Objective Co-production involves service providers and service users collaborating to design and deliver services together and is gaining attention as a means to improve provision of care. Aiming to extend this model to an educational context, the authors assembled a diverse group to develop co-produced education for psychiatry residents and medical students at the University of Toronto over several years. The authors describe the dynamics involved in co-producing psychiatric education as experienced in their work. Methods A collaborative autobiographical case study approach provides a snapshot of the collective experiences of working to write a manuscript about paying service users for their contributions to co-produced education. Data were collected from two inperson meetings, personal communications, emails, and online comments to capture the fullest possible range of perspectives from the group about payment. Results The juxtaposition of the vision for an inclusive process against the budgetary constraints that the authors faced led them to reflect deeply on the many meanings of paying service user educators for their contributions to academic initiatives. These reflections revealed that payment had implications at personal, organizational, and social levels. Conclusion Paying mental health service user educators for their contributions is an ethical imperative for the authors. However, unless payment is accompanied by other forms of demonstrating respect, it aligns with organizational structures and practices, and it is connected to a larger goal of achieving social justice, the role of service users as legitimate knowers and educators and ultimately their impact on learners will be limited.

Background Widespread policy reforms in Canada, the United States and elsewhere over the last two decades strengthened team models of primary care by bringing together family physicians and nurse practitioners with a range of mental health and other interdisciplinary providers. Understanding how patients with depression and anxiety experience newer team‐based models of care delivery is essential to explore whether the intended impact of these reforms is achieved, identify gaps that remain and provide direction on strengthening the quality of mental health care. Objective The main study objective was to understand patients’ perspectives on the quality of care that they received for anxiety and depression in primary care teams. Methods This was a qualitative study, informed by constructivist grounded theory. We conducted focus groups and individual interviews with primary care patients about their experiences with mental health care. Focus groups and individual interviews were recorded and transcribed verbatim. Grounded theory guided an inductive analysis of the data. Results Forty patients participated in the study: 31 participated in one of four focus groups, and nine completed an individual interview. Participants in our study described their experiences with mental health care across four themes: accessibility, technical care, trusting relationships and meeting diverse needs. Conclusion Greater attention by policymakers is needed to strengthen integrated collaborative practices in primary care so that patients have similar access to mental health services across different primary care practices, and smoother continuity of care across sectors. The research team is comprised of individuals with lived experience of mental health who have participated in all aspects of the research process.

Introduction: A practice hypothyroid register is part of the quality and outcomes framework. In literature, the prevalence of hypothyroidism is stated to be 2% but the prevalence, defined from quality and outcomes framework data, is 3.2% in the UK and 3.6% in Plymouth. We sought to investigate the diagnosis of hypothyroidism and reasons for prescription of thyroxine to patients on the hypothyroid register in Plymouth. Methods: A letter was sent to the 10 practices with the highest prevalence of hypothyroidism requesting a list of patients on their registers. The hospital pathology system was used to identify those with biochemically documented hypothyroidism (defined as thyroid stimulating hormone >10mU/L) For two large practices the clinical records of the remaining patients were reviewed to ascertain the reasons for prescription of thyroxine and whether it led to symptomatic improvement. Results: Seven practices responded with 1246 patients on their registers, of whom 43.6% had documented hypothyroidism. A review of notes of patients on the register, but without documented hypothyroidism, showed <25% to have an improvement in symptoms after prescription of thyroxine. Tiredness was the most common symptom prompting prescription of thyroxine. Conclusion: Of the patients on the register, only 43.6% had documented biochemical evidence of hypothyroidism and, from notes review of those without documented hypothyroidism, at least two-thirds may have been prescribed thyroxine outwith current national guidance. If this is correct, it has significant resource implications, impacts upon the workload of primary care, pharmacy and the laboratory service and may have clinical implications for patients.

In this Foundations article, the authors reflect on the meaning of time through their past work creating novel roles for psychiatric service users to be involved in the education of health professions trainees and faculty. Inspired by music composer Hector Berlioz, the authors explore and critique the ableist, chrononormative temporalities of academia, and medical education. The authors introduce the conception of crip time from critical disability studies and use it to reflect on their experiences of the different temporalities that people bring to service user engagement and other collaborative projects. “Crip time” can help challenge notions of pace and productivity to create a more inclusive space for teachers and learners in health professions education.