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

For too many years, quality improvement projects have been developed without meaningful service-user collaboration, with co-production often viewed as unattainable. Some projects have been effective — others, certainly not. Too often, when service users are involved, it is limited to providing feedback. Even feedback tools, such as questionnaires, are frequently designed in ways that restrict responses and simply confirm what the designer wants to hear.

As a mental health service user, I have repeatedly been told what would be “good for me” or “helpful,” with little reference to my own views or lived experiences. Fully co-produced projects are clearly the way forward and ultimately lead to more effective services — both for practitioners and for those in their care.

This project was initiated following a direct concern I raised (Viv) based on my experiences of using the crisis team and how the service could be improved. I shared this idea with a team leader (Fran), who recognised the validity of the concern and fully supported progressing it.

We first had the opportunity to attend the Academy’s Co-production in Action training programme, which we found invaluable in shaping our approach.

Our initial premise

When people are under the care of the crisis team, they are often seen or contacted by a large number of different staff members. This can lead to inconsistency in care and, in some cases, can exacerbate a crisis.

Repeated contact from multiple staff members can be frustrating for service users. It limits the opportunity to develop a sense of safety and trust, which is essential for effective communication and better outcomes.

When many staff members are involved, care plans are more likely to be inconsistently followed, delayed, or delivered in a way that compromises safety.

To better understand this, we gathered data from multiple sources, which demonstrated that a higher number of different staff contacts was associated with longer time on the caseload or, in some cases, complete disengagement from services.

The idea

Our proposal was to introduce a lead practitioner role within the Crisis Response Home Treatment Team, with the aim of reducing the number of different staff contacts for each service user. Staff feedback through a survey showed strong support for this approach as a more effective working model. We then held an open forum with staff and service users and attended an Enhanced Community Support group, all of which reinforced the view that this model would improve crisis care outcomes and create more consistent, supportive transitions to onward services.

The plan

• An initial appointment with a lead practitioner, followed by reviews at seven and fourteen days

• A small, consistent group of staff supporting the service user between these appointments

• Healthcare support workers leading on planned interventions and coordinating additional appointments

  
  

We have delivered training sessions with staff to introduce and embed this approach. Working in this way makes the crisis team more coherent, improves accountability, and enhances the care experience for both staff and service users. The model is now being rolled out across the team, with ongoing feedback and data collection to evaluate its effectiveness.

Reflections

Through this project, we have learned a great deal from one another. From my perspective as a service user, I have gained a deeper understanding of the challenges faced by mental health practitioners and the constraints within which services operate — particularly the demands on Fran’s time. This highlights the importance of allocating dedicated staff time for co-produced quality improvement work. Importantly, it also reinforces that lived experience and service-user ideas are valid and worthy of being heard.

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