What Co-Production Means in Commissioned Mental Health Services
Co-production has become a core expectation across commissioned mental health services, yet it is often poorly defined in operational terms. Providers are routinely expected to demonstrate how people who use services shape their own care, influence delivery models and contribute to service improvement, but without clear boundaries, this can drift into tokenistic consultation rather than meaningful shared decision-making. This article sets out what co-production actually means within commissioned mental health provision, and how it should operate alongside clinical responsibility, statutory duties and service governance. It sits within the wider body of guidance on co-production, lived experience and personalisation and links directly to how these principles are applied within established service models and care pathways.
Co-production versus consultation: a critical distinction
Commissioners and regulators are clear that co-production is not synonymous with consultation. Consultation involves seeking views or feedback, often at fixed points, with final decisions remaining firmly with professionals or organisations. Co-production, by contrast, requires shared influence over decisions that affect care planning, service delivery and improvement priorities.
In mental health services, this distinction matters because of the inherent power imbalance between professionals and people who rely on services. Genuine co-production means actively addressing that imbalance while still maintaining clinical accountability and safeguarding responsibilities.
Operational example 1: Co-produced care planning in community mental health
Context: A community mental health provider supporting adults with severe and enduring mental illness was experiencing high disengagement rates from care planning reviews.
Support approach: The service redesigned its care planning process so that individuals set the agenda for reviews, identified outcomes that mattered to them, and chose how progress would be measured. Clinicians retained responsibility for clinical risk decisions, but these were discussed transparently rather than imposed.
Day-to-day delivery: Care coordinators used pre-review preparation sessions, accessible documentation and shared language to ensure people could meaningfully contribute. Decisions were recorded in joint language rather than clinical shorthand.
Evidence of effectiveness: Audit showed improved attendance at reviews, clearer outcome statements and reduced complaints linked to feeling unheard.
Where co-production sits within clinical responsibility
A frequent provider concern is that co-production undermines clinical authority. In reality, commissioners expect co-production to operate within clear clinical frameworks. Shared decision-making does not remove professional responsibility for risk, safeguarding or treatment decisions, but it does require transparency about how and why those decisions are made.
Services must be explicit about which decisions are co-produced and which remain clinically led, and why.
Operational example 2: Co-produced crisis planning with clear boundaries
Context: A crisis and step-down service supporting people with repeated admissions needed more effective relapse prevention.
Support approach: Individuals co-produced crisis plans that identified early warning signs, preferred responses and trusted contacts. Non-negotiable safety thresholds were clearly stated.
Day-to-day delivery: Staff used plans consistently during out-of-hours responses, referring back to agreed preferences wherever possible.
Evidence of effectiveness: Reduced use of emergency detention and improved continuity across teams.
Commissioner expectation: demonstrable shared influence
Commissioner expectation: Commissioners expect providers to evidence how people influence decisions at individual, service and pathway levels. This includes care planning, service design and evaluation activity, not just satisfaction surveys.
Evidence typically includes co-produced documentation, minutes from lived experience forums and examples of service changes directly linked to lived experience input.
Regulator expectation: meaningful involvement, not rhetoric
Regulator expectation (CQC): Inspectors assess whether people are involved “as equal partners” in their care. They look for consistency between stated values and what people actually experience day to day.
Services that rely on policy statements without operational evidence are likely to be challenged.
Operational example 3: Co-production in service improvement
Context: A provider faced repeated feedback about poor transitions between teams.
Support approach: A lived experience panel worked alongside managers to redesign handover processes.
Day-to-day delivery: Transition checklists and joint meetings were introduced, shaped directly by service user experience.
Evidence of effectiveness: Complaints reduced and transition delays shortened.
Key governance considerations
Effective co-production requires governance controls, including clear role definitions, safeguarding oversight and routine review. Without these, co-production risks becoming inconsistent or unsafe.
Providers that embed co-production into governance frameworks are better placed to demonstrate quality, accountability and impact.