1. The elephant in the room. John Wattis University of Huddersfield
Education, training and supervision for professionalism based on co-production:
The elephant in the room.
John Wattis University of Huddersfield

2. Defining terms Professionalism: Education and Training: Supervision:
Different meanings in different contexts (e.g. sports)
In caring professions – being registered with a professional regulator like the GMC for medics and adhering to standards with respect to knowledge, skills and performance; safety and quality; communication, partnership and teamwork; and maintaining trust/integrity
Education and Training:
Training relates to specific skills
Education relates to developing intellectual capacity and the ability to maintain and apply it in complex situations - professionalism
Competency-based education
Supervision:
Managerial and developmental – how much of each?

3. Beyond Competencies
Co-production of mental health = professional competencies (knowledge & skills) + personal professional development (attitude/aptitude &motivation) + situational factors. + the other (thou-I relationship)

4. Competencies for professionals engaged in co-production of mental health?
A. Setting the Foundation  
1. Meeting Ethical Guidelines and Professional Standards
2. Establishing the working Agreement
B. Co-creating the Relationship
3. Establishing Trust and Intimacy with the person
4. Presence
C. Communicating Effectively 
5. Active Listening 
6. Powerful Questioning (to help the person explore their own needs, values, purpose and direction)
7. Direct Communication 
D. Facilitating Learning and Results  
8. Creating Awareness 
9. Co-designing Actions
10. Joint planning and Goal Setting
11. Jointly managing Progress and Accountability  Adapted from ICF standards for professional coaches

5. Definitions of Coaching
Coaching is partnering with clients in a thought- provoking and creative process that inspires them to maximize their personal and professional potential. (International Coach Federation)
Coaching is a skilled relationship that supports people through change, promotes a balanced life, accelerates personal development and enables people to realise their potential (JPW)

6. Personal Professional Development
Socialisation into professional role as a ‘limited expert’
Understanding professional standards and how to apply them
Interactive learning (involving people who use services)
Group discussions of ethical issues, complex situations etc.
Role models
Coaching and mentoring
Compassionate motivation
Resilience - the ability to sustain knowledge, skills, compassion and motivation to do the job.

7. Situational factors - Obstructions
Fragmented patterns of working with diffusion of responsibility
blocking the “thou-I” relationship
Time and caseload pressures
Limited sessions
Insufficient recovery time and support
Bad management systems and cultures
Top-down ‘command and control’
Authoritarian/bullying culture
Box-ticking
Work-arounds (how professionals get round these obstructions)

8. Factors promoting co-production of mental health
Team working
Mutual respect and support
Variety of special competencies and capabilities
Extended to the people we work with
Good leadership and supervision
Distributed leadership
Peer supervision can support co-production
Support, realistic expectations and supervision beyond the team
Good management systems and cultures
Better ways – e.g. TPS, VMPS

9. NAViGO (principles based on SRV)
People who use and work in services influence design & operation
Design facilities on domestic scale & style
Educate staff to understand their power & influence for good or bad
Ensure organisational design focuses on people who use services
Language is important ‘people’ not patients; avoid clinical jargon
Involve people who use services in all staff education & training
Make clinical and security features unobtrusive in buildings
Share common space
Encourage public access and interaction
Support people (staff & service users) to develop valued roles & creativity
Modified from Bond K (2017)

10. Alternative relationships
Paternalistic
We, the experts, act in the patient’s best interests
Informative
We, the experts, give the consumer/customer information to make choices
Interpretive/Co-productive
We put our expertise at the service of the people we work with, asking questions and using our knowledge to support them in finding the best course of action:
What is your understanding of the situation and its possible outcomes?
What are your fears and what are your hopes?
What are the trade-offs you are willing to make and not willing to make?
What is the course of action that best serves this understanding?
(modified from Atul Gawande, Being Mortal, 2011.)

11. The elephant in the room
Gus Spence veteran environmentalist said, some years ago, speaking of climate change and other environmental problems: “I used to think that with thirty years of good science we could address these problems, but I was wrong. The top environmental problems are selfishness, greed and apathy – and to deal with these we need a spiritual and cultural transformation.”

12. Discussion Some possible areas:
What are the competencies that are needed for professionals to work to co-produce mental health?
What are the personal qualities we need to develop in professionals to enable them to work in this way and how do we support them in this work (sometimes against the system)?
What social, cultural, political and organisational systems need to change to facilitate co-production?