Co-producing rural mental health services


  • To be able of creating a collaborative and effective collaboration among individual and health services.
  • To be able to support the development of wellbeing plan for an individual
  • To develop skills including action planning, self-awareness and providing information and guidance


  • Understanding their needs and helping the individual to understand them
  • Co-production of services
  • Understanding local support services for individuals


    9. Armsteins Ladder of Participation

    10. Co-production Readiness Assessment

This module aims to create a collaborative and effective collaboration among individual and health services. The method used is the “co-production”.

Co-production is about the active contribution of service users to the provision of services they receive from the state or another organisation. In other words, this is more than involvement but individualised service delivery based on information exchange and shared decision making. Central to co-production is partnership; it is about a new way of working, a new set of relationships between organisations and consumers, service providers and service users, clinicians and patients.

It is important to recognise that co-production is not the same as peer-only support networks or self-organised support. The strength of co-production is in the equal participation of every ‘expert’; be that ‘experts by experience’ or experts with professional, clinical or technical expertise.

An understanding of the 6 main principles, as outlined in this section of the tool kit, is key to understanding and implementing co-production. However, it is equally important in developing an understanding of co-production to consider the power balance between people (patients or service users) and professionals delivering services. Both the key principles and the sharing of power must combine to make co-production successful.

Activity 9: Armsteins Ladder of Participation

Aim: This exercise provides a model to help practitioners consider where they are in their journey towards working with individuals in a co-productive way. It uses Armsteins Ladder of Participation to encourage reflection on personal practice and to highlight how working co- productively may mean getting a better outcome.

Materials: Armsteins Ladder of Participation (Annex), exercise sheet (see below).

Method: Examine the ladder of participation as annex, thinking about how the various headings relate to your day to day work. Concentrate particularly on doing to, doing for and doing with.

Now think of specific examples in your individual practice when you have worked in the ways described – doing to, doing with and doing for – and complete the exercise sheet below.

Doing to

What I did?

Where does this fit on the Ladder of participation? What outcomes did it achieve?

How might you have achieved a better outcome?

Doing for

What I did?

Where does this fit on the Ladder of Participation? What outcomes did it achieve?

How might you have achieved a better outcome?

Personal Reflection

In my own practise do I tend to do to, for or with?

How can I ensure my day to day practise moves up the ladder towards ‘doing with’?


This exercise can be adapted to examine where a service or project is on the ladder of participation by substituting the phrase ‘what I did’ with ‘what we do’ or ‘what we are doing.

Activity 10: Co-production Readiness Assessment
Aim: The readiness assessment check list provides organisations with a simple to use checklist based on all key aspects of co-production and gives organisations/projects an opportunity to recognise existing good practice and identify priority areas for improvement or action going forward.

Materials: checklist, pens.

Method: These questions will help you reflect on the level of co- production in the service you work in, your project and others you may come across. Before beginning a cycle of co-production or a co- production project take some time to consider your answers, you may wish to involve others in asking these questions. Consider the questions then use the diagram to map out your answers against each of the key principles of co-production. Examine the diagram and identify elements which have gaps or less satisfactory answers. Use the action plan template to set SMART (Specific, Measureable, Realistic, Agreed, Timed) goals to improve fidelity to the key principles of co-production.


The diagram can be used with groups, with a facilitator encouraging discussion against each principle using the questions as a prompt to discussion. The discussion could be recorded using graphic facilitations methods. This exercise works well for examine individual practice with slight changes to the questions.


Are people’s (and their families/carers) direct experiences, skills an aspirations central to this project/all services?

Does all service design and delivery seek to build on and grow individual and community assets?

Is progress against this tracked?

Are everyone’s contributions vital to success, including service users?

Does the activity and work required within the project match the skills and responsibilities of everyone involved?

Is personal development a common expectation for everyone involved?


Does everyone know that it is their project not just the organisation’s? Do they each have an equal responsibility for it to run well?

Is asking explicitly for and providing help from others seen as positive and expected of everyone involved?

Are expectations of mutuality discussed when people become involved?

Is a wide range of skills and experiences valued?

Does this project/organisation see supporting peer networks that enable transfer of knowledge and skills as core work ?

Do staff and people engage in activities that connect to local networks and activities beyond the remit of the service/project?

Is growing networks outside the ‘project’ seen as a core activity?

Does everyone involved have an active part in initiating, running, evaluating, directing and delivering the project/services?

Do people work alongside professionals with their skills and opinions having equal weighting?

Are people are able to identify rewards that are valuable to them (not just money)?

The purpose of interactions is supporting people to live a good life.

Do staff roles focus on connecting people to networks and resources to do this, removing barriers where necessary and developing skills and confidence?

Are people actively supported to do more?


Key Element

What will we do

Who will do it

By When

How will we know its





Blur Roles