Co-production and involuntary psychiatric settings
| Published date | 10 December 2018 |
| Pages | 269-279 |
| DOI | https://doi.org/10.1108/MHRJ-05-2018-0012 |
| Date | 10 December 2018 |
| Author | David Pilgrim |
| Subject Matter | Health & social care,Mental health |
Co-production and involuntary
psychiatric settings
David Pilgrim
Abstract
Purpose –The purpose of this paper is to examine whether the popular policy assumption of co-production
is feasible in secure psychiatric settings.
Design/methodology/approach –The assumptions of co-production are listed and then used as a basis
for an immanent critique to test the feasibility described in the purpose of the paper. An explanatory critique
exploring consumerism in the welfare state then follows. These forms of critique are derived from the
philosophy of critical realism.
Findings –A distinction is made between the co-production of knowledge about mental health services and
the actual co-production of those services. It is concluded that the former has emerged but the latter is not
feasible, given the limitations on citizenship imposed by psychiatric detention.
Research limitations/implications –Evidence for the co-production of mental health services (rather than
the co-production of knowledge about those services) remains sparse.
Practical implications –The contradictions about citizenship created by the existence of mental health
legislation and the social control role of mental health services requires ongoing honest reflects by mental
health professionals and those responsible for the development of mental health services.
Social implications –As described above, mental health legislation pre-empts confidence in the
co-production of mental health services.
Originality/value –Whilst there is a small literature on co-production and mental health services,
alluded to at the outset, this paper uses immanent and explanatory critiques to deepen our understanding
of the topic.
Keywords Mental health services, Co-production, Critical realism
Paper type Conceptual paper
Introduction
The challenge of improving mental health or responding effectively to those with a diagnosis of
mental disorder crosses the boundaries of health, social and public policy. Controversies
abound in policy and research communities about the topic in relation to the epistemological
legitimacy of the psychiatric profession (the validity of psychiatric knowledge) and its role in
society. This paper deals with one particular aspect of the latter: the coercive social control role of
mental health services in a context of the appeal to improve public services by co-opting
the principles of consumerism. One expression of the latter has been the encouragement of the
co-production of services. Below, two competing processes are explored about the devolution
of professional power and the democratisation of decision making on the one hand and the
removal of citizenship without trial on the other.
Since psychiatric orthodoxy encountered extensive criticism during the counter-cultural period of
“anti-psychiatry”, a range of state-endorsed policy initiatives have emerged to mollify its critics.
These have included de-institutionalisation, service user involvement, user-led services and
recovery-focussed care (Scull, 1977; Anthony, 1993; Author; Carr, 2007). The most recent
reform ideology, arguably incorporating the user-orientated trajectory of these changes has been
the aspiration for co-production in mental health services (Clark, 2015; Faulkner, 2009;
Rose, 2009). The literature includes those focussing on the position of some BME groups, which Received 11 May 2018
Accepted 16 August 2018
David Pilgrim is Professor
at the Department of
Clinical Psychology, University
of Southampton,
Southampton, UK.
DOI 10.1108/MHRJ-05-2018-0012 VOL. 23 NO. 4 2018, pp. 269-279, © Emerald Publishing Limited, ISSN 1361-9322
j
MENTALHEALTH REVIEW JOURNAL
j
PAG E 26 9
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