Co-Produced Quality Assurance in Mental Health Services: Turning Lived Experience into Governance

Co-production is often strongest at the “front end” (events, surveys, engagement sessions) and weakest where commissioners and inspectors focus: governance, assurance and proof of improvement. In this series on mental health co-production and lived experience, we treat co-production as an operating discipline, not a communications activity. It also needs to align with mental health service models and pathways, because quality assurance must work across access, crisis response, step-down and longer-term support. This article sets out practical ways to turn lived experience into co-produced quality assurance (QA) that is safe, auditable and sustainable.

What co-produced QA is (and what it is not)

Co-produced QA means lived experience influences what the service measures, how it interprets risk and quality, and what it prioritises for improvement — within clear governance. It is not the transfer of accountability away from registered professionals. The provider remains responsible for safeguarding, clinical decision-making and compliance. Co-produced QA simply strengthens the service’s ability to test whether it is delivering what it claims.

The building blocks of a co-produced QA framework

A repeatable framework typically includes:

• Defined QA domains: safety, responsiveness, continuity, experience, outcomes, equity.
• Co-produced measures: a blend of quantitative indicators (timeliness, DNA, re-referrals) and qualitative indicators (understanding of plans, felt safety).
• Decision routes: who can approve changes, and how recommendations move through clinical governance.
• Audit trails: action logs, owners, deadlines, and re-audit schedules.
• Safeguarding and wellbeing arrangements: support, debrief, boundaries, and escalation if sessions raise distress or risk.

Operational Example 1: Co-producing an “experience-of-safety” audit

Context: Incident reporting suggested risk was managed appropriately, yet feedback indicated that people often felt unsafe during waiting periods or transitions, especially after crisis contacts.

Support approach: A lived experience group co-designed an audit tool that tested “experience-of-safety” alongside traditional clinical checks. A clinical governance lead ensured the tool remained aligned to policy and risk standards.

Day-to-day delivery detail: The audit sampled records from crisis and community teams and tested: (1) whether the person received a clear plan and understood next steps; (2) whether escalation routes were explicit; (3) whether follow-up occurred within agreed timeframes; and (4) whether staff recorded rationale for decisions. Findings were discussed in monthly governance meetings, and team leaders were required to implement corrective actions (for example, standardising “next steps” documentation fields and strengthening call-back management).

Evidence of effectiveness: Re-audit after eight weeks showed improved clarity in records and fewer cases where the person’s understanding was unknown. Complaints linked to “not knowing what to do” reduced, and staff supervision notes demonstrated more consistent focus on explanation and shared planning.

Operational Example 2: Co-produced learning from complaints and incidents

Context: Serious incident reviews and complaints responses produced recommendations, but actions were inconsistently embedded across teams. Themes repeatedly involved communication, discontinuity and unclear escalation.

Support approach: The provider created a co-produced Learning Review Group: lived experience members helped translate learning into “frontline practice changes”, while the provider retained formal investigation and safeguarding responsibilities.

Day-to-day delivery detail: Each month the group reviewed anonymised themes (not identifiable cases) and agreed 2–3 concrete practice changes, such as: introducing a “decision rationale” prompt in records, revising staff scripts for explaining thresholds, and adding a mandatory follow-up check after missed appointments for higher-risk individuals. Managers implemented changes through huddles, supervision prompts and micro-audits. Actions were tracked on a RAG-rated log reported to governance.

Evidence of effectiveness: Micro-audits showed higher compliance with new prompts, and repeat complaints themes reduced over two quarters. Staff reported greater clarity on expected communication standards, evidenced through supervision sampling.

Operational Example 3: Co-producing QA measures for engagement and equity

Context: The service met headline access targets but saw poorer engagement for specific groups (for example, people with autism traits, people with unstable housing, or people who preferred digital contact). Disengagement increased crisis presentations and safeguarding risk.

Support approach: Lived experience contributors worked with operational leads to co-produce measures that tested whether engagement adaptations were offered and whether follow-up was reliable when contact was missed.

Day-to-day delivery detail: The provider introduced a monthly dashboard with: DNA rates by team and cohort, follow-up after missed contact, and documented adjustments offered (format, timing, location, communication method). A co-produced review session interpreted the data and agreed priorities for improvement, such as targeted staff coaching, revised appointment options, and clearer escalation when people disengaged but risk indicators were present.

Evidence of effectiveness: Over three reporting cycles, DNA reduced and follow-up after missed contact improved. Safeguarding alerts linked to “loss of contact” reduced, and audit sampling showed more consistent documentation of reasonable adjustments.

Commissioner Expectation: QA that links to contract outcomes

Commissioner expectation: Commissioners expect QA to connect lived experience input to measurable contract outcomes: timeliness, reduced crisis escalation, improved continuity, and safer transitions. They will look for dashboards, audit results, action logs and evidence that changes were embedded across teams, not limited to pilot pockets.

Regulator / Inspector Expectation: Clear accountability and safe involvement

Regulator / Inspector expectation: Inspectors assess whether governance is effective and whether improvement is continuous. They will expect co-produced QA to be safely run (boundaries, support, safeguarding oversight) and to strengthen, not blur, accountability for risk management, escalation and restrictive practice decisions.

Keeping co-produced QA practical and sustainable

Co-produced QA fails when it becomes too broad or too informal. Providers keep it workable by limiting priorities, setting clear cycles (monthly themes, quarterly deep dives), using re-audit schedules, and ensuring every recommendation has an owner, deadline and evidence requirement. When structured this way, lived experience becomes part of the service’s core assurance engine.

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