1. Co-production in Secure Settings
Frank Reilly

2.  Definition that works in forensic settings
 Examples
 Methods
 Early results
 Toward skills
Project Objectives

3. Background: High
Secure Settings
•Restricted liberties
•Required programme of care
•Managing risk a high priority
•Dual purpose: protect the public/patients
and provide mental health care

4. ‘Co-production is a slippery concept’
(Adults’ Services: SCIE Guide 51)
-in high secure settings it can also be threatening
Background:
Definitions

5. Co-production assumes that individuals have:
*Assets that can be engaged in achieving self actualisation (Harrison
et al 2004)
*Potential for increasing independence and ‘citizenship’ or social
responsibility(Gershon 2004, Lyons 2006)
*Potential for the reduction of reliance on formal care and
agencies(Boyle and Harris 2009, Leadbetter 2004)

6. ‘To be truly transformative, co-production requires a relocation of
power towards service users. This necessitates new relationships
with front-line professionals who need training to be empowered to
take on these new roles’ (Realpe and Wallace 2010, p3)

7. Examples: Ward
talking groups
•No explicit ‘rules’....but the participants create
them
•Hierarchy ‘suspended’
•Not ‘assessed’
•Engages

8. Co-production exists when trust, the
support of autonomy and the sharing of
knowledge as power (both from and to
the patient) result in outcomes that are
personal to the patient/client.

9. Issues
 Importance of relational security
 Managing complex and shifting boundaries
 Reaction to failures/complacency

10. Potential Benefits
 Reinforces hope
 Improved understanding
 Reduce violent incidents
 Improve engagement in treatment

11. Project in action:Methods
•2x low secure sites (1x NHS, 1x private)
•1x High Secure site
•Potential comparison site in Ireland
•Staff focussed (ethical issues)

12. Project in action: Methods
•Purposive sample of recovery oriented staff
•6x semi-structured interviews each site (n=18)
•1xvignette focus group each low secure site
•2x iterations of Delphi questionnaire (‘wisdom
of crowds’)

13. Project in action: Early
results
•Relational security relies on apprentiship
•Private clinic restructured: values based for
relational skills
•Difference between staff who rely on structure
to those who build on it
•Organisation who value social therapy reap
benefits: lower assaults, better engagement

14. Where is the fit?
Relational security Co-production Recovery

15. The challenge?
Organisations that don't co-produce with their staff
find it difficult to facilitate co-production with their
consumers