‘Outside the Original Remit’: Co‐production in UK mental health research,lessons from the field

The aim of this discursive paper was to explore the development of co‐production and service user involvement in UK university‐based mental health research and to offer practical recommendations for practitioners co‐producing research with service users and survivors, informed by an overview of the key literature on co‐production in mental health and from a critical reflection on applied research through the medium of a case study. The paper is co‐written by a mental health nurse academic and a service user/survivor researcher academic. The authors argue that the implications of co‐production for mental health research remain underexplored, but that both the practitioner and service user/survivor researcher experience and perspective of co‐production in research can provide practical reflections to inform developing research practice. The theories and values of emancipatory research can provide a framework from which both practitioners and service users can work together on a research project, in a way that requires reflection on process and power dynamics. The authors conclude that whilst co‐produced investigations can offer unique opportunities for advancing emancipatory and applied research in mental health, practitioner researchers need to be more radical in their consideration of power in the research process.     

‘It is meant to be heart rather than head’; International perspectives of teaching from lived experience in mental health nursing programs

Consumer participation is a clear expectation of contemporary mental health policy. Most activity has concentrated in direct service delivery, and academic roles for mental health consumers have been slow to establish. An international project was undertaken to implement and evaluate meaningful consumer involvement in mental health nursing education. A learning module was co‐produced between ‘Experts by Experience’ (drawing on experience of mental distress and service use) and Mental Health Nurse Academics. This qualitative exploratory study aimed to capture how Experts by Experience perceive their contribution. Interviews were undertaken with Experts by Experience who delivered the learning module. Data were analysed thematically and subsequently interpreted with Critical Social Theory. Two main themes emerged from the findings: ‘there wasn't a barrier’ described how personal narratives enhanced relationships between Experts by Experience and students; and ‘made the human being visible’, described their experiences of allowing students to see the person behind a diagnosis. These findings suggest Experts by Experience teaching is valuable and potentially a tool in redressing stigma. Addressing poor public perceptions could attract higher numbers of quality practitioners to mental health and meet identified workforce shortages. The findings presented here strengthen the evidence base for Expert by Experience roles in mental health professional education. These findings can be considered in international curricula reviews and aid progress towards a more socio‐political, humanistic focus in mental health nursing, congruent with rights‐based reform agendas.     

‘Meet Me Where I Am’: Mental health service users’ perspectives on the desirable qualities of a mental health nurse

Nurses play a central role in the delivery of quality mental health services. Desired qualities of a mental health nurse, in particular therapeutic relationships, have been described in the literature, primarily reflecting the nursing paradigm. Service users’ perspectives must be more fully understood to reflect contemporary mental health policy and to recognize their position at the centre of mental health service delivery and to directly influence and contribute their perspectives and experiences to mental health nursing education. A qualitative exploratory research project was undertaken to inform and enhance understanding of what service users see as the desired qualities of a mental health nurse. The project was co‐produced by service users as experts by experience, and mental health nurse academics to ensure the service user perspective was privileged. This international project conducted in Europe and Australia included a series of focus groups with service users (n = 50). Data were analysed thematically. Being with me was a major theme identified and reflected the sub‐themes: respect towards service users as persons; empathy, compassion and effective communication; understanding service users; knowledge of services; and fostering hope and believing that recovery is possible. These qualities specifically reflecting the service user perspective must be central to mental health nursing curricula to facilitate the development of holistic care and recovery‐oriented practice. These findings were utilized to directly inform development of a co‐produced mental health nursing learning module, to maximize genuine service user involvement, and to fully realize the benefits of service user led education for undergraduate nursing students.     

‘There's more to a person than what's in front of you’: Nursing students’ experiences of consumer taught mental health education

Holistic and person‐centred nursing care is commonly regarded as fundamental to nursing practice. These approaches are complementary to recovery which is rapidly becoming the preferred mode of practice within mental health. The willingness and ability of nurses to adopt recovery‐oriented practice is essential to services realizing recovery goals. Involving consumers (referred herein as Experts by Experience) in mental health nursing education has demonstrated positive impact on the skills and attitudes of nursing students. A qualitative exploratory research project was undertaken to examine the perspectives of undergraduate nursing students to Expert by Experience‐led teaching as part of a co‐produced learning module developed through an international study. Focus groups were held with students at each site. Data were analysed thematically. Understanding the person behind the diagnosis was a major theme, including subthemes: person‐centred care/seeing the whole person; getting to know the person, understanding, listening; and challenging the medical model, embracing recovery. Participants described recognizing consumers as far more than their psychiatric diagnoses, and the importance of person‐centred care and recovery‐oriented practice. Understanding the individuality of consumers, their needs and goals, is crucial in mental health and all areas of nursing practice. These findings suggest that recovery, taught by Experts by Experience, is effective and impactful on students’ approach to practice. Further research addressing the impact of Experts by Experience is crucial to enhance our understanding of ways to facilitate the development of recovery‐oriented practice in mental health and holistic and person‐centred practice in all areas of health care.     

Seeking and defining the ‘special’ in specialist mental health nursing: A theoretical construct

In the context of an enduring debate about the distinct identity of mental health nursing, this qualitative study explored the nature, scope and consequences of mental health nursing practice. Data for interpretation were generated through interviews with 36 mental health nurses, five of their clients and one health care colleague, each of whom were asked to speak in as much detail as possible about what they believe is special about mental health nursing and what had influenced them to arrive at this understanding. Using a constructivist grounded theory approach, the study generated a substantive theory of recovery‐focused mental health nursing expressed as ‘Being in the here and now, side by side, co‐constructing care’. The study revealed that the distinct nature and identity of mental health nursing provides the foundation that primes and drives practice scope and consequences. Conceptual interpretations of the data emphasized the mental health nursing perspective of care as an acquired lens founded in nursing as a profession and enhanced by the relational interplay between the nurse and the client that facilitates the nurse to adopt recovery‐focused practices. This theoretical construct holds the potential to be the mediating connection between client and mental health nurse. By situating mental health nursing and its central role in practice as something co‐constructed, findings from this study can be expanded beyond the Australian context, particularly in terms of mental health nursing's distinct professional identity and practice.     

‘Anyone can have a mental illness’: A qualitative inquiry of pre‐registration nursing students’ experiences of traditional mental health clinical placements

Nurses play a crucial role in mental healthcare provision. Like many countries, Australian nursing students are educated in comprehensive pre‐registration programmes which include mental health clinical placements. Placements play a vital role in students’ education, providing the opportunity to engage with consumers and develop mental health nursing knowledge and skills. There is limited knowledge of student perspectives on traditional placements in contemporary recovery‐oriented mental health services. This interpretive qualitative inquiry aimed to explore nursing students’ experience of traditional mental health clinical placement and how it influenced their practice and their understandings of recovery from mental illness. Data were collected from focus groups with n = 31 nursing students in a large metropolitan public mental health service. Thematic analysis resulted in three themes of experience: humanizing people with mental illness; learning about recovery; and shifting perspectives on mental health nursing. Through a positive placement experience where they felt supported and included by staff, students came to see consumers as people rather than diagnoses, developed greater understanding of mental health nursing work and were more likely to consider mental health nursing as a career choice. Peer‐support workers were an important influence on students’ understandings of recovery and have a key role to play in educating students on placement. Students need to be prepared and supported by university and clinical staff to deal with vicarious trauma that may occur on placement. Mental health placements play a crucial role in attracting students into the field, and it is imperative they remain part of comprehensive pre‐registration education.     

Sharing power in criminal justice: The potential of co‐production for offenders experiencing mental health and addictions in New Zealand

Co‐production has begun to make inroads into research, policy, and practice in mental health and addictions. Little is known, however, about the role co‐production has or could have in shaping how the criminal justice system responds to mental health and addictions. Given that a large majority of prisoners in Aotearoa New Zealand have been diagnosed with either a mental health or substance use disorder within their lifetime, it is imperative alternative approaches are considered if we are to reduce the high imprisonment rates and contribute positively to health, safety, and well‐being of all New Zealanders. In this study, we explore how co‐production has been conceptualized and used in criminal justice systems internationally, and offer an experiential account of our first steps into co‐production both in service delivery and research. We conclude by proposing a way forward to expand partnerships between those who have experience‐based expertise and researchers within the criminal justice context, offering a small‐ and large‐scale project as potential examples of what co‐production may look like in this space.     

‘Art Lift’ intervention to improve mental well‐being: An observational study from UK general practice

Arts for health interventions are emerging as an alternative option to medical management of mental health problems and well‐being. This study investigated process and outcomes of an art intervention on patients referred by primary care professionals, including associations between patient characteristics (e.g. sex), progress through the intervention (e.g. attendance), and changes in mental well‐being. Referral criteria included people with anxiety, depression, or stress; low self‐esteem, confidence, or overall well‐being; and chronic illness or pain. The study took place in UK‐based general practitioner practices, with a total of 202 patients referred to a 10‐week intervention. Patient sociodemographic information was recorded at baseline, and patient progress assessed throughout the intervention. Significant improvement in well‐being was revealed for the 7‐item (t = ?6.049, d.f. = 83, P < 0.001, two‐tailed) and 14‐item (t = ?6.961, d.f. = 83, P < 0.001, two‐tailed) scales. Of referred patients, 77.7% attended and 49.5% completed. Most patients were female, and from a range of socioeconomic groups, and those who completed were significantly older (t = ?2.258, d.f. = 145, P = 0.025, two‐tailed). Findings reveal that this art intervention was effective in the promotion of well‐being and in targeting women, older people, and people from lower socioeconomic groups.