Are Coercion and Co-Production Compatible?

I was fortunate to attend a very stimulating seminar entitled ‘Co-production in Coercive Environments’ on 6th July 2017 at the University of Huddersfield. The key question for the seminar was the possibility, or impossibility, of co-production in the conditions of detention under the Mental Health Act (MHA). ‘Co-production’ refers to genuine collaboration between service users and mental health professionals and/or academics in relation to a project of common concern ‒ such as the provision of services, research, campaigning, or public involvement.

A very clear keynote paper by Professor David Pilgrim drew the conclusion (with which I agree) that co-production is impossible under conditions of involuntary detention under the MHA. People detained under the MHA, he maintained, (1) enjoy a kind of diminished citizenship, (2) are in a situation of dependency in relation to mental health professionals, (3) are ascribed a diminished standing as rational and moral agents, and (4) are not in a position to determine their own interests without this determination being over-ridden by the agenda of the professionals. In all these four respects, he argued, the situation of people detained under the MHA is incompatible with authentic collaboration.

David’s argument against the possibility of people detained under the MHA participating in co-production was set in the context of a characterisation of the MHA which emphasised the peculiar character of the powers it gives to the state to detain people. It is, he noted, extraordinary that people who are charged with no crime are detained involuntarily for periods of up to six months: this is a treatment of citizens which would, in other circumstances, expose the state to charges of false imprisonment and possibly assault.

I have myself been involuntarily detained on more than one occasion under the MHA, but my own view of the character of the Act is much less negative than that advanced by David Pilgrim. It is certainly extraordinary that people who are charged with no crime should be detained involuntarily by the state, but severe mental illness is itself extraordinary, and may require an extraordinary response. People detained under the MHA should not be treated, primarily, as dialogical partners who may engage in co-production: they should be treated, primarily, as people who urgently need psychiatric care.

If one adopts this way of looking at the situation of people detained under the MHA, one may look more positively at what can be achieved in relation to co-production. Although co-production is impossible in the context of involuntary detention, the effort to engage with service users in a non-hierarchical manner, which aspires towards genuine collaboration, may nevertheless be useful. Dr Pamela Fisher suggested during the discussion following David Pilgrim’s paper that it might be helpful to think of co-production as a journey, rather than an achieved destination; and in the paper she presented it was spelt out that this journey should be understood in terms of the democratisation of relationships and the inclusion of marginalised perspectives and experiences.

This broad line of approach is consonant with that exemplified in the talk given by Charlotte Scott, who is an Approved Mental Health Practitioner (AMHP), and who is conducting research into the way AMHPs make decisions during MHA assessments, drawing on service users’ views of those assessments. Her focus is on how AMHPs actually do ‒ and how they ideally might ‒ engage with service users in such a way as to recognise their differing perspectives and to involve them as participants in the assessment. I found this attention to the content and structure of interactions between professionals and service users very interesting. While the effort to democratise relationships and to include marginalised perspectives cannot issue in co-production in the conditions of detention under the MHA, Charlotte’s paper showed in a concrete way how this effort can positively affect engagement with service users who are subject to involuntary detention.