Notes about me, without me: Research about me, without me.

backgroundIn mental health services, documentation is dominated by providers who write clinical notes without the input of the individuals accessing the services. Although these notes are essential, they often exclude the voices and perspectives of those accessing services. We suggest that this one-sided approach can lead to feelings of alienation, loss of agency, and misrepresentation. MAIN BODY: Our commentary explores co-writing, an approach to documentation where both the provider and the person accessing services jointly contribute to the notes. Co-writing can include various formats, from typed notes to drawings or dictated content, reflecting a more inclusive process. We present co-writing not just as a practical innovation but as an ethical shift aligned with ethics of care and concepts of care. We propose that by inviting individuals to co-author their narratives, co-writing offers opportunities to challenge traditional power imbalances in mental health services and improve the accuracy, emotional relevance, and inclusivity of documentation. We also suggest and examine the limitations and challenges of implementing co-writing, such as provider resistance, time constraints, and ethical considerations around consent and confidentiality. Strategies such as professional training, mentorship, and clear guidelines are suggested to support sustainable implementation. Although co-writing is promoted as a collaborative documentation practice, our analysis reveals that the research underpinning it rarely involves people with lived experience leading or co-creating the research. We present a commentary that critically points out that gap and calls for the co-writing of the evidence base itself to inform practice.

conclusionWe suggest that co-writing clinical notes has the potential to transform mental health documentation from a provider-dominated task into a collaborative, empowering process. It offers a more ethical and accurate representation of individuals' experiences. We call for further research led by people with lived experience, and for the development of policies, training, and infrastructure that support the ethical integration of co-writing into mental health services.