A balancing act: navigating the nuances of co-production in mental health research.

BACKGROUND: In the context of mental health research, co-production involves people with lived expertise, those with professional or academic expertise, and people with both of these perspectives collaborating to design and actualize research initiatives. In the literature, two dominant perspectives on co-production emerge. The first is in support of co-production, pointing to the transformative value of co-production for those involved, the quality of services developed through this process, as well as to broader system-level impacts (e.g. influencing changes in health system decision making, care practices, government policies, etc.). The second stance expresses scepticism about the capacity of co-production to engender genuine collaboration given the deeply ingrained power imbalances in the systems in which we operate. While some scholars have explored the intersections of these two perspectives, this body of literature remains limited. MAIN TEXT: This paper contributes to the literature base by exploring the nuances of co-production in health research. Using our mental health participatory action research project as a case example, we explore the nuances of co-production through four key values that we embraced: 1. Navigating power relations together 2. Multi-directional learning 3. Slow and steady wins the race 4. Connecting through vulnerability CONCLUSIONS: By sharing these values and associated principles and practices, we invite readers to consider the complexities of co-production and explore how our experiences may inform their practice of co-production. Despite the inherent complexity of co-production, we contend that pursuing authentic and equitable collaborations is integral to shaping a more just and inclusive future in mental health research and the mental health system at large.

BACKGROUND: In the context of mental health research, co-production is a process where people with lived experiences, those with academic or professional experience, and people with both of these perspectives collaborate to design and actualize research initiatives. In the literature, there are two main opinions about co-production. The first opinion is that co-production is beneficial for those involved, improves the quality of services, and can also have impacts at higher system levels (e.g. influencing changes in health system decision making, care practices, government policies, etc.). The second opinion is doubtful that co-production has the ability to foster authentic collaboration because of the differences in power between academic and health systems. Even though some scholars have looked at both opinions, there is not a lot of research on this. MAIN TEXT: This paper contributes to the literature base exploring the nuances of co-production in health research. Using our mental health participatory action research project as a case example, we explore the nuances of co-production through four key values that we embraced: 1. Navigating power relations together 2. Multi-directional learning 3. Slow and steady wins the race 4. Connecting through vulnerability CONCLUSIONS: By sharing these values and associated principles and practices, we invite readers to consider the complexities of co-production and explore how our process may inform their engagement with co-production. We argue that pursuing authentic collaborations is key to shaping a more just and inclusive future in mental health research and the mental health system at large.

'We are in for a culture change': continuing professional development leaders' perspectives on COVID-19, burn-out and structural inequities.

INTRODUCTION: The COVID-19 pandemic positioned healthcare systems in North America at the epicentre of the crisis, placing inordinate stress on clinicians. Concurrently, discussions about structural racism, social justice and health inequities permeated the field of medicine, and society more broadly. The confluence of these phenomena required rapid action from continuing professional development (CPD) leaders to respond to emerging needs and challenges. METHODS: In this qualitative study, researchers conducted 23 virtual semistructured interviews with CPD leaders in Canada and the USA. Interview audiorecordings were transcribed, deidentified and thematically analysed. RESULTS: This study revealed that the CPD leaders attributed the pandemic as illuminating and exacerbating problems related to clinician wellness; equity, diversity and inclusion; and health inequities already prevalent in the healthcare system and within CPD. Analysis generated two themes: (1) From heroes to humans: the shifting view of clinicians and (2) Melding of crises: an opportunity for systemic change in CPD. DISCUSSION: The COVID-19 pandemic increased recognition of burn-out and health inequities creating momentum in the field to prioritise and restrategise to address these converging public health crises. There is an urgent need for CPD to move beyond mere discourse on these topics towards holistic and sustainable actionable measures.

Finding connection "while everything is going to crap": experiences in Recovery Colleges during the COVID-19 pandemic.

BACKGROUND: Recovery Colleges (RCs) are mental health and well-being education centres where people come together and learn skills that support their wellness. Co-production, co-learning and transformative education are fundamental to RCs. People with lived experience are recognized as experts who partner with health professionals in the design and actualization of educational programming. The pandemic has changed how RCs operate by necessitating a shift from in-person to virtual offerings. Given the relational ethos of RCs, it is important to explore how the experiences of RC members and communities were impacted during this time. To date, there has been limited scholarship on this topic. METHODS: In this exploratory phase of a larger project, we used participatory action research to interview people who were accessing, volunteering and/or working in RCs across Canada. Semi-structured interviews were conducted with twenty-nine individuals who provided insights on what is important to them about RC programming. RESULTS: Our study was conducted amid the COVID-19 pandemic. Accordingly, participants elucidated how their involvement in RCs was impacted by pandemic related restrictions. The results of this study demonstrate that RC programming is most effective when it: (1) is inclusive; (2) has a "good vibe"; and (3) equips people to live a fuller life. CONCLUSIONS: The pandemic, despite its challenges, has yielded insights into a possible evolution of the RC model that transcends the pandemic-context. In a time of great uncertainty, RCs served as safe spaces where people could redefine, pursue, maintain or recover wellness on their own terms.

BACKGROUND: Recovery Colleges (RCs) are mental health and well-being education centres where people come together and learn skills that support their personal recovery journeys. WHAT DID WE WANT TO KNOW? WHAT APPROACH DID WE TAKE?: In this phase of a larger project, we used a participatory action research approach to interview people who were accessing, volunteering and/or working in RCs across Canada. This research approach draws on the knowledge of all researchers and participants and places equal value on personal and professional experiences. Therefore, this study was created and shaped by, with, and for people who participate in RCs in partnership with academic researchers. WHAT DID WE DO?: Twenty-nine individuals shared what is important to them about RC programming. Our study took place during the COVID-19 pandemic during the pandemic-related restrictions such as social distancing. WHAT DID WE LEARN?: The results of this study demonstrate that RC programming is most effective when it: (1) is inclusive; (2) has a "good vibe"; and (3) equips people to live a fuller life. The pandemic, despite its challenges, could inform an evolution of the RC model that lasts beyond the pandemic.

Evaluating recovery colleges: a co-created scoping review.

BACKGROUND: Recovery Colleges (RCs) are education-based centres providing information, networking, and skills development for managing mental health, well-being, and daily living. A central principle is co-creation involving people with lived experience of mental health/illness and/or addictions (MHA). Identified gaps are RCs evaluations and information about whether such evaluations are co-created. AIMS: We describe a co-created scoping review of how RCs are evaluated in the published and grey literature. Also assessed were: the frameworks, designs, and analyses used; the themes/outcomes reported; the trustworthiness of the evidence; and whether the evaluations are co-created. METHODS: We followed Arksey and O'Malley's methodology with one important modification: "Consultation" was re-conceptualised as "co-creator engagement" and was the first, foundational step rather than the last, optional one. RESULTS: Seventy-nine percent of the 43 included evaluations were peer-reviewed, 21% grey literature. These evaluations represented 33 RCs located in the UK (58%), Australia (15%), Canada (9%), Ireland (9%), the USA (6%), and Italy (3%). CONCLUSION: Our findings depict a developing field that is exploring a mix of evaluative approaches. However, few evaluations appeared to be co-created. Although most studies referenced co-design/co-production, few described how much or how meaningfully people with lived experience were involved in the evaluation.