What Is ‘Really’ Required To Incorporate The User Narrative In The Changing Health Systems?

The concept of recovery emerged from the service user movements in the 1970s, most notably in Anglo-Saxon countries, challenging traditional medical approaches to treating people with mental illness and how services for these individuals are organised and delivered.

Over the last decade, the recovery movement has attracted widespread interest and as a result, has become part of broader change and improvement processes across mental health systems in many industrialized countries. However, recent debates suggest that such narratives are often used by mental health and educational systems to promote their own agendas. In this context, user narratives are no longer considered a transformative act of co-production or resistance and they are a commodity servicing primarily the interests of these systems.

Co-production has become a way of talking about service-user participation in mental health services. Co-production relies on a seemingly ‘simple definition—people who use services collaborate in the production of services’ and is generally presented as a ‘valuable element of quality and service improvement’. However, the concept of co-production is also known for its ‘excessive elasticity, evident in the various ways in which it has been defined and interpreted’. Not surprisingly, co-production has been described as a paradoxical space, with a potential to both reinforce and transform existing practices and systems.

Needham and Carr (2009) provided a helpful distinction between three levels of co-production, however Sapouna (2020) argues that the contribution of user-narratives can only be meaningful in the context of pursuing the third level of transformative co-production as described by Needham and Carr;

At its most effective, co-production can be transformative, requiring a relocation of power and control, through the development of new user-led mechanisms of planning, delivery, management and governance. It is important to be aware of these levels when claims are made about co-production in professional education.