Co-production involves a redistribution of power. In the first instance, this requires respect for people’s choices and preferences about their care. For this reason, policy initiatives such as the introduction of personal budgets and the personalisation agenda constitute progress – they help to re-instate marginalised people as self-determining citizens. Choice is a cornerstone of co-production, but, equally, it should be about much more than this. People sometimes wonder how personalisation differs from co-production. My response is that co-production supports people’s choices but recognises that they do not make choices in circumstances of their own choosing. Many people in mental distress are caught up in complex and oppressive entanglement of powers which severely constrain choices.
What about a person who can’t face getting out of bed because of the emotional, mental, social and material challenges which they face? ‘Fine’, some would say, ‘that’s their choice’. After all, it’s a key liberal principle that people can make choices as long as they don’t harm others. And, anyway, co-production should provide freedom to get up and go to bed when you want. What tends to get overlooked is that identity is a relational, not an individual, achievement or process. Everything we remember, think and feel is a co-creation. It has long been argued that personal autonomy is embedded in relationships of interdependence. A feminist ethic of caring potentially offers the basis for a way of thinking about citizenship that recognises everybody as interdependent and having the potential and responsibility to be caring and cared for. We are all dependent on each other for our sense of self.
A person’s sense of self is undone by injustice and isolation, and it can be repaired through solidarity with others. The survivor identity emerged as a result of a political and collective response to institutional oppression. The breakthrough occurred when mental distress was no longer regarded as a personal tragedy but as political issue which demanded collective action. A liberal understanding of identity risks turning back the clock by once again by placing all the emphasis on the individual and their personal choices. This is why the expression ‘user led’ should be used with caution. If it’s all down to people’s choices then they can easily be written off as unable or unwilling to appropriately manage their lives. The unwell person can be left in bed all day without consideration of the relations of power and powerlessness that make staying in bed the most appealing option.
Co-production should be about solidarity and engagement, not neglect justified by a rugged individualism which fails to challenge the social relations which hold people in situations of despair. Co-production should enhance and extend personal choices but it should do so whilst resisting the political and social conditions in which those choices are made.
Blog: Reimagining Professionalism in mental health: towards co-production
Yes! This should be shared widely
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