Becky Ince
Rebecca Ince – Research Fellow, HSMC/TSRC

Blog by Rebecca Ince – Research Fellow, HSMC/TSRC

Project: The contribution of the voluntary sector to mental health crisis support.

In part 1 of this blog I expressed a need to understand and illuminate exactly how co-production in social research influences the research process and the knowledge produced. I explored the first two ways in which one of the elements of co-production in our research – our Service User Reference Group - have already significantly impacted and improved our research, both conceptually and methodologically.

The first of these was broadening our conceptual understanding of mental health crisis to understand it as a process over time, and improving our awareness of the difference between first crises and subsequent ones. This impacted the ways in which we conducted our literature review and how we interviewed national stakeholders. The second was their feedback that perspectives on crisis may change over time, leading to a significant change to our methodology by including repeat interviews with people who use crisis services.

Here in part 2 we will explore two other ways in which the SURG have influenced our research – once again both methodologically and conceptually.

1. Integration vs independence – changing our line of questioning in national stakeholder interviews

A recent policy review championed the voluntary sector for being trustworthy, addressing people’s needs holistically, and being flexible to local community needs, and encouraged statutory services to work in partnership with VSOs (See this 2016 report by the DoH, NHS England and Public Health England). Our SURG, however, suggested that VSOs becoming more integrated with statutory services may compromise some of their appeal. They gave the following reflections:

  • People can be fearful about contacting statutory services for support, especially after previous negative experiences. Services such as drop-in crisis cafes which are not in close communication with statutory organisations are sometimes considered a safer option.
  • A completely anonymous service such as the Samaritans helpline, which someone can call with no fear of disclosure to other parties such as the community mental health team, was considered highly valuable precisely because of its independence.
  • If VSOs and statutory organisations are explicitly working together, there should be better communication between them about the individual’s circumstances and history to prevent them from having to tell what is often a distressing story repeatedly to different people.

On reflection, the research team changed our lines of enquiry when interviewing national stakeholders: Our questions previously included asking how voluntary sector and statutory sector services could be better integrated, which we realised was couched in an assumption that integration was inherently a good thing. As a result of the SURG’s input, we changed this to a more balanced question about whether or not services should be integrated and under what circumstances.

2. “Don’t discount the knitting groups!” - how wide to cast the net when including VSOs in our typology.

Having developed an initial typology of crisis VSOs from some interviews and database analysis, the research team had questioned whether to include organisations with no explicit organisational focus on mental health or crisis, but which are providing important support such as hobby groups and meetups – the archetype being a weekly knitting group.

Our SURG very clearly argued for keeping these VSOs in mind throughout the research, highlighting their role in prevention and keeping people going, because for some people in crisis these informal activities may be the only social contact they have, especially important during ‘testing times’.

The point was also made that the ‘knitting together’ (excuse the pun) of various forms of support and social contact make up a patchwork of services, tools and resources that help people to manage on a daily or weekly basis. The precariousness of people’s lives - even when not experiencing a crisis - was highlighted, and the effects of not having access to these groups could be a deeper, more severe crisis than otherwise.

Once again, our SURG have had significant influence on both our methods – changing our line of questioning to national stakeholders – and our conceptual framework in terms of which organisations belong in our typology. Undoubtedly they will continue to provide incisive and valuable feedback and we are tremendously grateful to the SURG for all of their comments so far.

However, the SURG is only one element of co-production built into our research design. We have five co-researchers employed in the research team with lived experience of mental health crisis as well as stellar research skills, who organise and design the research, collect and analyse data, and will be involved in writing and dissemination. We also have a Study Steering Group which incorporates perspectives from carers and people who have used services. The combination of forms of co-production is proving extremely valuable so far – and we will reflect on the other ways in which it has influenced our research at a later date.

Thanks for reading!

Please note: This research is funded by the National Institute of Health Research (NIHR). However, the views expressed in this blog are the author’s personal views not those of NIHR.