Working in mental health and substance abuse services
In 2010 I was working as a social consultant in a mental health and substance abuse service unit in Norway. It was an inpatient treatment unit, and people with mental health and addition problems could live there from two weeks to a year. They took part in individual and group therapy, sports and music therapy and other activities. My job was to collaborate with patients and the welfare and health services about the home, social and economic situation.
Action research begins with a knot in the gut
The first year I worked there, I noticed patients who were visibly intoxicated while in treatment. Since psychiatric treatment was provided, it was difficult to say whether the patients were using illicit or prescribed drugs. However, these services aimed at helping people conquer their substance abuse problems. Patients who were high or drunk thereby sabotaged their own and other patients’ treatment.
I couldn’t believe how obvious it was. But, when I raised the issue among my colleagues and leaders, I discovered resistance about confronting the patients regarding this and other issues. As a matter of fact, there were several meetings about the patients without them, and patients weren’t involved in any of the discussions or decisions about the quality of the treatment provided here. I continued to bounce into an invisible, or rather unspoken wall that kept the patients excluded as stakeholders in addressing important issues. And a knot grew in my gut. This didn’t feel right.
An idea evolved into a PhD-study
In action research the researcher engages in collective mobilization to improve something within a context such as in an organisation, a community or other. Empowerment and participation from stakeholders are key.
In my view, the benefits of accessing the patients’ knowledge when addressing drugged behavior was apparent. But like in many other services back then, user involvement in service development was not part of practice. Consequently, I started working on an idea that resulted in the initiation of an action research project in a PhD-study. The aim was to increase user involvement in service development in this treatment unit and a connected activity unit. Also, I would facilitate dialogue between the staff (health, social and sports professionals) and patients about service development. Many of these stakeholders would be involved as co-researchers, so they could lead service development processes with other stakeholder participants in this context.
User participation or co-production?
The main aim was that developing, experiencing, and evaluating an action research design would result in a ‘user participation’ method. Such method had been called for in Norwegian mental health and addiction policy. It seemed that everyone wanted increased user involvement, but no one knew how to do it systematically. The full research process is described in my thesis, so I won’t go into the specifics. Let me tell you however, that theory on user involvement/participation could not describe the results from this study. We went beyond delegated power to service users and user-led innovations: After all, the co-researchers, participators, and I collaborated to improve service quality. We also co-created a new public service.
First, both patients and staff were involved in service development, also the leaders contributed greatly. For instance – Attitudes among staff and leaders changed to becoming more including patients in service development – A fixed meeting between the stakeholders was established as a space to resolve conflict, discuss the quality of treatment, and decide activities. It was named the Ideasmithy. – Patients took on more responsibilities in preparing meals and more – The sports and music equipment were upgraded – User-led admissions was established as a new service – The illicit drug-use in treatment among patients stopped Second, we managed to co-innovate a method that would ensure service user and provider impact on service development decisions. ‘Co-‘ means that we all contributed to the final ‘user-participation’ method-design. – Co-researchers were involved in deciding research questions and how to do interviews and conduct dialogue seminars, they also led these interventions – We evaluated these experiences and together developed what was initially named a co-production method. (Co-production is described underneath) Finally, in 2013 by the end of the PhD-study, a few co-researchers and I managed to get funding for a follow up study. So that, between 2013 and 2015 we evaluated the co-production method while providing it to other public services. When this team offered the new service that included guidance, training, and implementation of the co-production method, this was co-provision. A term that describes how patient, staff, leader, and action researcher stakeholders equally contributed to delivering the service. |
I discovered both ‘co-innovation’ and ‘co-provision’ in theory about co-production. In short, co-production means that citizens, service users and/or civil society organisations collaborate with practitioners/service providers and/or policy makers about improving existing public services.
The co-creation method
This collaborative understanding of user and other involvement was more in line with both the ambition and the results in my PhD. However, the distinction between co-production and co-creation concepts was blurrier in 2013 than it is today. So that, in the final theoretical analysis in my thesis, I updated and change of the name to a co-creation method. You can read the full explanation there, but bottom line: the co-creation concept goes beyond improving existing services, as it includes collaborations between stakeholders about creating knowledge, improving services, innovating and initiating new services, and value creation.
Dreams
It took me 10 years to finalize the thesis. Apparently, that’s also normal. Meanwhile, I had started working in the social worker education in the Western Norway University of applied sciences. When Corona pandemic resulted in lock-down and more screen-time, I could focus on finalizing the thesis. In that quiet space, another dream formed.
Observing the extreme weathers and disasters in the last decade I have become more worried about the environment than ever before. But I felt that my hands were tied because I had to complete the PhD. As wildfires and corona virus spread across the globe, I struggled to read and write, and another knot in the gut grew tight. I started to dream about how to contribute with my expertise, how I could do something for the environment and the future of the planet. One day I called my brother to explore my options. That’s when we developed the B-12 plan.
The B-12 plan
I wanted to use my knowledge from experience and scientific analysis to facilitate co-creation processes focusing on environmental protection and sustainability. Specifically, I was curious about how to build intergenerational trust and momentum for change by using the co-creation method. However, I made a deal with my brother that I would not contact anyone about this until my thesis was acknowledged. Then, I would have more focus and impact. The thesis was acknowledged in April 2021.
The reason my brother suggested that the plan should be called B-12, was that he thought that if I had locked my enthusiasm inside for so long, it would be like giving me a shot of B-12 straight in the butt: all the energy would catapult me into this new project.
The business idea
My brother was partly right, when rested I was ready! But I felt I needed a longer break from scientific writing – after years working long hours, the computer repulsed me. I didn’t know that it would take a year before I got this motivation back, but initially I decided to wait until after the summer holiday to make any decisions. That way I could clear my mind about how I wanted to approach the B-12 plan.
During summer 2021, the libertycommute idea materialized and by fall I had begun exploring options related to starting my own business. I considered starting a small, flexible business to provide facilitation of co-creation processes for businesses, public services, communities, and civil society organization who wanted to become more sustainable. Ironically, I thought that a small business compared to being employed in a university, would make bureaucracy easier. But when it took nine months to get the formal rights to this business idea, I began to doubt if this was a good place to invest my time. By then, several other doors had opened in academia and civil society that could support the B-12 plan.
Furthermore, I had some concerns about conflicting interests if I was to start a business: Would I compete with my own business if I contributed to research about co-creation and sustainability? I also had become active in the environmental movement through the libertycommute project and experienced this as particularly meaningful. I saw how I could contribute on important issues. So, when I considered my options, I specifically explored where I could make the most of my capacity. Starting a business from scratch would not allow me to immerse fully in academic opportunities that supported the B-12 plan, and vice versa if I also wanted to stay in academia. Which I did, as the joy of writing had returned.
Something different
I decided to explore how to enable others to make use of the PhD-knowledge and the co-creation method without having to start my own business. To simplify matters, I took money out of the equation – because with money comes reports, forms, accounting, and other time-consuming bureaucratic activities.
That’s when I remembered Edgar Cahn and Timebanking in the co-production literature. Timebanking is a global movement on several web-platforms where skills are exchanged without money changing hands. So, if you help someone for an hour in this network, you earn an hour. Consequently, you can spend it on something you need help for.
Favors
My idea may not be Timebanking, because I won’t keep count of the hours invested in this. However, the pay it forward ideology is present here also. The currency is engagement and knowledge – not money.
Here’s the deal. We all want to contribute to the survival of this planet for future generations. My contribution on this webpage is a scientifically developed and tested co-creation method. I have tried to describe it in a manner that will make it possible to initiate co-creation processes without my presence. However, if you need my expertise on co-creating sustainable solutions, I encourage you to exchange adequate favors with me. This way we can strengthen our contributions to a sustainable planet.
If you want to use the tools in the co-creation method presented underneath to co-create sustainable solutions in your organisation, community, or family even: Feel free! But first, please do me a favor:
I’d love to know about what you are doing/planning to do, so send me an email about it.
This favor will increase my knowledge about various ways to co-create sustainability.
– With your permission, I can contribute such knowledge as a favor to others in terms of guidance.
– With your permission, this knowledge can also inform my teaching, so the students can more easily understand co-creation of sustainable solutions and develop their own practices.
If you need me as a reflexive partner on how to facilitate co-creation processes where the focus is on sustainability and/or environmental protection, please do me a favor:
Please contact me here, and answer these two questions:
- Which of the UN sustainability development goals do you plan to address with your efforts, and how?
- How can I improve the text on this web-page about the co-creation method, so it becomes even more comprehensible?
This favor will
a) Increase my knowledge about how to reach the various the sustainability development goals through co-creation processes
b) Increase my knowledge about how to make the web-page more accessible and understandable
– With your permission I can contribute such knowledge as a favor to others in terms of guidance.
– With your permission this knowledge can also inform my teaching, so the students can more easily understand co-creation of sustainable solutions and develop their own practices.