Mental health inequalities are widening and increasing! Co-production can help.

The effects of the COVID-19 pandemic on our mental health have widened the existing inequalities while adding new ones to address. In this blog, Rory explores how co-production might be able to help address mental health inequalities, many of which have been created and or exacerbated by lockdown.

A New Mental Health Challenge

A recent study looking at adult mental health in the UK population before and during the lockdown suggests that in addition to established mental health inequalities, other sources of inequalities have widened, with pronounced increases of mental distress in younger age groups, and in women. Many of us have experienced difficulties coping during this time to some degree or another but the seemingly universal feeling of gloom about 2020 is misleading: we all respond differently and have distinct mental health needs we must look after. The term ‘mental distress’ is used to describe a range of mental health concerns, from things such as anxiety and depression, to others such as schizophrenia. External circumstances complicate this further. Support systems, resources, and individual responsibilities differ from person to person. The latest research points to newly emerging inequalities in mental distress, with those living with young children and those in employment at the start of the pandemic being at risk of larger increases in mental distress.

“The problems for mental health from COVID-19 and governmental responses to the pandemic are not necessarily new; instead, pre-existing mental health inequalities could become more entrenched and tackling them might be even more challenging. The pandemic has brought people’s differing life circumstances into stark contrast: access to outside and inside space, household crowding, lack of school provision and childcare, food insecurity, domestic violence, addiction, access to internet and maintenance of social connectivity, as well as economic reserves are all relevant to mental health.”
Pierce M., Hope H. et al (2020)

More distress is far from the only effect lockdown has on mental health. The study also warns about economic consequences of the pandemic leading to the emergence of long-term effects of economic recession on mental health including increasing suicide rates and hospital admissions for mental illness. The study proposes that policymakers, commissioners, and service providers need reliable information about mental health changes so that the decisions they make are underpinned by knowledge of the scale of changes in population mental health, and who is most vulnerable to symptoms of mental distress. Accessing this pool of information requires the use of methods such as co-production in both research and service delivery so that changing needs can be addressed, and we can close in on mental health inequalities.

Co-production in Mental Health Research

Co-production has been around for decades but it has never been more important to promote its use in mental health settings. Just seven years ago, it was largely absent from mental health research literature but now there are numerous examples readily available in studies about implementing co-production in mental health organisations, mental health training of community groups, as well as nursing education, and the Scottish Health Service to name just a few!

Though it’s difficult to give co-production a single universal definition (we talk about how we approach it as Co-Production Collective later in this blog), this also means it has great versatility for mental health research and can be adapted to a variety of projects. It can even be incorporated into highly traditional formats such as a randomized controlled trial of mental health peer support.

“Through balancing all the factors relevant for a decision, contributed by all experts (methodological, clinical, and experts by experience), randomized controlled trials can be conducted in a way which incorporates and values service user perspectives, delivering research with great social accountability which is also hopefully of higher quality and more relevant to service users and their mental health journeys.”
Goldsmith LP, Morshead R, et al. (2019) Co-producing Randomized Controlled Trials

A study exploring access to support services for depression by presenting data generated solely by co-researchers (a panel of end users) found that involvement alone is tokenistic unless it also offers the opportunity for co-researcher to develop skills and expand their knowledge in order to increase the quality of analysis. This way, co-production can reveal richer data, but it is one of the criticisms it may face as an approach. While it fosters trust between researchers and people who share their lived experience, these discussions around mental health will inevitably be emotional, leaving one party vulnerable and the other feeling unable to help. Additionally, the research team may have concerns that such findings will not be taken seriously. However, this is precisely what makes it valuable as it reveals elements of mental health that may otherwise remain hidden due to negativity or inefficient engagement between researchers and service users. Allowing emotional work to happen is one thing, the real challenge is tuning into communication styles and continuously working towards understanding.

“Not everyone wanted to share emotions openly, while others welcomed the opportunity to do so. Understanding people’s preferences was part of team development.”
The PARTNERS2 writing collective, Allen, D., Cree, L. et al. (2020)

The benefits gained by developing such a team as the above study did and letting co-production happen are immense. People are not just interviewed about their mental health and their painful experiences that cause distress in the present as a participant in the research, but they have an active role to play as co-researchers. Implementing co-production in traditional mental health services goes even further in terms of positive benefits for those involved. Co-producing service delivery allows the focus to be on rebuilding the sense of identity lost through illness by learning new skills, increasing confidence, improving social relationships, increasing self-worth, improving levels of resilience and quality of life. By its very nature, co-production increases service-user control and reduces the negativity that sometimes surrounds mental health, and as a result it has also been shown to increase service users’ self-esteem and sense of belonging, which, when combined with the development of old and new skills, can improve their chances of gaining employment, even becoming empowered by the knowledge gained by engaging with their own mental health experiences.

Our Approach to Co-production

Rather than trying to define co-production, the Co-production Collective accepts and celebrates the fact that there are numerous answers to the simple question of ‘What is co-production?‘. During each of our sessions, we refer everyone to ‘Our approach to co-production’, as is shown in the image below, we believe that ‘Co-production is an approach to working together in equal partnership and for equal benefit’.

At our official launch on 22 October 2020, we revealed our new name and core values, we work to hold these true in everything that we do. Soon we will be sharing our ‘Direction for 2020-22’. This is our co-produced strategy for the future, which includes our vision (how we see the future), mission (how we are going to get there) and core values plus ‘Our Ambitions’ for the next 2 years.

If you have thoughts about what healthcare research and services should look like, what co-production is meant to be, or would just like to find our more and connect to hundreds of people (including patients, carers, healthcare practitioners, researchers, students – basically anyone who is interested!) then join our network by emailing us at coproduction@ucl.ac.uk

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