R E - IMAGINING PROFESSIONALISM IN MENTAL HEALTH : ENACTING CO - PRODUCTION The Bristol Co-production Group

B ACKGROUND : THE “B RISTOL CO - PRODUCTION GROUP ” A group of service users, carers, mental health practitioners and academics were formed initially to co-produce a change in mental health assessments to be piloted Our approach was based on the “3 keys” - a practical application of values-based practice to mental health assessments The challenge for the 3 keys developers was to make it real! 2

“T HE 3 K EYS TO A SHARED APPROACH IN MENTAL HEALTH ASSESSMENT ” 3 Co-produced by: Professor Bill Fulford (academic lead), Lu Duhig (carer lead) and Laurie Bryant (service user lead) The 3 keys are: First key: active participation of the service user and carer Second key: a multidisciplinary approach Third key: strengths, resiliencies and aspirations of service users and carers

W HAT THE B RISTOL GROUP DID AND HOW IT DID IT Facilitated meetings - to start with Power imbalances - addressed co-productively Initially aimed for a co-produced change in assessment to be piloted by a mental health team As the project progressed, there was a change in the d irection – although there were well formed ideas, none was finally selected for the pilot We found though the journey to be as important as the destination - dissensus 4

D ISSENSUS Dissensus, is a values-based form of co-produced decision making where every voice is heard Where disagreements as well as agreements are ‘held in play’ and a balanced solution reached We used dissensus as our model for working and our disagreements as well as our agreements stayed on the table as the discussions continued. An example - the group used dissensus as our model for interacting and decision-making when we moved our focus from a co-produced change in assessment to broader co-production and collaborating on other projects The dialogue gave a balanced solution to areas of agreement and disagreement 5

R E - IMAGINING PROFESSIONALISM : POWER IMBALANCES THE PROFESSIONAL PERSPECTIVE Professionals relinquishing their power is: a challenge - for both practitioners and academics necessary for co-production & re-imagining professionalism For the professionals’ reactions, I give observations of some challenges without any ‘blame’ Strength of our group is academics and practitioners sharing power equally with service users and carers Was a challenge for new practitioners joining us - two examples: Those practitioners not from the immediate group making and taking multiple mobile phone calls throughout the meeting New professionals coming on board in later in the early days were uncomfortable being in the position of catching up 6

E VALUATION: DESPITE THE CHALLENGES WERE THERE USEFUL OUTCOMES? Cohesive, mutually respectful and trusting group formed with authentic sharing of power  Some power imbalances were not overcome – some people chose to leave Dissensus successfully used as our model for decision making Jointly written and delivered teaching of 1 st year mental health nursing students with collaboration in seminars Filmed discussions with academic as resource for 3 rd year mental health nursing students Discussion and focus groups with service users and carers Collaboration on book chapter Journal article co-written 7

E VALUATION ( CONT.) 3 keys aide-mémoire cards etc. produced for service users, carers, practitioners and others Conferences spoken at by academics, practitioners and service users about our results Recorded discussion of Bristol group and co-production for a website A talk to a Foundation Trust member’s day for a region of a Mental Health Trust Participation in a research project  Although some ideas were formed, no change in assessment was selected to be piloted with an assessment team The journey, though different than expected, seems of as much value as the original goal 8

F OR THE FUTURE ? We have a well established co-production group We have plans for further collaborations The conferences’ programmes and Collaborating Centre tie in with our work and it will therefore be critical to have ongoing support from the Collaborating Centre 9

R EFERENCES The 3 Keys The National Institute for Mental Health in England (NIMHE) and the Care Services Improvement Partnership (2008) 3 Keys to a Shared Approach in Mental Health Assessment. London: Department of Health. Full text downloadable from the Collaborating Centre Website: valuesbasedpractice.org and follow the links More about VBP/Full Text Downloads valuesbasedpractice.org Book chapter Fulford, K.W.M., Duhig, L., Hankin, J., Hicks, J., and Keeble, J.(2015) Values-based Assessment in Mental Health: The 3 Keys to a Shared Approach between Service Users and Service Providers. Ch 73, in Sadler, J.Z., van Staden, W., and Fulford, K.W.M., (Eds) The Oxford Handbook of Psychiatric Ethics. Oxford: Oxford University Press Journal article Hicks, J., Keeble, J., and Fulford, K.W.M. (2015) Mental Health Co- production in Bristol: Seeking to Address the Challenges. Pps 18 – 19, January/February, Mental Health Today 10