Mental Health Europe’s definition of co-creation: A collaborative approach involving all actors in mental health working together on an equal basis to develop and implement policies, services, programmes, and communication that foster positive mental health according to a psychosocial model and human rights-based approach. (Mental Health Europe, 2022).
Everybody has mental health. Issues arise when there is mental distress, leading to mental health problems and mental health issues. Whilst often the responsibility for mental health is shifted towards professionals and service providers, this collaborative approach puts the onus on everyone. All actors include persons with a lived experience, relatives, carers, professionals, academics, authorities at policy making positions or decision makers. Everyone is on a continuum to have a better future for mental health.
The Co-creation approach moves from the biomedical model which focuses the attention on illness, medical factors and genetics to the psychosocial model which draws attention to the human experience. The biomedical model primarily promotes treatment through medicines which may not always result in meaningful recovery for the person. On the other hand, the psychosocial model builds on the approach that there are varied experiences which can have an impact on the person’s life. These may include socio-economic factors, level of education and challenging or traumatic experiences in one’s life etc. Thus, instead of focusing on what one is not able to do, this model promotes support and adjustments to overcome the barriers leading to meaningful healing and recovery. Through the psychosocial model one does not exclude the use of medical treatment but rather considers recovery as a unique personal journey and experience which may differs from person to person and is based on options, collaboration, choices, and control.
The human rights perspective builds on the United Nations Convention on Rights of Persons with Disability (UNHCRPD) principles which fosters the full and effective participation and social inclusion of people with mental health problems and psychosocial disabilities. These principles are in line with the principles of the Maltese Mental Health Act 2012 which is based on a rights approach and recognises the fundamental freedoms and demands for meaningful participation in society.
Successful Co-creation, according to Mental Health Europe is based on 7 principles: Inclusivity, Equality, Respect, Reciprocity, Power-sharing, Accessibility and Transparency.
What do these principles imply for me as a person? Inclusivity means that everyone is to be always included from prevention to intervention and rehabilitation. It means that the views of all concerned are considered to have a comprehensive approach and nobody is excluded.
Equality entails that everyone has a voice and is considered essential in this mental health dialogue, be it patient, carer, professional or policy maker. The views of the patients or as they are now perceived to indeed be experts by experience, together with that of carers who have a very close lived experience of the condition are considered equally important to formulate the development of services and policies together with professionals and policy makers.
Respect and Reciprocity go hand in hand since all participants are encouraged to come together being respectful of the views and expectations of each other in order to build on a constructive dialogue. Being open to share thoughts, feelings and reciprocate in a trustworthy and meaningful way helps to consolidate the partnerships which are extremely important for co-creation to develop and strengthen the way forward in mental health. We need to have everyone on a level playing field in a respectful manner without underestimating one another but believing that everyone has a valid contribution to overcome the barriers and stigma still linked to mental health. Through respect and reciprocity, we get shared learning and shared meaning.
When decisions are made the power-sharing by treating all individuals equal at the decision-making table results in a more democratic process where there is shared responsibility and shared ownership of decisions taken. Unfortunately, when decisions are taken without the consultation or involvement of service users/patients/carers, albeit with the best intentions, outcomes may not necessarily reach the intended beneficiaries in a meaningful way. Thus, it is strongly recommended that the process is based on transparency and allowing accessibility to all by providing adaptations and all necessary resources for all to participate equally in the process.
Having constructive collaboration around the co-creation principles is considered to be beneficial and advantageous for all concerned. The patients, or better still, experts by experience, will feel more empowered and motivated in actively participating in their own care as well as being valid contributors towards improved services development and eradication of stigma linked to mental health problems. On a personal level co-creation transforms the therapeutic relationship so that the service users gain ownership of their recovery journey.
Organisations, be it support groups or service providers, are actively encouraged to find the best ways to collaborate in order to maximise experience, expertise and resources especially in times when resources, be they human or financial are limited. The value that working Better Together is advantageous for all cannot be disputed. This is not an easy process to get together on the same track, it will take time and energy however it is worth the effort. Thus, let us encourage all involved to truly collaborate and co-create for a Better Mental Health for all.
Dr Gertrude A. Buttigieg is from the Office of the Commissioner for the Rights of persons with Mental Disorders