Co-production of community mental health services: Organising the interplay between public services and civil society in Denmark

Abstract

Co-production involves knowledge and skills based on both lived experiences of citizens and professionally training of staff. In Europe, co-production is viewed as an essential tool for meeting the demographic, political and economic challenges of welfare states. However, co-production is facing challenges because public services and civil society are rooted in two very different logics. These challenges are typically encountered by provider organisations and their staff who must convert policies and strategies into practice. Denmark is a welfare state with a strong public services sector and a relatively low involvement of volunteers. The aim of this study was to investigate how provider organisations and their staff navigate between the two logics. The present analysis is a critical case study of two municipalities selected from seven participating municipalities, for their maximum diversity. The study setting was the Community Families programme, which aim to support the social network of mental health users by offering regular contact with selected private families/individuals. The task of the municipalities was to initiate and support Community Families. The analysis built on qualitative data generated at the organisational level in the seven participating municipalities. Within the two "case study" municipalities, qualitative interviews were conducted with front-line co-ordinators (six) and line managers (two). The interviews were recorded, transcribed verbatim and coded using the software program NVivo.The results confirm the central role played by staff and identify a close interplay between public services and civil society logics as essential for the organisation of coproduction. Corresponding objectives, activities and collaborative relations of provider organisations are keys for facilitating the co-productive practice of individual staff.Organised in this way, co-production can succeed even in a mental health setting associated with social stigma and in a welfare state dominated by public services. K E Y W O R D Scivil society logic, community mental health services, co-production, organisational level, public service logic, qualitative study | 123 VAEGGEMOSE Et al. | INTRODUCTIONAcross Europe, countries make efforts to involve civil society in the co-production of healthcare services to meet the demographic, political and economic challenges of the contemporary welfare state (Pestoff, 2009). The basic idea is to combine the professional knowledge of healthcare providers with knowledge and skills based on the lived experiences of citizens. Citizens can be involved individually as volunteers or collectively within civil society organisations. The concept of co-production was developed in the 1980s in response to a greater awareness of the limitations of the "provider-centric" model of the welfare state (Nimegeer, Farmer, Munoz, & Currie, 2016;Ostrom, 1996;Parks et al., 1981;Pestoff, 2014;Pestoff, Brandsen, & Verschuere, 2013). In practice, the organisation of co-production has several challen...

Implementing co-production in traditional statutory mental health services

“…This is highlighted by Dunston et al (2009), who identify that the difference between co-production and other initiatives is that it emphasises and relies on partnership practice between all stakeholders (Figures 2 and 3). The idea behind co-productive practice is to combine professional knowledge with experiential knowledge to strive towards an optimal outcome (Palumbo 2016, Vaeggemose et al 2018. Co-production is a method by which service users become effective members of the multidisciplinary team through the process of using the first person narrative (Palumbo 2016).…”

“…Co-production has several challenges (Vaeggemose et al 2018) and, according to Cepiku and Giordano (2014) and Phillips and Morgan (2014), incurs significant costs. This is contradicted by Barker (2010), Durham College and the Regional Municipality of Durham Social Services Department (2016) and Filipe et al (2017), who identify that it is of economic benefit to services.…”

“…However, Owens and Cribb (2012) emphasise that the challenges to co-production are not all centred around power and autonomy. Carr et al (2016), the National Development Team for Inclusion (2016) and Vaeggemose et al (2018) identify that restrictive professional practice, administrative and legal issues are barriers because they prevent services from creating this cultural change. Adams et al (2014) identify that coproduction requires services to develop more slowly.…”

“…Co-production has barriers due to the fact that the priorities of the health systems do not match the service user's societal values (Vaeggemose et al 2018) and, therefore, it is difficult to implement in a health setting (Palumbo 2016).…”

Changing attitudes: The impact of Expert by Experience involvement in Mental Health Nursing Education: An international survey study

“…More substantive and meaningful participation is emerging, with a movement towards coproduction (Department of Health and Children, , INVOLVE, ; Vaeggemose et al . ). Coproduction, in this context, is characterized by consumers and health professionals in practice or educational settings, collaborating in partnership on projects featuring equitable power relations between, and relationships founded on, trust and mutuality (Gill ).…”