价值;其能力和影响;以及其货币价值（Slay和Stephens，2013年：16-18）。这可以被称为“公共价值”，其中不仅有服务用户的利益，但更广泛的社会目标的会议和社会凝聚力的增强（奥斯本等，2016）。2012年《公共服务（社会价值）法》规定了这些目标，尽管该法的实施有限，而且“价值”的定义和衡量尚未发展（白色，2017年）。此外，有必要为公共价值的构建提供更强有力的经验证据（Hartley et al，2017），尤其是合作生产如何产生这些（阿尔福德，2011）。总的主题是对共同制作的不同理解之间的紧张关系，服务用户作为个人“消费者”的看法与寻求集体行动实现民主和赋权的社区团体之间的紧张关系（Beresford，2010年）。这与如何理解价值密切相关;正如福塞特等人（2018）所解释的那样，精神健康方面的共同制作是由在经济限制下工作的需要驱动的，但共同制作应该关注如何最好地提供平等和正义（巴恩斯等人，2010）。我20年的社会关怀职业生涯为这些问题提供了深刻的见解。考虑到联合生产的可能性的广泛规模和价值构建的复杂性，鼓励采用各种研究方法（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，以避免加强现有的排斥和障碍（Beresford，2007年）。因此，示范性行动研究是适当的，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等人，2006年）。除此之外，批评性话语分析的元素将被用来评估价值创造的修辞，利用其揭示社会关系中潜在的不平等的潜力（Fairclough et al，2011），以心理健康为代表的话语（巴恩斯和碗，2001）。研究方法将包括与服务用户和从业人员的访谈和焦点小组。这将涉及接近心理健康康复学院，合作生产的关键网站和丰富的价值来源，以服务用户，社区和委员（Meddings等人，2014），并与网络在线互动，探索这些话语舞台，以允许对社会运动的修辞进行批判性分析（Unger等人，2016）。捕捉价值的平衡还可能涉及在游戏事件或模拟中映射利益相关者的互动（Hartley等人，2017）。对跨文化、全国和国际案例研究的比较分析将进一步支持制定政策的建议（同上）。研究设计本身应该是一个参与性的过程，因此保持最初的开放性（巴恩斯和科特雷尔，2012年）。

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).