Carers and Co-Production: Enabling Expertise through Experience?

Purpose To provide a brief overview of the literature to date which has focussed on co-production within mental healthcare in the UK, including service user and carer involvement and collaboration. Design The paper presents key outcomes from studies which have explicitly attempted to introduce co-produced care in addition to specific tools designed to encourage co-production within mental health services. The paper debates the cultural and ideological shift required for staff, service users and family members to undertake co-produced care and outlines challenges ahead with respect to service redesign and new roles in practice. Findings Informal carers (family and friends) are recognised as a fundamental resource for mental health service provision, as well as a rich source of expertise through experience, yet their views are rarely solicited by mental health professionals or taken into account during decision-making. This issue is considered alongside new policy recommendations which advocate the development of co-produced services and care. Research Limitations Despite the launch of a number of initiatives designed to build on peer experience and support, there has been a lack of attention on the differing dynamic which remains evident between healthcare professionals and people using mental health services. Co-production sheds a light on the blurring of roles, trust and shared endeavour (Slay and Stephens, 2013) but, despite an increase in peer recovery workers across England, there has been little research or service development designed to focus explicitly on this particular dynamic. Practical Implications Despite these challenges, coproduction in mental healthcare represents a real opportunity for the skills and experience of family members to be taken into account and could provide a mechanism to achieve the ‘triangle of care’ with input, recognition and respect given to all (service users, carers, professionals) whose lives are touched by mental distress. However, lack of attention in relation to carer perspectives, expertise and potential involvement could undermine the potential for coproduction to act as a vehicle to encourage person-centred care which accounts for social in addition to clinical factors. Social Implications The families of people with severe and enduring mental illness (SMI) assume a major responsibility for the provision of care and support to their relatives over extended time periods (Rose et al, 2004). Involving carers in discussions about care planning could help to provide a wider picture about the impact of mental health difficulties, beyond symptom reduction. The ‘co-production of care’ reflects a desire to work meaningfully and fully with service users and carers. However, to date, little work has been undertaken in order to coproduce services through the ‘triangle of care’ with carers bringing their own skills, resources and expertise. Originality/Value This paper debates the current involvement of carers across mental healthcare and debates whether co-production could be a vehicle to utilise carer expertise, enhance quality and satisfaction with mental healthcare. The critique of current work highlights the danger of increasing expectations on service providers to undertake work aligned to key initiatives (shared decision-making, person-centred care, co-production), that have common underpinning principles but, in the absence of practical guidance, could be addressed in isolation rather than as an integrated approach within a ‘triangle of care’.

(Dis)located Olympic Patriots: Sporting Connections, Administrative Communications and Imperial Ether in Interwar New Zealand

During the interwar period (1919–1939), protagonists of the early New Zealand Olympic Committee (NZOC) worked to renegotiate and improve the country's international sporting participation and involvement in the International Olympic Committee. To this end, NZOC effectively used its locally based administrators and well-placed expatriates in Britain to variously assert the organization's nascent autonomy, independence and political power, progress Antipodean athlete's causes and counter any potential doubt about the nation's peripheral position in imperial sporting dialogues. Adding to the corpus of scholarship on New Zealand's ties and tribulations with imperial Britain, both in and beyond sport (e.g. Beilharz and Cox, 2007, “Settler Capitalism Revisited,” Thesis Eleven 88: 112–124; Belich, 2001, Paradise Reforged: A History of the New Zealanders from the 1880s to the Year 2000, Auckland: Allen Lane; Belich, 2007, Making Peoples: A History of the New Zealanders from Polynesian Settlement to the End of the Nineteenth Century, Auckland: The Penguin Group; Coombes, 2006, Rethinking Settler Colonialism: History and Memory in Australia, Canada, Aotearoa New Zealand and South Africa, Manchester: Manchester University Press; MacLean, 2010, “New Zealand (Aotearoa),” In Routledge Companion to Sports History, edited by Steve W. Pope and John Nauright, 510–525, London: Routledge; Phillips, 1984, “Rugby, War and the Mythology of the New Zealand Male,” The New Zealand Journal of History 18 (1): 83–103; Phillips, 1987, A Man's Country: The Image of the Pakeha Male, Auckland: Penguin Books; Ryan, 2004, The Making of New Zealand Cricket, 1832–1914, London: Frank Cass; Ryan, 2005, Tackling Rugby Myths: Rugby and New Zealand Society 1854–2004, Dunedin: University of Otago Press; Ryan, 2007, “Sport in 19th-Century Aotearoa/New Zealand: Opportunities and Constraints,” In Sport in Aotearoa/New Zealand Society, edited by Chris Collins and Steve Jackson, 96–111, Auckland: Thomson), I will examine how the political actions and strategic location of three key NZOC agents (specifically, administrator Harry Amos and expatriates Arthur Porritt and Jack Lovelock) worked in their own particular ways to assert the position of the organization within the global Olympic fraternity. I argue that the efforts of Amos, Porritt and Lovelock also concomitantly served to remind Commonwealth sporting colleagues (namely Britain and Australia) that New Zealand could not be characterized as, or relegated to being, a distal, subdued or subservient colonial sporting partner. Subsequently, I contend that NZOC's development during the interwar period, and particularly the utility of expatriate agents, can be contextualized against historiographical shifts that encourage us to rethink, reimagine and rework narratives of empire, colonization, national identity, commonwealth and belonging.