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Seminars, Lectures & Study Days

Co-productive Ethics: Bridging the Fact-Value Divide in Mental Health Service Provision

by Revd Julian Paul Raffay, Specialist Chaplain (Research Education and Development), Spiritual and Pastoral Care Department, Mersey Care NHS Trust; PhD candidate, Department of Theology and Religion, Durham University

Thursday 26 April 2018 (4.30-6pm)
Spirituality, Theology & Health seminar series (Durham University)

This seminar took place in Seminar Room B (D/TH004, Dept. of Theology & Religion, Abbey House, DH1 3RS, Durham).

To watch the Lecture, please click on the video below:


Mental health services – described as ‘a broken and demoralised system that does not deliver the quality of treatment that is need for people to recover’ – commonly ignore faith communities. This seminar reports on a constructivist grounded theory thesis with embedded co-production exploring collaboration. Thirty participants were interviewed: mental health service users, carers, staff, faith leaders, and community organization leaders. They identified the Enlightenment bifurcation as causing vulnerabilities. I surmised agent-focused medical ethics to be an artefact of the fact-value divide, under undue utilitarian influence.

Co-productive ethics identifies service users and carers as having vital contributions towards effective mental health services that bridge the divide. It proposes that faith communities and mental health services become critical friends in supporting communities to develop services prioritizing health promotion and recovery.

This seminar will set the history of mental health provision within MacIntyre’s fact-value debate and introduce co-productive ethics. Moore’s organizational ethics will provide opportunity to explore how it might influence future services. Issues for ecclesiology and practical theology will be raised and opportunity provided for discussion. A key question is whether co-productive ethics is a valid construct.


Having returned to St John’s College, I am now in the fifth year of the DThM course. Having served as vicar and mental health chaplain, my grounded theory research explores closer working between faith communities and mental health services. The concept of co-productive ethics emerged from the study data. Most study participants drew from mental health services and faith communities what they needed. They suggested the division between mental health service and faith communities reflects MacIntyre’s fact-value divide. This led me to propose that agent-focused approaches to care are inadequate and potentially harmful. Participants considered both fact and value as essential to recovery and potentially critical friends. Co-productive ethics challenges narrow definitions of medical evidence and sets a new standard. Collaboration between service users, carers, and staff to co-create services has potentially very different outcomes. Austerity provides its own impetus. Co-productive ethics, rooted in grounded theory, challenges both churches and practical theological models.

I am currently working in Mersey Care as Specialist Chaplain (Research, Education, and Development). I am conducting a pilot study as part of an action research cycle into the impact of co production on spiritual and pastoral care (chaplaincy) services. Phase One used grounded theory to study what mental health service users wanted from chaplaincy. Significantly, it offered a novel understanding of spirituality, rooted in service users’ response to institutionalization. In Phase Two, we identified a baseline (conventional chaplaincy). The current mixed methods study (Phase Three) is considering issues standing in the way of conducting a clinical trial (Phase Four). This will evaluate co-produced chaplaincy. We hope the methodology and findings will lead to similar research in allied health professions. Working alongside a lived experience advisory panel, embeds co production within the research.

My MTh in Chaplaincy Studies dissertation used grounded theory to explore service user and staff opinions of spiritual assessment. I theorised that nurses experience a perfect storm that risks turning them into technicians and service users into data. I proposed a two-stage approach to assessing spiritual strengths and needs.

Also relevant to my work is the award-winning study day Mental Health: Challenge or Opportunity? Co-written with another mental health researcher (Emily Wood), this is undergoing its second academic evaluation and holds out the prospect of national rollout.