How can co-production be made a reality in youth work-led mental health?
How real relationships, backed by supportive, resourceful management and funding, create the conditions for effective co-production.
Within mental health, there are perennial rallying cries for people who experience mental health difficulties to have greater involvement in the creation of services that provide care, help and support.
Termed ‘co-production’, this has been talked about more than actually carried out. Similarly, calls for greater availability of early interventions to prevent the escalation of mental health difficulties grow more strident every year, while complaints grow of their absence.
In creating the five-year Right Here programme, Paul Hamlyn Foundation and the Mental Health Foundation intended to provide a powerful stimulus for those wishing to commission and fund more effective mental health interventions that focus on early intervention and prevention, with young people actively involved as ‘co-producers’.
What did Right Here learn?
Initially, the main area of young people’s participation was through membership of youth panels in each of the partnerships, as required by the foundations. In the words of the Right Here evaluators, the Institute for Voluntary Action Research (IVAR), these panels were “charged with shaping delivery and being part of the governance. This played out differently in each area, ranging from the young people being given the lead to commission and fund project work in Newham, to recruiting project staff in Sheffield, to designing and shaping materials in Brighton and Hove and setting out the youth voice on participative models of youth work in Fermanagh.”
In each area, it was expected that a core group of young people would guide the partnership and influence the services and activities provided to a wider group of young people in the area.
For example, in Right Here Sheffield, the STAMP group – the project’s main youth participation group – supported the development of the project from the application stage through to the final phase of delivery. Over time, the group took on work that would influence local mental health provision. STAMP worked with Child and Adolescent Mental Health Services (CAMHS) workers to evaluate their ‘You’re Welcome’ standards and the group researched young people’s experience of the Improving Access to Psychological Therapies (IAPT) service. Like all of the original youth panels, it was also intended that the STAMP group would have a role in decision-making in the project, both at operational and strategic levels.
This model of young people contributing formally to management and organisation did not endure until the end of the programme. In part, this was as a result of a relaxation in the two foundations’ expectations of the two youth panels’ role; this is illustrated by the findings of the first iteration of a process evaluation in 2010, which highlighted the need for a wider range of participatory approaches than the original ‘blueprint’ set at the beginning of Right Here.
As the IVAR evaluation says, “By the summer of 2011, the youth panels became more activity-based, with less of a focus on governance and decision making. In Brighton and Hove, the panel was disbanded, replaced by three autonomous volunteer teams who met to discuss their work. By 2012, the Newham panel had split into two: one concentrating on events organisation and management and the other on media and film, with the two coming together at a series of locally significant events. Fermanagh introduced a youth-led grant scheme, which enabled other young people to bid to run programmes of their own. While in Sheffield, the youth panel (STAMP) took on creative tasks, including designing a board game and promotional materials.”
This reflects one of the intrinsic challenges of co-production. For a project to be a true partnership between paid professionals and unpaid volunteers, it must be possible to shape the project using the wishes of those volunteering their time as well as those who are receiving a wage for their labour. Volunteers would often prefer to be carrying out activities rather than managing those activities for others. That is not to say that involvement at a strategic or organisational level is not a suitable goal for young people, but it is clear that for many of the young people engaged in the projects, it was not their main priority.
IVAR also found that attitudes to young people’s involvement were by no means straightforward and there could be uncomfortable power dynamics that seemed to “cause most discomfort where it [the power] was hidden or not acknowledged”. “For some adults engaged in Right Here locally and nationally, the power of the youth panels (for example in Right Here Newham) felt disempowering or unsettling. Other adults were more comfortable with young people’s engagement in the initiative and there seemed to be an emerging ‘club’ of workers who ‘understood youth’ and used that to exert power in, for example, meetings.”
The funding of co-production within a framework that has defined goals and expectations also creates a tension where young people are ‘in control’ but also told that there are a number of choices that they cannot make without compromising the purpose of the project. Developing early intervention and wellbeing programmes to support the mental health of young people can be a task that requires knowledge, experience and insight. As each Right Here partnership was being measured against its delivery of outcomes, it is easy to see how young people initially involved in youth panels may have wished to move beyond that role. Co-production works best when all partners are able to contribute their best qualities and skills to the process. Youth workers are best at youth work; young people are best at knowing what it is like to be a young person. When volunteers give their time freely – as the young people did for Right Here partnerships – and they become unhappy with the role due to feeling under-utilised or over-burdened, the response is likely to be withdrawal of participation.
What can we conclude?
Co-production as a practice requires flexibility and trust, both on the part of those involved in the co-produced project and on the part of those that fund or commission it. It is possible to create conditions for co-production to be successful, but it comes out of real relationships between all involved, backed up by supportive, resourceful management and funding.
While traditionally configured young people’s services may have access to resources, those resources are tied up in structures that make the flexibility required for co-production unlikely to happen. Right Here represents an example of what is possible when resources are placed within projects and organisations that are closer to communities in which it is possible to be more agile and to change, develop and grow through the course of ‘finding out through doing’.
Vital to this process is a shared understanding by all parties of the overall goal of projects. When there is a unity of direction, co-production is about forging different paths to achieving it. Where co-production is embedded in project structures that allow for trying, failing and then succeeding, it can nurture true partnerships between young people and professionals, and consequently enable innovation.