The Practice Guide

During the project, interesting activities and case studies from the field practice in the participating countries were presented and discussed. For example, the concept of co-production from Great Britain (The Social Care Institute for Excellence) and its application in mental health care was presented (link to resources on Co-production). Co-production means, according to this resource, that people with different views and ideas come together with the aim of improving a situation to everybody's benefit. This concept was related to better social and health services provision. Some participants related it to their experience with community groups (e.g., older people living in a specific community in Portugal, Travellers in Ireland, Roma people in the Czech Republic) or in fieldwork using multi-professional networks around specific patients.

We would like to stress again that stating the aim of the partnership is very important. For example, if the implication is to thereby reduce costs of service provision, this can cancel out the declared goal of enhancing the dignity and autonomous decision-making of patients in such initiatives (link to material on co-production) because it shifts the burden of the service provision to family members and self-help groups of frail people. Negotiating and balancing different MOTIVATIONS behind the proclaimed partnership is therefore crucial. 

Another important consideration concerns status differences (power of expertise, position and knowledge) not only between professionals and non-professionals but also between different professional groups (social workers, nurses, medical doctors, physiotherapists etc.). These differences are real and need to be addressed (in the PPR packages CONTEXT + OWN POSITION + HOW I SEE THE PARTNERS). Every profession and professional position have a specific status in society. During their education, the students are usually led to develop their professional identity and to be proud of themselves as professionals.

How do your professional identity and position influence your sense of worth in society and as a human being? What aspects of your role as a Social Worker, Nurse, Physiotherapist, Teacher, or Researcher make you proud?

Differences in status do not only concern professions but also human abilities and attributes. People move in and identify with different networks and social "bubbles". Comparing oneself to others and aiming for positive feedback, belonging to specific networks and reaching higher status in a group or network (for instance, by getting more "likes") indicates a permanent but subtle struggle to stand out. This can cause invisible barriers in collaborative partnerships. It is not constructive to deny or neglect the many differences among people.   

What are you proud of as a person? Are you pleased to be intelligent, to be well-oriented, to be fast, to be responsive, to be friendly, to be kind to others, to be helpful, to be effective etc.? Are you able to value those who are not knowledgeable, not smart, not well-oriented, not kind to others, not cooperative etc.? How can you create a good atmosphere of cooperation and value others? Does better cooperation have a higher status in your "social bubble" than non-cooperation?

It is well-known in teamwork theory that the most efficient teams that have diverse members. However, the composition of the team must contain certain abilities which enable the team to fulfil its tasks. When we think about the participation of certain members in a community partnership, for example, professionals and service users, we do not want to negate some members' professional expertise or management abilities and skills. Instead, we should recognize and value them. Likewise, we should appreciate the "experts by experience" as valuable members. All members of the partnership should contribute to the common goal by offering their specific expertise without dismissing the expertise of others. 

Tensions may arise in finding the right balance of risk and responsibility in collaborating with people with mental illness or dementia or another type of service user considered a risk. For example, trying to understand the desires and preferences of people with dementia can get tricky when they seem to make an "unwise decision" or when their choices differ from those of their family caregiver (especially when they rely on their family member's support to follow through with the decision). Without learning to trust that taking such risks brings more good than harm, it's hard to challenge our own expectations and assumptions about what seems "wise" to us.

Peer advocacy groups in a range of educational, research and practice contexts can be forms of collaboration that bring a greater balance of power and influence. This has been developed as a recognized form of self-representation by service user groups, and these groups can effectively build relationships with academics, students, practitioners, and researchers. They reduce the risk of participation in teaching and research becoming tokenistic. The following set of principles and processes, used by the Irish Advocacy Network (www.irishadvocacynetwork.com) in the context of mental health, is such an example that could be modified for different country contexts (link to O2).

Building a realistic, reflexive-participative partnership in the field means considering all mentioned problems concerning differences in status and knowledge. Removing barriers in the form of hidden agendas and false preconceptions is a long-term process based on openness and reflexivity. To encourage those who would like to start their own exercise, we present an example by a supervision student. He has a professional background as a physiotherapist and started to think about how to help his client with chronic illness with the support of the RPP scheme. This is not a "best practice" example but shares Jarda's starting point in RPP in his situated practice. 

Here is the example of supporting network around the patient with chronic illness.