Watching Sausage Being Made: Lessons learned from the co-production of governance in a behavioural health system

Abstract

We draw out lessons from a multi-level governance system implemented to create more consumer oversight and involvement in the governance of behavioural health services. Through two rounds of interviews, we identified key areas of design that were difficult to implement, resulting in the system continuing to operate as a top-down environment rather than a flatter arrangement. Although new governance structures can be implemented, the underlying culture of government has to shift to allow real buy-in. Until this happens, multi-level governance systems will remain single-layered and command and control systems. The patina of change will cause frustration and animosity among participants.

Key words:

• Co-production
• governance
• behavioural health

ACKNOWLEDGEMENT

The authors would like to thank The John D. and Catherine T. MacArthur Foundation’s Network on Mental Health Policy Research for support for this project and for feedback throughout the research process.

Notes

1 While the term ‘Native American’ is typically used to refer to the indigenous people on the North American continent, the term ‘Indian’ is used in our work in deference to the preferred language used by the tribes in New Mexico.