Riga Presentation v2

Co-production in Secure Settings

Frank Reilly

Definition that works in forensic settings

Examples

Methods

Early results

Toward skills

Project Objectives

Background: High Secure Settings

•Restricted liberties

•Required programme of care

•Managing risk a high priority

•Dual purpose: protect the public/patients

and provide mental health care

‘Co-production is a slippery concept’ (Adults’ Services: SCIE Guide 51)

-in high secure settings it can also be threatening

Background: Definitions

Co-production assumes that individuals have:

*Assets that can be engaged in achieving self actualisation (Harrison et al 2004)

*Potential for increasing independence and ‘citizenship’ or social responsibility(Gershon 2004, Lyons 2006)

*Potential for the reduction of reliance on formal care and agencies(Boyle and Harris 2009, Leadbetter 2004)

‘To be truly transformative, co-production requires a relocation of power towards service users. This necessitates new relationships with front-line professionals who need training to be empowered to

take on these new roles’ (Realpe and Wallace 2010, p3)

Examples: Ward talking groups

•No explicit ‘rules’....but the participants create

them

•Hierarchy ‘suspended’

•Not ‘assessed’

•Engages

Co-production exists when trust, the support of autonomy and the sharing of knowledge as power (both from and to the patient) result in outcomes that are personal to the patient/client.

Issues

Importance of relational security

Managing complex and shifting boundaries

Reaction to failures/complacency

Potential Benefits

Reinforces hope

Improved understanding

Reduce violent incidents

Improve engagement in treatment

Project in action:Methods

•2x low secure sites (1x NHS, 1x private)

•1x High Secure site

•Potential comparison site in Ireland

•Staff focussed (ethical issues)

Project in action: Methods

•Purposive sample of recovery oriented staff

•6x semi-structured interviews each site (n=18)

•1xvignette focus group each low secure site

•2x iterations of Delphi questionnaire (‘wisdom

of crowds’)

Project in action: Early

results

•Relational security relies on apprentiship

•Private clinic restructured: values based for

relational skills

•Difference between staff who rely on structure

to those who build on it

•Organisation who value social therapy reap

benefits: lower assaults, better engagement

Where is the fit?

Relational security Co-production Recovery

The challenge?

Organisations that don't co-produce with their staff find it difficult to facilitate co-production with their consumers