A Critical History of Co‐Production in the Design and Delivery of UK Mental Health Services

BACKGROUND: The term co-production is now very common and risks losing its original egalitarian and emancipatory meaning. Questions about what the term means relate to how the concept developed historically. We conduct a critical history of the concept to shed some light on this and inform contemporary practice. OBJECTIVES: To chart the history of co-production focusing on co-production in the design and delivery of mental health services; critically examining the extent to which the original egalitarian promise has been realised. METHODS: We draw on early foundational texts, key UK policy frameworks and legislation, mental health service user/survivor movement accounts and more recent guidelines, using illustrative cases to critically examine the concept. RESULTS: Early accounts from the US stressing reciprocity, shared power, and active citizenship directly influenced approaches to UK mental health services. Further accounts from the user/survivor movement stressed the importance of power sharing and a critique of medical models of mental distress. UK policy frameworks and legislation have since brought co-production from the margins to the mainstream, introducing a tension between a mainstream concept of co-production influencing services through collaboration and a service user/survivor concept of co-production as equal power sharing. CONCLUSION: Historically there have been a range of conceptions of co-production with different notions of what power sharing means for service users working alongside professionals. LIVED EXPERIENCE OR PUBLIC CONTRIBUTION: Both authors have past lived experience of using psychiatric services. The manuscript was also shared with a small group of user/survivors with a particular interest in co-production and their feedback incorporated in the final draft.