Introduction

As noted in Chapter 1, users of health and social care services have become increasingly organised, and within this, increasingly self-organised. Although there are signs that this process is spreading to other sectors of care, including acute medicine, it is in the fields of mental health problems, learning difficulties and physical disability that it has been most long-standing; these are the roots of the user movement. We sought to take advantage of this relative maturity as a means to understanding the implications of user self-organisation for developing concepts of citizenship. The research was therefore confined to these sectors, and a comparison of mental health and physical disability was chosen as one which provided a potentially useful contrast between a sector largely concerned with personal services (mental health) and one with a much wider focus, including services but also the environment and the social origins of ‘disability’. We did not, however, start out by identifying particular user groups for study: we describe below how they were identified.

Research objectives

Our research objectives were both policy-related and conceptual; the former centred on the relationship of user group activity to new forms of agency management, and the latter on notions of consumerism and citizenship as a means of understanding the significance of user groups. The separate perspectives of user groups and actors within the statutory agencies (whom we term ‘officials’) were also to be addressed. In summary, our objectives were to use a purposive sample of user groups in each of the two specified service sectors to analyse

• • (from the perspective of the user groups) the topics on which influence was sought, the strategies employed, and their resulting influence within the system of local governance;

• • (from the perspective of officials) the legitimacy accorded to groups and their specific activities, the strategies adopted for dealing with them, and the place accorded to them within the wider context of official activity.

Overall, our objectives were to examine this activity in the context of contemporary notions of consumerism and citizenship.

Selecting the user groups

The research adopted a case study design. Our starting point was user self-organisation rather than official ‘user involvement’ strategies. As intended, we studied three mental health groups and three disabled people’s groups. Following meetings with national umbrella organisations, local groups were selected to enable exploration of different strategies for achieving influence.