Time is on our side: operationalising ‘phase zero’ in coproduction of mental health services for marginalised and underserved populations in London

Abstract

Coproduction is increasingly positioned as the gold standard for improving health engagement with marginalised groups. Yet little is known about how key factors such as power, position and culture impact success. Our research aims to identify the psychosocial factors and resources that enable successful coproduction between Black, Asian and other Minority communities and statutory agencies within a coproduction network for mental health services in London. Within our multi-site ethnography, 53 individuals completed: participatory learning appraisal (PLA) workshops, focus groups, and semi-structured interviews. Unstructured observations of network activities were also completed. Data were analysed using thematic network analysis.The findings highlight that coproduction is enabled by symbolic, relational and material resources. Resources are input before coproduction activities begin, within a newly conceptualised 'phase zero'. Unconstrained by typical funding cycles, the phase shifts power, resources and relationships through recognising and addressing power asymmetries and histories of oppression facing marginalised groups. Implications for coproduction are discussed.

Using participatory action research to reimagine community mental health services in Colombia: a mixed-method study protocol

“…It is informed by co-production principles, to enable a platform for involving community members in a process of thinking through what changes are needed to improve access to, and the quality of mental health services. 20 Co-production principles demand the inclusion of everyday actors, or potential service users, within processes of design and development. We will achieve this through involving everyday community members using a CPAR 21 model, to think through what changes are needed to improve access to and quality of mental health services.…”

Working in the wake: transformative global health in an imperfect world

“…This would ideally come before project planning as a route to making visible, and potentially upsetting and transforming, historical power differentials between groups. 20 Where possible, projects should attempt to work with communities to establish the boundaries and value of this research to them and their lives. When using the term community, it must extend beyond the realm of government, policy and NGO stakeholders-to actual everyday people; the potential service users of any programme or project later developed.…”

“…This would ideally come before project planning as a route to making visible, and potentially upsetting and transforming, historical power differentials between groups. 20 Where possible, projects should attempt to work with communities to establish the boundaries and value of this research to them and their lives.…”

“…Crucially coproduction should be conducted within a transformative paradigm that acknowledges the differential resource contributions made by all actors. This would ideally come before project planning as a route to making visible, and potentially upsetting and transforming, historical power differentials between groups 20. Where possible, projects should attempt to work with communities to establish the boundaries and value of this research to them and their lives.…”

Creative processes in co-designing a co-design hub: towards system change in health and social services in collaboration with structurally vulnerable populations

“…For example, structural vulnerability in the healthcare context may arise from informational asymmetry between providers and patients (Bennett and Irwin, 1997), or from the overlapping and mutually reinforcing power hierarchies arising from socioeconomic barriers, racial discrimination, cultural considerations, and immigration status or labour force participation (Bourgois et al, 2017;Mulvale and Robert, 2021). Structurally vulnerable populations have historically been underrepresented in research engagement opportunities, limiting research relevance and transferability, and perpetuating exclusion from health services (Bonevski et al, 2014;Black et al, 2018;Gonzalez et al, 2020;Burgess and Choudary, 2021). Co-design research is thus seen as a way to affect the vulnerability of communities by acting upon systems, policies, individuals, groups, and institutions (Farr, 2018;Røhnebaek and Bjerck, 2021).…”