Coproduction in mental health organizations: how to make it work

Context Against the increasing incidence of mental health diseases worldwide, recovery is emerging as an effective method, focused on the strict collaboration of professionals with patients, their relatives, and the society at large, in order to design, manage and evaluate the patients’ personal care pathways. However, despite recovery and co-produced approaches proved to facilitate the patients’ rehabilitation and wellbeing, evidence on how they can be successfully implemented in mental health organizations still lacks. This paper aims to assess potential enablers and barriers for the application of coproduction approaches in health care organizations, through a literature review and an empirical analysis. Methods A systematic literature review has been carried out to identify enablers and barriers that encourage or limit the adoption of coproduction in healthcare organizations. 647 papers were identified through the keyword search and 84 were selected as coherent within the research’s aim. 28 different models and methodological approaches emerged from the search. However, they tended to be very general and no model explained how to implement coproduction in mental health organizations; thus, an empirical analysis was completed to gather evidence in support of this unexplored domain. Specifically, we selected four mental health organizations in Northern Italy, which are trying to adopt coproduction approaches in different organizational settings. Overall, 11 patients, 5 caregivers and 10 professionals were interviewed about their personal experience on coproduction and the perceived enablers and barriers. The interviews lasted 14 hours and 12 minutes, they were recorded, transcribed and validated by the interviewees. Results The literature research showed that the presence of a widespread network in support of coproduction (professionals, caregivers, policy makers, etc) that is trained accordingly facilitates the implementation of coproduction, as well as the use of shared medical plans, co-designed among professionals, patients and relatives. These enablers were confirmed in the cases, despite relatives are not always keen to be involved. About the barriers, both the literature and the practice point at the absence of solid methods to assess the return of investment for coproduction: policy makers hardly know what coproduction is and the current organizational and financial systems are not aligned with it (i.e. fee for service vs. personal budget of care). Yet, the literature stresses that professionals are seldom willing to collaborate equally with the patients, while the cases show the opposite. However, practitioners perform coproduction practices on top of their required activities, without being rewarded for it. Discussion Informed by the literature, the cases provide indications about priorities for future research in the field of patients’ involvement in mental health care. First, there is a need to generate methodologies to assess the outcomes of these approaches. All the interviewees agreed that coproduction is time-consuming and hard, but worth it: this evidence should be translated into measurable items and assessed. The assessment and widespread communication of positive results may determine a twofold advantage in our view: first, it shows policymakers and health organizations’ managers that coproduction is effective; second, it increases the social acceptance of people affected by mental diseases patients. Second, new ways to improve knowledge and commitment of professionals, relatives and patients towards coproduction are needed. For example, psychiatrist and psychologists’ training paths could include specific courses on it, while patients and families could be reached by targeted communication campaigns in schools, job places, or public locations.