Co-production in high secure settings

Reilly, Frank and Stewart, Ailsa and MacIntyre, Gillian (2013) Co-production in high secure settings. In: International Conference on Mental Health Nursing, 2013-05-22 - 2013-05-24, Finland. (Unpublished)

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Co-Production and its application to compulsory environments in health and social care Background Co-production – understood to mean the sharing of power and trust between a professional and the person they are supporting- as a means of working jointly between powerful institutions and their clients has the potential to realise qualitative benefits for mentally disordered offenders and people subject to compulsory treatment orders, both in terms of sharing power and the lived experience of illness, recovery, enablement and reducing the likelihood of reactive violence. Objectives •To identify what co-production means in the context of health and social service delivery to those subject to compulsory measures. •To identify theoretical models of co-production from the current literature-or to create one based on theory and evidence-to assess current practice in high secure settings •To update current tools/create new tools to assist practitioners in high secure settings apply co-productive practices to their interaction with people subject to compulsory mental health measures. •Methods The paper outlines the literature review of a two year project which began in January 2013 •Results: The paper discusses models of co-production – and core, measurable aspects of the approach -and the challenges in utilising such models within a compulsory context. •Conclusions: The usefulness of co-production is considered, outlining the conditions that influence its effective application in high secure settings. In particular the paper examines the influence of legal restrictions and perceptions of risk have on the co-production in settings where security- of patients, between patients and of staff- is as important as the therapeutic milieu. •Implications for nursing practice The initial literature review highlights that power sharing is the core of any co-productive relationship. This requires a re-examination of the professional and social distance between social care and medical personnel and compulsory patients. This is also reflected in the 'desistence' literature in criminal justice social work where strategic accommodation and the need to meet performance targets can undermine opportunities to establish lasting change. This is challenging to professionals working in high secure environments where control and security have equal prominence to therapeutic milieu. Engaging patients with a propensity for violence using a co-productive approach on the reasons for the determination of their risk has the potential to improve their insight and may lead to greater agency 1 as well as a reduced likelihood of violence. Defining the roles in the therapeutic relationship along co-productive lines may provide confidence for nurses and other clinicians to share power and value engaging in a co-productive manner.