“They talk the talk but don’t walk the walk”. Introducing the concept of participatory assimilation in mental health care innovation

The language of participation has become increasingly prevalent in mental health care. However, this article contends that the promises of participatory approaches, particularly of so-called co-design, have not been fulfilled. We introduce and describe the concept of participatory assimilation, trying to clarify this phenomenon. By presenting and analyzing a scenario regarding psychosis, we argue that the performative involvement of individuals with lived experience in mental health care co-design processes undermines the role of individuals with lived experience as legitimate epistemic agents and upholds the authority of researchers. Under the guise of inclusion and innovation, this type of participation runs the risk of perpetuating current power imbalances by assimilating opposing viewpoints into the prevailing ones. We discuss how the hierarchical context of mental health care provides fertile ground for participatory assimilation, that mandating participation by policy can lead to window dressing, and that co-methodologies are no silver bullet. Although the example in this article concerns co-design and psychosis explicitly, we consider it symptomatic of a deeper, systemic issue regarding what constitutes legitimate knowledge in this field. To prevent participatory assimilation, we recommend involving people with lived experience as decision-makers and mapping power balances by using participatory frameworks.