Recently, we spoke with Dan Stears — mental health advocate, LGBTQ+ campaigner, and lived experience expert who has spent more than two decades navigating mental health services as a service user. Today, Dan serves as Chair of the Service User Council at Greater Manchester Mental Health NHS Foundation Trust in the UK, where he helps bridge the gap between lived experience and institutional decision-making.
Dan is a passionate advocate for co-production — the practice of designing systems with people, not for them. And he doesn’t sugarcoat it:
“There’s no point designing a service for a community without input from the people who’ll use it. You’re building something no one wants.”
Dan shared his story — and his belief that co-production is the foundation of safe, inclusive, and effective behavioral healthcare.
Co-production isn’t about giving people limited choices. It’s not tokenism or after-the-fact consultation. It’s about shared decision-making and equal power from the very beginning.
Where traditional consultation might ask, “Which of these three layouts do you prefer?” — co-production starts by asking, “What’s missing? What do you need?”
As Dan puts it:
“True co-production starts with a blank sheet of paper — not a polished plan. It means recognizing that service users, clinicians, architects, designers, and administrators all bring equal value. And it means being prepared to be wrong.”
To clarify the distinction, Dan offered this analogy:
“Consultation is asking, ‘Which of these three colors do you prefer for the wall?’
Co-production is asking, ‘Do we actually need this wall?’”
In other words, consultation happens after decisions have already been made. Co-production happens before, starting from scratch, with those who will ultimately use the service at the table.
To understand how deep engagement can go, Dan refers to the Ladder of Co-Production, a model from the UK’s National Co-production Advisory Group and Think Local Act Personal. It charts the spectrum of user involvement, from coercion at the bottom (where people are told what’s happening) to full co-production at the top (where people help shape the outcome from the start).
Coercion – No choice. Decisions made without input.
Consultation – Limited voice. Input after the fact.
Co-Production – Full collaboration from the outset.
“Even well-meaning teams can fall into the trap of faux inclusion,” Dan reminds us. “True co-production demands humility. It asks: Are we brave enough to share the pen?”
In behavioral health design, there’s no one-size-fits-all solution. But when we listen deeply to people who’ve used the system, we begin to recognize patterns — repeated needs, shared frustrations, and universal hopes.
“You expect 20 people to have 20 different stories. But actually, you hear echoes,” Dan says.
“Those echoes define the design brief.”
From more homelike doorways to softer lighting to more communal spaces — these changes aren’t “nice-to-haves.” They’re how people say: This makes me feel safe.
For co-production to succeed, leaders must be willing to let go of control. Dan acknowledges that this isn’t easy, especially for senior executives. But transparency builds trust — and that’s where change begins.
“I’ve seen leadership teams struggle to give up control. But when they admit their fears, it opens the door to real equity,” he says.
Co-production isn’t about replacing professionals or discarding clinical expertise. It’s about balance — combining professional knowledge with real-world experience.
As Philip Ross, Co-Founder of Safehinge Primera, puts it:
“Co-production is not abdication — it’s translation. We listen carefully, then use our design skills to shape solutions that reflect what people actually need.”
One of the clearest examples of co-production in action comes from Greater Manchester Mental Health NHS Foundation Trust (GMMH) — a UK behavioral health provider.
Service users at GMMH began raising concerns about the food in inpatient units. While meals met nutritional standards, they lacked warmth, choice, and cultural variety — something Dan and his team recognized as an opportunity for change.
“People can spend weeks, months, even years in these facilities,” Dan explains.
“Nobody wants to eat the same three-week menu for a year. Food should bring comfort, not just calories.”
Service users called for meals with flavor, identity, and joy — the kind you’d choose in a local diner or that reminds you of home. And the system listened.
GMMH leadership worked with service users to redesign the food program:
Increased per-meal budgets
New themed menus (like “Fakeaways” and “European Week”)
Staff and service users co-creating food ideas
Culturally relevant, comforting meals
This wasn’t just about food — it was about dignity. About being heard.
“A good meal can offer hope. And hope is a gateway,” Dan says.
“Hope in food becomes hope in therapy, in relationships — and in life.”
What seems like a small detail — a better meal — became a transformational spark for co-design and connection.
It didn’t require millions in funding. It required one thing: listening.
Service users said, “We deserve better.” And leadership said, “You’re right.”
As a result, GMMH topped the UK’s PLACE assessment rankings for food quality across all mental health providers, and their catering team was nominated for a national award.
“Our catering manager just got back from a national awards ceremony in London,” Dan says.
“Imagine that — a kitchen team in a behavioral health facility being celebrated for improving patient recovery.”
In his role at GMMH, Dan doesn’t see himself as speaking for others, but helping make space for them.
“I’m not speaking for everyone — I’m holding the door open so more people can speak.”
That includes creating safe spaces for sharing lived experience — especially around trauma, self-harm, or suicidal ideation.
Dan’s advice for those taking on co-production roles?
Say yes to training, even if you’ve done it before.
Try to bring solutions, not just complaints.
Protect your own well-being — this is emotional work.
Make space for other voices.
And never stop listening.
Recent research across the UK shows measurable outcomes from co-production in mental healthcare:
A 2023 study in Frontiers in Sociology found that including lived experience researchers in COVID-19 mental health projects led to better, more relevant outcomes.
A 2025 review in The Lancet Psychiatry identified 20+ patient outcome tools co-developed with service users — and found them to be more effective for both clinicians and patients.
A 2023 Bristol-based initiative created a trauma-informed model for women using primary mental health services, resulting in safer, more accessible care.
In the West Midlands, the Reach Out Project embedded peer support workers into secure mental health units — leading to reduced hospitalizations and stronger community outcomes.
NHS England’s Patient and Carer Race Equality Framework (PCREF) now requires providers to co-produce strategies with racialized communities — marking a national shift toward equity.
Co-production isn’t a shortcut. It takes time, honesty, and effort. But whether it’s transforming meals or reshaping entire systems, the evidence is clear: it works.
When people feel heard, they begin to believe their lives matter — and healing begins.
Whether you're designing a new facility, improving therapeutic environments, or rethinking patient pathways — co-production makes it stronger.
At Safehinge Primera, we bring lived experience into every step of the design process — because we know that great design begins with listening.