Working With, Not For: A Fully Co-Produced Approach to Improving Crisis Care

For too many years, Quality Improvement projects have been formulated without service user collaboration and with co-production being regarded as unattainable. Some have been effective – others, certainly not. Often when service users have been approached, it is for feedback; even questionnaires compiled for feedback are designed in such a way that are so limited and get the feedback the designer wants. 

As a mental health service user, I have been told what will be “good for me” or “helpful” with little reference to my views or experiences. Fully co-produced projects are definitely the way forward and will ultimately make services more effective for practitioner and those under their care. 

Our project was initiated from a direct concern raised by myself (Viv) pertaining to my experiences of using the crisis team and how it could be improved upon. I suggested the idea to a team leader (Fran) who understood the validity of the concern and got fully onboard with moving it forward. 

Firstly, we had the opportunity to attend The Academy’s Co-production in Action Training Programme, which we found invaluable. 

Our initial premise 

Often when people are under the care of the crisis team they are seen or contacted by a multitude of different staff members. This leads to an inconsistency of care and can exacerbate crises. 

Contact from so many staff members is frustrating for the service user. There is no time to develop a sense of safety which helps build trust, making communication more effective and leads to better outcomes. 

When many staff members are involved, care plans are neither adhered to or delivered in a safe and timely manner.

We set about gathering data from differing sources which showed the greater number of different staff contacts had an impact on how long the service user was on the caseload or disengaged completely.

Our idea was to instil a lead practitioner role within Crisis Response Home Treatment Team and limit numbers of varying staff contacts.

In a staff survey, the feedback showed that they also would find this a better working model. We held an open forum for staff and service users and attended an Enhanced Community Support group which also confirmed that this model would not only improve crisis team care outcomes but make the transfer of care to forwarding agencies more helpful and consistent.

The plan

The first appointment with a lead practitioner who would book in to see the service user seven and fourteen days later, with a smaller group of other staff members seeing the service user in between.

Healthcare support workers to lead on planned interventions and booking other appointments.

We have completed training sessions with staff to showcase this idea. Working to this formulation will make the crisis team more coherent and all staff accountable. It also improves the care process for both staff and service users. 

This approach is being rolled out across the team and we will use ongoing feedback and data to evaluate its effectiveness. 

In doing this project, we have learnt so much from one another. From my perspective – the service user – I have become more aware of the difficulties faced by mental health practitioners and the limitations of the services, especially Fran’s time. There is a valid rationale for dedicated staff time to be allotted to co-produced Quality Improvement projects. It also seems that finally my ideas are valid and listened to. 

The project demonstrates the inherent value of co-production and service user lead innovation within mental health services.