Research Article: Co-producing Psychiatric Education with Service User Educators: a Collective Autobiographical Case Study of the Meaning, Ethics, and Importance of Payment

Date Published: December 23, 2019

Publisher: Springer International Publishing

Author(s): Sophie Soklaridis, Alise de Bie, Rachel Beth Cooper, Kim McCullough, Brenda McGovern, Michaela Beder, Gail Bellisimo, Tucker Gordon, Suze Berkhout, Mark Fefergrad, Andrew Johnson, Csilla Kalocsai, Sean Kidd, Nancy McNaughton, Charlotte Ringsted, David Wiljer, Sacha Agrawal.


Co-production involves service providers and service users collaborating to design and deliver services together and is gaining attention as a means to improve provision of care. Aiming to extend this model to an educational context, the authors assembled a diverse group to develop co-produced education for psychiatry residents and medical students at the University of Toronto over several years. The authors describe the dynamics involved in co-producing psychiatric education as experienced in their work.

A collaborative autobiographical case study approach provides a snapshot of the collective experiences of working to write a manuscript about paying service users for their contributions to co-produced education. Data were collected from two in-person meetings, personal communications, emails, and online comments to capture the fullest possible range of perspectives from the group about payment.

The juxtaposition of the vision for an inclusive process against the budgetary constraints that the authors faced led them to reflect deeply on the many meanings of paying service user educators for their contributions to academic initiatives. These reflections revealed that payment had implications at personal, organizational, and social levels.

Paying mental health service user educators for their contributions is an ethical imperative for the authors. However, unless payment is accompanied by other forms of demonstrating respect, it aligns with organizational structures and practices, and it is connected to a larger goal of achieving social justice, the role of service users as legitimate knowers and educators and ultimately their impact on learners will be limited.

Partial Text

We used a modified reflective topical autobiographical approach to this work, which focuses on a snapshot of the person’s story that is of some topical interest [25–27]. In this article, because none of the stories were specifically autobiographical, we give readers a snapshot of our collective experiences of working together to write a manuscript about payment in co-production (the case). We thus invite others who are engaged in related activities to build a “shareable understanding” of co-production ([25], p. 28). Our approach can best be described as a collaborative autobiographical case study approach.

Our group held the unanimous belief that service user educators must be paid for their work. Limitations in how this ideal is operationalized were and are inevitable, however. While we have strongly advocated in our work for service users to be paid for their contributions to the planning and delivery of education, we only had enough funds at the end of our grant to provide honoraria for two in-person meetings to support the writing of this manuscript. This limitation meant that most of the work involved in preparing this manuscript was unpaid for those of us who do not have jobs that include or reward writing academic papers. The juxtaposition of that reality and our vision for an inclusive process led us to reflect deeply on the meaning of paying service user educators for their contributions to academic initiatives. These reflections revealed that payment had meaning and implications at many overlapping levels: the personal, the organizational, and the social.

This collaborative autobiographical case study illustrates some of the complexities of co-produced psychiatric education. Drawing inspiration from colleagues who also see health professions education as a fundamentally socio-political act [41, 42], we have insisted on paying service user educators in our projects. However, paradoxically, the writing of this manuscript was only modestly funded, which tested the very basis of our collaboration and forced us to reflect deeply together on the meaning of payment in co-produced education.




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