4Pi is a framework for the involvement of service users and carers – in our own care, in our communities, in service delivery and evaluation and in organisational governance and strategy.
4Pi is a simple framework on which to base standards for good practice, and to monitor and evaluate involvement.
The framework builds on the work on many people: mental health service users and carers and others who have lived and breathed involvement and shared their experiences in various ways, both written and unwritten.
Meaningful involvement means making a difference: it should improve services and improve the mental health, wellbeing and recovery of everyone experiencing mental distress.
Developed by people with lived experience as part of the National Involvement Partnership (NIP) project, the 4Pi National Standards ensure effective co-production, thus improving experiences of services and support. They were formally launched at the NSUN AGM 29 January 2013.
4Pi was the result of an NSUN hosted project, the National Involvement Partnership (NIP), which was funded by the Department of Health (Innovation, Excellence, Strategic Development) voluntary sector funding. The aim of the three year project was to strengthen and ‘hard-wire’ involvement in to the planning, delivery and evaluation of the services and support we use for our mental health and wellbeing needs.
This framework established some basic principles to encourage people to think of involvement in terms of principles, purpose, presence, process and impact (4Pi).
The 4Pi National Involvement Standards continue to influence people beyond the boundaries of NSUN. We have a long list of articles, newsletters, resources and websites where 4Pi has received a mention or recommendation – even receiving international acclaim. Our Reality and Impact report a couple of years ago showed that the standards are well-used.
The Five Year Forward View for Mental Health describes 4Pi as a framework that ‘…will help ensure services and interventions are accessible and appropriate for people of all backgrounds, ages and experience’ and should support CQC inspection of ‘the quality of co-production in individual care planning, carer involvement and in partnership with communities to develop and improve mental health services.’
Please note: funding for the 4Pi project has now ceased, and we are unable to offer consultancy and training around the usage of the 4Pi Involvement Standards. However, we still encourage organisations and services to make use of the resources (which you can find below) about understanding and using the 4Pi framework.
The 4Pi framework
Statement of intent:
Our vision is of ‘nothing about us without us’. Meaningful involvement for us means involvement that makes a difference: it should improve services and improve the mental health, wellbeing and recovery of everyone experiencing mental distress.
Meaningful and inclusive involvement depends on a commitment to shared principles and values. This includes valuing the contribution of service users and carers equally to those of professionals.
The purpose of involvement should be clear and clearly communicated to everyone involved in the activity as well as the wider organisation.
A diversity of service users and carers should be involved at all levels and all stages of an organisation or project. The people who are involved should reflect the nature and purpose of the involvement. Service users and carers should have the opportunity to be involved separately as they may have different priorities.
The process of involvement needs to be carefully planned in terms of issues like recruitment, communications, being offered appropriate support and training and payment, so that service users and carers, including those from marginalised communities, can get involved easily and make the best possible contribution.
For involvement to be meaningful, it needs to make a difference to the lives or the experiences of service users and carers. This means we will be clear about the purpose of involvement, the individuals and groups who will be present and their role in the process. That process and the desired impact of involvement will be explained from beginning to end. When a particular piece of work is complete we will feed-back on what has been achieved to those involved. By working to the 4Pi Framework we will make the best of working together which should improve outcomes for all.
Why use the 4Pi Standards?
4Pi is a simple framework that can help services meet their statutory obligations. Apart from the benefits and the moral imperative to involve people in their care and treatment, development and delivery of services, services also need to meet the requirements of national regulatory and inspection bodies such as NICE, the CQC and the Health and Social Care Act. The 4Pi National Involvement Standards have been signed up to by over 70 organisations and were cited in the NHSE Five Year Forward View for Mental Health report and the Department of Health Social Work for Better Mental Health Programme.
The core purpose of involving people must be to improve lives. Developing good practice policies and procedures for involvement has no meaning if those policies and procedures do not improve individual experiences and the quality and efficiency of services. Good involvement has many benefits for all concerned – for individuals, communities, services, professionals and organisations. These are the benefits we identified in our main report ‘Involvement for Influence: the 4Pi Standards for Involvement’.
- Involvement in individual care and treatment can increase self-esteem, improve individual outcomes and increase people’s satisfaction with services. The greatest benefits result when people agree with the purpose of their treatment and when they have choice and control.
- Involvement in communities can build resilience, provide opportunities for peer support and mentoring and increase our social capital.
- Involvement in services can lead to enhanced quality of care, improved quality of life, a reduction in compulsory admissions, improved relationships between staff and service users, and improved outcomes for service users; it can also lead to improved outcomes for providers.
- Involvement in planning, commissioning and governance can improve information and access for service users, and have positive effects on decision-making processes and staff attitudes and behaviour.
It is vital that service users are involved in defining the outcomes of services for these benefits to be maximised.
4Pi report: executive summary
4Pi report: involvement for influence full version
Companion report: the language of mental wellbeing
Companion report: Service User Involvement in Health and Social Care Policy and Legislation
You can also Download the 4Pi poster here
Word versions of the report and executive summary:
Please note: funding for the 4Pi project has now ceased, and we are unable to offer consultancy and training around the usage of the 4Pi Involvement Standards. We are also no longer actively adding organisations to the list of signatories below. However, we still encourage organisations and services to make use of the resources (which you can find above) to understand and apply the 4Pi standards to involvement work.
Who signed up?
The Advocacy Project
The Angelou Centre
Avon and Wiltshire Mental Health Partnership NHS Trust
Bristol, North Somerset, and Gloucestershire CCG
Building A New Direction (BAND)
Canterbury Christ Church University
Centre for Mental Health
Council of Somali Organisations
Disability Rights UK
East Kent Mental Health Commissioning, part of Kent and Medway CCG
Everyone’s Business Campaign
Gateshead Advice Centre
Healthcare Quality Improvement Partnership (HQIP)
Healthwatch Tower Hamlets
Hertfordshire Partnership University NHS Foundation Trust (HPFT)
Institute of Health and Society, University of Worcester
Lincolnshire Partnership NHS Foundation Trust
Local Survivors in Partnership (LSIP) – A service user and carer led group based in Leicester, they currently have no website
London Borough of Hounslow
Manchester Users Network
Mental Health Alliance South West
Mental Health Investment Programme – Camden CCG
Mental Health Foundation
Midlands Partnership NHS Foundation Trust
National Deaf Children’s Society
National Institute for Health and Care Excellence (NICE)
Newcastle West CCG
NIHR CLAHRC Northwest London
NIWE Eating Distress Service
North East Together
North West London Collaboration of CCG’s
Northamptonshire Foundation Trust
Rethink Mental Illness
Rotherham, Doncaster and South Humber Foundation Trust
Self Help Services
Shaping Our Lives
Sheffield Health and Social Care NHS Foundation Trust
Social Care Institute for Excellence (SCIE)
South Eastern Hampshire CCG
South London and Maudsley NHS Foundation Trust
Spectrum Centre for Mental Health Research, Lancaster University
St Andrews Healthcare
Strategic Clinical Network London
Sheffield User Survivor Trainers (SUST)
Sussex Partnership NHS Foundation Trust
Together for Mental Wellbeing
University of Worcester
WISH – A Voice for Womens Mental Health
West London Collaborative
Young Minds North East
Other resources on co-production
- The Ladder of Co-Production by Think Local Act Personal and National Co-production Advisory Group (NCAG)
- Social Care Institute for Excellence’s Co-Production guidance
- A Co-Production Model by the Coalition for Personalised Care
- The Co-Production Collective‘s work – including their November 2022 “What is the value of co-production?” resource and their new Co-Production Library