The key finding
A 2024 systematic review examining nine studies found that genuinely sharing power in mental health research co-production—where researchers work alongside people with lived experience—remains a persistent challenge. Despite 2018 guidelines from the UK’s National Institute for Health and Care Research emphasizing power-sharing as a core principle, the review identified three major themes: researchers and participants must battle against powerful institutional systems, empowerment happens through trusting relationships, and the process is inherently turbulent and complex. The review concluded that meaningful change requires action from research funders, universities, and healthcare providers, not just individual research teams.
What the study looked like
Researchers conducted a systematic review with thematic synthesis, searching three major databases (CINHAL, Embase, and PubMed) for qualitative or mixed-method studies published after 2018 that examined power dynamics in co-produced mental health research. Co-production means that people with lived experience of mental health conditions work as active partners throughout the research process, not just as study subjects. Two reviewers independently screened studies for inclusion and assessed their quality using the Critical Appraisal Skills Programme tool for qualitative research. The final analysis included nine papers that met all criteria. Importantly, the review team itself included a lived experience researcher who contributed to the design, analysis, and writing—practicing the co-production approach they were studying.
Why researchers think this happened
The review authors argue that power imbalances persist because research operates within deeply hierarchical systems—universities, funding bodies, and healthcare institutions—that were not designed with power-sharing in mind. These structures create barriers even when individual researchers have good intentions. The analysis revealed that while respectful, trusting relationships between researchers and lived experience partners can facilitate some power-sharing at the project level, these micro-level efforts bump up against macro-level institutional norms. Traditional academic structures reward certain types of expertise and credentials, often marginalizing the experiential knowledge that lived experience researchers bring. The turbulence identified in the third theme reflects this fundamental tension: sharing power authentically requires disrupting established ways of working, which is uncomfortable by nature.
How to read this carefully
This review synthesized only nine studies, a relatively small evidence base, which means the findings may not capture the full diversity of co-production experiences globally. The studies reviewed were primarily qualitative, describing experiences and perceptions rather than measuring outcomes quantitatively. We cannot determine from this review whether power-sharing in co-production leads to better research quality or outcomes—only that achieving it remains difficult. The review focused specifically on mental health research published after 2018, so findings may not generalize to other health fields or earlier work. Additionally, while the inclusion of a lived experience researcher strengthens the review’s credibility, we should recognize that power dynamics likely influenced this review process itself.
What this means for everyday life
If you or someone you know has lived experience with mental health challenges, this research suggests that participating in research as a co-producer—not just a study subject—can be empowering but also frustrating. The barriers are real and systemic, not just about individual attitudes. For those working in research, universities, or healthcare, the findings point to a need for institutional changes: flexible funding structures, recognition of experiential expertise, and time for relationship-building. For everyone else, this research highlights a broader principle: genuinely sharing power with those most affected by decisions—whether in healthcare, education, or community planning—requires more than good intentions. It demands systemic change, patience with messiness, and recognition that people with lived experience bring irreplaceable knowledge to the table.