Coproduction: Notes of caution
This piece is written from the perspective of consumer/survivor leadership. The challenges raised are in the spirit of belief in what consumer/survivor leadership has to offer Victoria’s mental health reform efforts.
Whatever led the Royal Commission into Victoria’s Mental Health System to decide not to engage a consumer/survivor commissioner it, the decision was a missed opportunity.
It resulted in consumer/survivors being positioned more as autobiographers than actors, more objects of others’ compassion than holders of experiential expertise that can define problems and solutions.
Human rights issues we encounter are more able to be disappeared when we are positioned as ill, and others extrapolate from our stories.
Modelling coproduction at all levels
If a Commissioner with personal experience of using Victoria’s public mental health service system had been appointed and thus present at the decision-making table, it would have sent a strong message to the sector about the necessity and value of coproduction.
From the outset, the concerns of consumer/survivors would have stood on an equal basis with medical, legal and carer concerns.
The debates that need to be had between these perspectives would have been powerfully and meaningfully engaged with, modelling and paving the way for much needed open sector debates that will be the foundation for new ways of working together.
A powerful message would have been sent for the very first time that consumer/survivor leadership is essential to all processes and outcomes of change.
Rather than relegated to storying “suffering” or “overcoming the odds”, consumers would have been an essential and unique source for analysing systems and driving innovation and knowledge about what does and doesn’t work, precisely because we have lived it.
The State would have signalled that it understands consumer/survivor leadership is ready, willing and able right now. We don’t have to wait for some future when our “capacity” is built – capacity and innovation are built by diving in and learning along the way.
This work still needs to be done, and is especially urgent as we move into implementing reform.
Redistributing power and resources
The challenge of coproduction is twofold. It requires investment in consumer/survivor leadership and it means understanding that the status quo is not viable. It’s not viable on quality grounds, moral grounds and anti-discrimination grounds.
In coproduction, power and resources must be redistributed. That’s scary. That means thinking about who controls the agenda for change, how change will happen, how activities are prioritised and who gets to make and enact decisions.
If the arrangements in place to implement reform replicate the status quo, it cannot be coproduction.
Sherry Arnstein’s (1969) ladder of participation is still salutary. Partnership (coproduction) is the third rung from the top of the ladder, down from delegated power, which is below citizen control.
Arnstein wrote that in a partnership, the “have nots” usually have to pressure power-holders in order to have any power, whereas in delegated power, it is power-holders who have to start the bargaining process.
Citizen control does not mean absolute control, but ensuring that “have nots” can govern a program or an institution and be in full charge of policy and managerial aspects.
Translating these insights to the context of Victoria’s mental health system reforms, it would be possible for government to delegate decision-making authority over specific plans and programs to consumer/survivor groups and our organisations.
Formal influencers, not just advisers
I hope we will see consumers/survivors in delegated positions working not just on areas of direct concern to the lived experience workforce, but also working on the development of, for example, the new wellbeing outcomes framework.
The proof of the coproduction pudding is what level of influence consumer/survivor leadership roles will have, and whether they can veto, engage in negotiation, identify and bring partners together and do more than advise.
Consumer/survivor leadership roles must operate within structures and processes that give them formal influence and at the same time resource them to work directly with their communities.
Calling something coproduction when there has not been redistribution of power and resources, and deep philosophical and financial commitment to consumer/survivor leadership in all sites of decision-making authority, risks being an exercise in gaslighting.
Cath Roper holds a pioneering consumer academic role at the Centre for Psychiatric Nursing. She is co-author of the manual 'Co-production: putting principles into practice in mental health contexts'.
At our forthcoming symposium Preparing for Reform she will participate in a panel on Coproduction in practice.