Co-Production: Collaborative Approach to Mental Health Improves Outcomes

International study reveals that inclusive and collaborative approaches to the co-production of mental health services increase equality and improve outcomes.


A new study published in the International Journal of Mental Health Nursing found that a collaborative, strengths-based approach to mental health services, known as co-production, can lead to decreased medication use, improved outcomes, and greater dignity in treatment. In the co-production of mental health services, client and service-user skills and expertise are respected and utilized in the development and implementation of treatment. This approach accounted for reductions in hospital visits and the decreased use of psychiatric medication among participants compared to traditional service centers.

The researchers, Raffaella Pocobello, Tarek el Sehity, Luca Negrogno, Carlo Minervini, Maddalena Guida, and Cosimo Venerito, used a mixed-method approach to examine the impact of co-production in mental health supports with more traditional therapies. The results indicate that those involved in co-production had a rate of hospitalization 63% lower than those served in three more conventional mental health service centers. Over one-third of those engaged in co-production reported that they had recently decreased or discontinued psychotropic medication prescriptions compared to approximately a fifth of participants enrolled in traditional supports. Qualitative results demonstrate that participants experienced co-production as respectful, strengths-based, liberating, sustainable, socially inclusive, and recovery-oriented.

“Co-produced services emphasize the active and valuable roles of users, family members, and citizens in providing the services needed in the mental health sector. Co-production has been defined as a ‘theory with a set of values and principles, rather than a model,’ based on the delivery of ‘an equal and reciprocal relationship between professionals, people using services, their families and their neighbors.”

Co-production is one of the various emergent approaches to mental health service delivery (e.g., dialogic praxis), promoting empowerment, community connection, and sustainable gains through respectful partnership. It is integrative and designed to be preventive, encouraging clients to draw from tools already within them and their communities. Though not without criticism, co-production represents one available user-led mental health initiative offering an alternative to the biomedical model.

Clients, or “users,” participate in regular assembly meetings with their family members, providers, and various other community members in which they discuss various issues and plan community events. The authors highlight that these meetings have critical organizational, therapeutic, and political implications. Consistent with the nature of this approach, Pocobello and colleagues’ research techniques were solidified through participation in an assembly meeting founded on co-production with clients and other community members.

Participants in this study included clients at a co-produced center in Italy, the Marco Cavallo Center (MCC; n = 37), and individuals receiving mental health services at three other traditional service centers in Italy. Data included cross-sectional survey results about client patterns of hospitalization and psychiatric medication use as well as results from a large focus group conducted at the MCC surrounding client experiences of MCC compared to traditional mental health services.

A negative binomial regression analysis provided insight into trends in quantitative data. Researchers responsible for analyzing focus group data once transcribed were not present for the focus group, which happened in an assembly format. However, it is important to note that multiple individuals involved in the project design and analysis process had prior connections with the MCC. Focus groups were conducted in the assembly meeting format.

The quantitative results suggest that co-production may have a preventative effect:

“The co-produced [mental health center] decreased the percentage of hospitalizations by 63% as compared to traditional mental health services. Further, 39% of MCC users reported a reduction in or even withdrawal from psychiatric medications against 22% of the comparison group.”


“[The] qualitative study provided an understanding of the differences in the views and experiences of users between co-produced and traditional mental health services. According to the narratives of MCC participants, the center adheres to the co-production values identified by Cahn (2000): recognizing peoples’ assets, valuing work differently, promoting reciprocity, and building a social network.”

This study extends the literature previously available that examines co-production in mental health services by integrating quantitative data (previously lacking in the field). The researchers also documented the extent to which co-production is experienced as proactive, an essential principle of its design.

In line with these principles, the study applied a participatory approach to the examination of co-production and identified numerous benefits associated with practices informed by co-production in mental health services for adults.



Pocobello, R., Sehity, T., Negrogno, L., Minervini, C., Guida, M., & Venerito, C. (2019). Comparison of a co‐produced mental health service to traditional services: A co‐produced mixed‐methods cross‐sectional study. International Journal of Mental Health Nursing. DOI: 10.1111/inm.12681 (Link)


  1. “Over one-third of those engaged in co-production reported that they had recently decreased or discontinued psychotropic medication prescriptions compared to approximately a fifth of participants enrolled in traditional supports.”

    So, that’s (over) 33% compared to (about) 20%, a difference of 13% give or take, for those who find the sentence above a bit unclear.

    Doesn’t co-production just boil down to “I’d rather not take that stuff, I hear it’s poisonous”.

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  2. sorry, I’m not in the market for co-accepting.
    I don’t like people in the MH biz, who deserve the much needed help
    themselves so badly.
    It took me years to see the disorders in the MH system.

    And they exist because we are all people with problems.
    The helpers should come out of the closet though, it will “help” everyone lead a more authentic life.

    That is co-mmunity.

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