Bridging the gaps with co-creation

My personal narrative, marked by caring for loved ones with mental health conditions and facing the loss of family to these struggles, has highlighted the critical need for mental health services to evolve further, ensuring that they not only meet clinical needs but also embrace the holistic needs of service users and their carers.

The potential of co-creation to bridge these gaps cannot be overstated. Although the term “co-creation” is increasingly used across health and community settings, its meaning often remains ambiguous, frequently used interchangeably with related concepts like co-design and co-production without a clear, universally accepted definition (Vargas et al., Reference Vargas, Whelan, Brimblecombe and Allender2022). This article adopts the definition provided by Pearce et al. (2020), which positions co-creation in mental health services as the process of generating new knowledge through the application of various collaborative methods within the delivery of programmes or policies. This definition outlines co-creation as encompassing four collaborative stages: co-ideation, co-design, co-implementation, and co-evaluation. Each stage signifies a step towards creating mental health services that are not only evidence-based but also intricately tailored to meet the multifaceted needs of service users.

Co-ideation involves brainstorming and generating ideas collaboratively between service users, carers, peer workers, service providers, researchers, and mental health professionals, ensuring innovations are grounded in real-world experiences and needs. Co-design builds on this, turning ideas into actionable plans and prototypes, with insights from lived experiences directly informing service development. It sees all stakeholders working side by side to create the service or intervention, ensuring the outcomes reflect service users’ needs and build upon their strengths. Co-implementation extends the partnership into the delivery phase, with services provided in a manner that respects and utilises the expertise of professionals and those with lived experiences equally. Finally, Co-evaluation involves assessing the effectiveness and impact of services collaboratively, ensuring feedback from all stakeholders, especially those with lived experiences, is integral to continuous improvement and refinement.

The synergy between co-creation and the recovery movement, underscoring empowerment, personal growth, and active participation, is particularly resonant with my journey. By championing an environment where service users are co-creators in their care pathways, mental health services can more effectively support the unique recovery journeys of individuals (Senneseth et al., Reference Senneseth, Pollak, Urheim, Logan and Palmstierna2022). This collaborative ethos not only questions traditional hierarchies within mental health care but also resonates with the CHIME framework’s core principles of agency, meaning, and connectedness, encapsulating the essence of a recovery-oriented approach (Kvia et al., Reference Kvia, Dahl, Grønnestad and Frahm Jensen2021).

Leveraging personal experience and best practices

Through the lens of my personal experience, coupled with best practices from the field, it is clear that a mental healthcare system reflecting the needs and aspirations of those it serves is possible. This requires ongoing education, transparent communication, and a commitment to re-evaluating and refining co-creation processes to ensure they remain responsive and effective. The involvement of individuals with lived experience as vital contributors to the care process, along with the integration of peer support, underscores the necessity of flexibility, responsiveness, and a commitment to respecting the individuality of each person’s journey.

To implement recovery values and principles in the real world and consequently realise a transformative vision for mental health care, the following systemic changes in policy and practice are imperative:

1. 1. Institutionalising co-creation: Mandate the active involvement of service users and their carers across all mental healthcare phases, from service conceptualisation to evaluation. Establish formal structures to facilitate co-creation as a standard practice within mental health institutions (Pearce et al., Reference Pearce, Maple, McKay, Shakeshaft and Wayland2022 Reference Pearce, Maple, Shakeshaft, Wayland and Mckay2020).

2. 2. Investing in peer support programmes: Enhance financial and logistical support for peer support initiatives, recognising them as essential complements to professional services. This includes funding training programmes, integrating peer roles within mental health teams, and evaluating the impact of peer support (Shalaby and Agyapong, Reference Shalaby and Agyapong2020, Storm et al., Reference Storm, Fortuna, Brooks and Bartels2020, Richard et al., Reference Richard, Rebinsky, Suresh, Kubic, Carter, Cunningham, Ker, Williams and Sorin2022).

3. 3. Enhancing training on recovery and co-creation: Broaden the scope of training for mental health professionals to cover recovery principles, the value of lived experience, and co-creation practices. Aim to cultivate more empathetic, person-centred care approaches (Arblaster et al., Reference Arblaster, Mackenzie, Buus, Chen, Gill, Gomez, Hamilton, Hancock, McCloughen, Nicholson, Quinn, River, Scanlan, Schneider, Schweizer and Wells2023).

4. 4. Ensuring accessibility and universality: Guarantee that mental health services are accessible to everyone, addressing barriers related to cost, location, culture, and language. Strive to eliminate disparities in mental healthcare access and quality (Muhorakeye and Biracyaza, Reference Muhorakeye and Biracyaza2021).

5. 5. Promoting continuous evaluation and improvement: Implement ongoing evaluation mechanisms for mental health services, prioritising feedback from service users to inform improvements and ensure alignment with recovery and co-creation principles (Lin et al., Reference lin, Harris, Black, Bellissimo, Di Giandomenico, Rodak, Costa-dookhan, Shier, Rovet, Gruszecki and Soklaridis2023).

Achieving an inclusive, compassionate, and effective mental healthcare system requires the concerted efforts and collaboration of every stakeholder within the ecosystem. Each plays a crucial role in transforming the landscape of mental health services:

• Mental health practitioners: Essential in fostering empathy and partnership, they should leverage the insights of service users and carers to deliver person-centred care that truly addresses individual needs.

• Policymakers and funders: Their role is pivotal in ensuring that mental healthcare frameworks support peer support, value lived experience, and encourage collaborative practices.

• Service users and carers: Their advocacy for participatory rights in care decisions is crucial. By contributing their insights and experiences, they help shape services to meet real-world needs and ensure that care delivery is resonant with those it aims to support.

• Peer workers: As individuals with lived experience, peer workers bridge the gap between service users and providers, offering unique insights, empathy, and support that foster a more understanding and supportive care environment.

• Service providers and management: They play a key role in implementing the principles of co-creation and recovery-oriented care within organisations. Their commitment to amplifying marginalised voices, combating stigma, and promoting mental health literacy is essential for making care more accessible, inclusive, and equitable.

• Researchers and academics: Through continuous investigation into the effects of recovery-oriented care and co-creation, they guide best practices and inform policy, ensuring that mental health services are based on evidence that reflects the complexity of human well-being.

• Universities: As institutions of learning and research, universities are vital in educating the next generation of mental health professionals. They also contribute to research that drives innovation in mental healthcare practices and policies.

These stakeholder groups are interconnected, with their roles complementing and reinforcing one another to advance a unified vision for mental health care that is recovery-oriented, co-created, and deeply respectful of each individual’s journey.

The path towards a more inclusive, effective, and compassionate mental healthcare system is both challenging and rewarding. It requires us to question long-held assumptions, to embrace uncertainty, and to commit to continuous learning and adaptation. Yet, the promise of a mental health system that truly supports recovery, values lived experience, and thrives on co-creation is a goal worth striving for.