Co-Production in Mental Health Services That Stands Up to Scrutiny

February 3, 2026

Co-production is often described as “working together”, but in regulated and commissioned mental health services it must be more than good intent. Commissioners increasingly expect lived experience involvement to influence service design, access routes, risk approaches and quality improvement. Inspectors, in turn, look for evidence that people are listened to, that feedback changes practice, and that involvement is inclusive rather than tokenistic. This article focuses on how co-production is operationalised and governed within co-production, lived experience and personalisation and how it can be embedded into mental health service models and pathways without undermining clinical responsibility.

What “good” co-production looks like in practice

In operational terms, co-production means people with lived experience have defined roles, a clear purpose, and genuine influence on decisions that matter. The stronger models are structured around:

clear decision routes (what can be influenced and how)
diverse representation (not just the most confident voices)
support and remuneration (so involvement is accessible)
feedback loops (what changed, what didn’t, and why)

Without these elements, co-production becomes difficult to sustain and hard to evidence.

Operational example 1: Improving access and referral communications

Context: A community mental health provider received recurring complaints that access routes were confusing and that triage felt inconsistent and impersonal. People reported being “bounced” between services and unsure what would happen next.

Support approach: A small lived experience working group was formed to review referral information, triage letters, and the first-contact experience. The group was briefed on the pathway constraints (capacity, thresholds, clinical risk triage) so recommendations were realistic.

Day-to-day delivery: The working group reviewed real documents and listened to recordings of first-contact calls (with permissions and anonymisation). They redesigned written communications using plain-English templates and a single-page “what happens next” pathway map. Triage staff then piloted a revised call script with prompts for choice (preferred times, preferred contact method, consent to involve family/carers).

Evidence of effectiveness: The provider tracked fewer inbound “chase” calls, fewer complaints about access, and improved patient-reported experience measures at first contact. Changes were logged as actions within the QI register and reviewed at the governance meeting.

Governance: making co-production auditable

Co-production fails under scrutiny when there is no audit trail. The simplest approach is to treat co-production like any other improvement mechanism: define scope, record actions, and review impact. Effective governance usually includes:

terms of reference and membership criteria
meeting schedules and minutes
decision logs showing how input was considered
action tracking with owners and deadlines
impact measures (experience, complaints, outcomes, safety indicators)

Commissioner expectation: evidence of influence, not activity

Commissioner expectation: Commissioners typically expect co-production to demonstrate influence on service delivery or system working, not just the existence of a forum. This means being able to show “what changed” and the rationale where change was not possible due to clinical or contractual constraints.

Regulator expectation: involvement is meaningful, inclusive and safe

Regulator expectation (CQC): Inspectors look for evidence that people’s views are actively sought and acted upon, and that involvement is not limited to a narrow group. They also consider whether people are supported to participate safely, including around trauma, boundaries, and confidentiality.

Operational example 2: Co-producing a restrictive practice reduction plan

Context: A supported living mental health service had rising incidents involving restraint and police involvement during crisis episodes. Staff described fear and uncertainty; people described feeling controlled and unsafe.

Support approach: The provider created a co-produced restrictive practice reduction programme, involving people with lived experience of restraint and crisis care. The programme focused on triggers, relational practice, and early de-escalation.

Day-to-day delivery: The group reviewed anonymised incident themes and developed “what helps” de-escalation guidance. This was embedded into staff training and supervision prompts. Managers introduced a post-incident debrief model that included the person (where appropriate), emphasising learning rather than blame. The service also created a “crisis preference” prompt within care records so staff could follow known calming strategies before escalation.

Evidence of effectiveness: The provider tracked restraint rates, police call-outs and injuries, and triangulated this with qualitative feedback from people supported. Learning was reviewed monthly, and the programme remained a standing agenda item under safeguarding and quality governance.

Safeguarding, boundaries and risk management

Co-production requires careful safeguarding and boundary setting. Providers must manage confidentiality, consent and emotional safety, particularly where lived experience involvement intersects with trauma histories. Practical safeguards include:

clear confidentiality agreements and safe handling of information
support arrangements (check-ins, debriefs, signposting)
role descriptions and escalation routes for concerns
diversity planning so involvement is representative

Operational example 3: Co-producing staff training scenarios and supervision prompts

Context: Staff training was heavily policy-based and not translating into improved relational practice. Feedback suggested staff could “recite procedures” but struggled with emotionally charged encounters.

Support approach: People with lived experience co-designed realistic scenarios to be used in training and reflective supervision. The aim was to improve empathy, communication and consistency.

Day-to-day delivery: The provider introduced scenario-based learning sessions facilitated by a trainer and a lived experience contributor. Scenarios were then converted into supervision prompts (e.g., “What did we miss early?”, “How did we offer choices?”, “How did we explain decisions?”). Managers used these prompts in monthly supervision and recorded themes for service learning.

Evidence of effectiveness: The provider recorded improved staff confidence scores, reduced complaints about communication, and stronger evidence in supervision records that reflective practice was occurring. The approach also supported inspection readiness by showing learning embedded into practice.

How to avoid “tick-box” co-production

Common failure points include: unrepresentative groups, no decision routes, no recorded outcomes, and limited feedback loops. Providers strengthen credibility when they can demonstrate co-production as a governed process with measurable impact, rather than a one-off engagement exercise.