This study aimed to understand how rules-based environments in secure mental
health care across Scotland and Ireland affect forms of coproduction and how staff
conceptualise this process. The research was required because existing
coproduction studies have predominantly focused on community settings, leaving a
critical knowledge gap about collaborative partnerships within secure care
environments where safety and security concerns limit traditional approaches.
Using thematic analysis of 28 interviews and three focus groups with 33 staff across
high, medium, and low-security facilities, the research reveals that coproduction
exists along a developmental continuum from compliance through cooperation to
authentic coproduction, characterised by trust, reciprocity, and autonomy. The study
demonstrates how environmental conditions, staff orientation, cognitive biases, and
institutional cultures significantly influence coproduction potential, with off-ward
spaces affording greater relational engagement opportunities than high-stimulus
ward environments.
By applying game theory to staff-patient interactions, the research illuminates how
repeated interactions foster cooperation despite power imbalances, creating Nash
equilibria where maintaining peace benefits both parties. The findings suggest that
seemingly inconsequential daily interactions represent legitimate expressions of
coproduction overlooked by previous definitions, expanding classical
conceptualisations beyond service design to include relational processes that
contribute to shared outcomes.
The study offers practical recommendations including rotating staff between ward
and off-ward positions, addressing team dynamics that reinforce custodial cultures,
and implementing dynamic risk assessments that meaningfully involve patients.
Whilst acknowledging limitations, particularly the absence of patient perspectives,
this research provides nuanced understanding of how coproduction manifests within
security constraints, offering insights for theory, research, and practice development
in secure care environments and broader coproduction applications.
| Date of Award | 29 Jan 2026 |
|---|
| Original language | English |
|---|
| Awarding Institution | - University Of Strathclyde
|
|---|
| Sponsors | University of Strathclyde |
|---|
| Supervisor | Gillian MacIntyre (Supervisor) & Beth Weaver (Supervisor) |
|---|