Anja Hollowell and an anonymous author
In February 2020, we attended the co-production event Teasing out the Tensions, hosted by the organisation previously known as INVOLVE (now known as NIHR Centre for Engagement and Dissemination), the NIHR advisory body that promotes public involvement in research. It was interesting, informative and thought-provoking. Although the event seems like a life-time ago, looking back at our reflections, we feel that they are arguably even more important now than they were back then – what with the impact that the pandemic has had on people’s mental health and the issues surrounding co-production in Covid-related mental health research.
INVOLVE asserts that co-production should represent “a deliberative process which requires public members and ‘professionals’ to be involved on an equal footing throughout every stage” or as someone at the event put it, “an exchange of ideas”. It was good to see that the whole event was organised in this spirit, embodying the values of co-production (power sharing, inclusive approach, valuing all types of knowledge, reciprocity and relationship building) as much as possible. There was even a discussion in one of the sessions about whether we should introduce ourselves with our job titles. Doing so can sometimes create a sense of hierarchy, although it can be useful for networking purposes – this was just one of many dilemmas that emerged throughout the course of the day! In fact, this was an important take-away message: just because we know we might not reach an answer, doesn’t mean that discussing the questions isn’t important.
We believe co-production makes research more relevant and meaningful. This is because someone who does not have personal experience of something can never understand it in the same way as someone who does. If you take the time to speak to someone involved in co-produced research, you’ll often find that they think the collaboration was worth it. A person at the event summed it up well: “[Co-production is] like making a cake with a group of novices, very messy but great results can happen.”
Despite this, some people are reluctant to use co-production. This may be because they occupy positions of power, conferred by their qualifications or professional position, and are anxious about relinquishing this. They may be sceptical as to how effective and meaningful co-production can be – does power sharing really happen? Other barriers include a lack of awareness of it as an approach, understanding and/or skills. Insufficient resources, for example time and funds, also present significant obstacles as co-production inevitably takes longer than doing research in silos. These challenges may impede the uptake of co-production or yield only tokenistic results.
Some of these barriers could be influenced by processes outside of our immediate spheres. Peter Beresford OBE, Professor of Social Policy at Brunel University, reflects on the how these processes or fraught relationships have evolved over time, in his recent commentary on 'PPI Or User Involvement'. In his keynote speech at the co-production event, he discussed how politics in the UK clash with the values of co-production, for example by leaning towards a more business-like model for success. The emphasis is on easy wins and short term or more tangible success, rather than long term, collective gain. Co-production isn’t compatible with this type of framework. Instead of immediate profitability, the aim of co-production is to genuinely improve people’s lives which, if it’s going to be sustainable, takes time and can’t be a quick fix. What’s more, he said, we need to stop seeing healthcare as a consumer product and more as a human right. Indeed, this is something that has been brought into sharp focus recently, but it is important to note that it isn’t just something that only applies to the current situation.
Peter Beresford also emphasised the need for co-production to be viewed as a methodology and not part of a process. It’s a way of working that extends right from a project’s conception to its conclusion. Because of this, it can present a lot of challenges.
These challenges are why many feel that more evaluation of co-production needs to happen – to ensure that we are continually improving. Although this is welcomed by McPin, our position is that we don’t need evaluation per se to tell us that co-production is the right thing to do, but we do want to learn with others how to do it well. Lizzie Cain, from the UCL Centre for Co-production, picked up on some issues surrounding evaluation and co-production in her workshop. We left with a new take: yes, evaluating co-production is important, but perhaps what’s more imperative is exploring what evaluation is there for in the first place. The negative connotations of evaluation (the process of judging the quality, importance or value of something) can cause resistance to it. Examining how well or badly you’ve done something – and something incredibly difficult at that – might feel invalidating or even judgemental. But we need to remind ourselves that it’s about exploring ways to grow, not dwelling on our flaws: we are aiming for progress, not perfection.
Indeed, evaluation is something that McPin has been thinking a lot about recently, as we have continued with our involvement and research work throughout the pandemic. Like many, we have had to work closely with our Lived Experience Advisory Panels (LEAPs) and partners to figure out how best to adapt to working together in a remote and digital way. For example, our recent work in PARTNERS2. In terms of research, we are considering how to do community research, when you can’t walk around in your community easily and meet people. Going forward, we will be reflecting on what worked well and is worth keeping as part of our methods, and how to continue adjusting our approaches as this period of transition to normal or a ‘new-normal’ way of working progresses. This continued reflection (one of the ‘features’ of co-production, according to INVOLVE) can be seen as a form of evaluation. For more on this we recommend reading Colin King and Steve Gilllard’s reflection narrative.
It’s clear that the mental health sector has taken some definite strides in identifying what the barriers are to co-production in research. In some places, people are starting to figure out what changes need to happen for good co-production to happen and make it a foundation upon which all research is built on. And although we may not have the answers, if we continue to work collectively at having this conversation and embrace the fear and uncertainty of asking difficult questions, then we will make some progress.
Anja Hollowell is a Public Involvement in Research Officer at the McPin Foundation.