This chapter is a critical examination of ‘transformative co-production’ in mental health and explores the challenges for co-production operating within limits of psychiatric culture, institutions and clinical paradigms. It presents a critique of the origins and policy construction of co-production, a purportedly radical approach to public service, system and social reform. The challenges of inherent power asymmetries and co-option tactics within traditional mental health services are examined with reference to recovery and peer support and the implications of the historical legacy of the asylum are explored. The chapter concludes that co-production will not work without thorough attention to underlying epistemic injustices that continue in psychiatric systems.