“The PIEineers” — ‘Co-Production in a Psychologically Informed Environment (PIE)’

16.08.19: This week’s highlight developing Psychologically Informed Environments (PIE) across Centrepoint, was another trip to see the West Yorkshire services, specifically to meet with some young people from the region in Bradford. These amazing young people; our first informally named ‘PIEineers’, kindly gave up their free time to meet with me. All of them are either currently in services or have just moved on, and therefore are perfectly placed to work directly with the organisation to develop our PIE thinking. After all, PIE is most successful when it is meaningfully ‘co-produced’ with the end users; both the staff and the young people that access Centrepoint services.

So what is ‘co-production?’ The term is commonly used in public policy and practice (e.g. the UK Government’s 2016 Mental Health Policy Strategy) to argue for the involvement of service users or those with relevant ‘lived experience’ in developing and designing the services they use in partnership with all the key stakeholders in the commissioning process. ‘Co-production’ as a concept, a critique of existing services and a guide for future action had its initial roots in the 1970s in connection with the civil rights and social action work in the USA (Realpe & Wallace, 2010). It is more increasingly used in the UK following the recognition that those who use services have knowledge and experience that can be used to make those services better, not only for themselves but for others that may need to access those services in the future (c.f. https://www.thinklocalactpersonal.org.uk/Browse/Co-production/

But what does ‘co-production’ actually look like? It has been argued to involve the ongoing connection and communication between those who both utilise and deliver services, wherein there is an equally valued sharing of ideas and knowledge between participants to the benefit of all involved, and a shared consideration of outcomes. One of the early proponents of co-production, Edgar Cahn (2000), presented four core values of co-production, which highlight the importance of recognising the strengths people bring to the table, whichever part of the system they come from. This occurs by recognising people as assets; growing their capabilities to engage in the process, building social networks and working in reciprocal relationships where there are mutual responsibilities and expectations. However, true ‘co-production’ is often rare despite its important role in delivering cost-effective services (Stevens, 2008) and PIE argues that ‘co-production’ must at least be meaningful for all parties involved. What is key therefore, is that professionals are ‘doing with’ service users as far as possible rather than ‘doing to’ or ‘doing for’.

Consequently, during our inaugural ‘PIEineers’ meeting this week, it was important to ensure that the young people participating were clear what was meant by a PIE so that could give an informed view and their voices could be heard, and therefore time was spent discussing PIE and what is might mean for Centrepoint. It was genuinely humbling hearing their stories to date, but also inspiring that despite the challenges and difficulties that these young people have already faced in their lives to date, they were passionate, motivated and interested in how they can make the lives of other homeless young people better through a PIE. They wanted to be involved, to be part of and belong to Centrepoint’s PIE journey, and they wanted their voices heard. Moreover, the ideas and points they made were useful and illuminating. After all, who better to think about how to improve services than the people that need to use them? And the young people also wanted to get involved not only because they wanted to share their views, but also because they may positively benefit from developing skills and experience that they can use to gain future employment and / or increase self-confidence to reach their potential, a key secondary benefit of ‘co-production’.

For example, we discussed ways that the young people can help develop the PIE staff training, to ensure that it reflects the issues that they face in today’s modern society and utilises psychological techniques and skills that are relevant for them. Ways to modify the physical environment to make Centrepoint services feel more like a ‘home’ was also a lively discussion with plenty of realistic ideas about what changes they would like to see, with several clearly linking positive mental health and feeling ‘valued’ when experiencing a homely and welcoming rather than a clinical or ‘hostel’ like environment in services. They were also keen to support the PIE evaluation that is being proposed in Centrepoint with the University of Southampton, noting ways to engage young people in data collection and even suggesting further methods to meaningfully capture the range of views that young people who use our services may have.

Finally, the young people were reflective when considering the role of attachments in their life to date, agreeing that a framework that doesn’t unnecessarily pathologise young homeless people was positive and important. Many of those present noted that it was the relationships that they had formed with staff at Centrepoint that had finally helped them to feel included and as belonging somewhere, which was the ‘secure base’ that they needed to move on and begin to fulfil their potential.

This was just the first meeting of our new ‘PIEineers’, and I am hopeful that many more will follow. It is important that Centrepoint young people not only have a seat at the table and voice to express their views, but that their voices are heard and inform or ‘co-produce’ the future PIE in Centrepoint. And if this group of young people are anything to go by, then this will be a positive, lively and informative part of our Centrepoint PIE journey….

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