Introduction: the policy context

The active participation of the public and service users in shaping public services has been a cornerstone of UK social policy since the 1980s. In the health and social care sector, this ‘user involvement’ has been promoted across all levels of service interaction, from individual service encounters to service management and planning, with influences from both consumerist and democratisation agendas. Within mental health services, organised groups of service users/survivors have had an important role. The forums and mechanisms that enable user involvement in these services therefore encompass local and national service user/survivor groups and networks (both independent and service-led) as well as NHS statutory patient and public involvement structures, service user participation in policymaking and implementation groups, and user consultation exercises.

Research across a range of sectors has repeatedly found an implementation deficit for user involvement policies (Bochel et al, 2007). In the context of mental health, evidence suggests that, at all levels, the aims of user involvement are still not fully realised (see, eg, Connor and Wilson, 2006; Carr, 2007), and that there is some cultural change but no structural, decision-making change (Campbell, 2006). Furthermore, recent mental health policy imperatives in the UK towards increased surveillance and control of service users, including the introduction of new mental health legislation that extends the compulsory powers of services into the community, appear to conflict with advancing user involvement. It has therefore been widely argued that meaningful participation for service users cannot be achieved through a bureaucratic, managerialist, consumerist approach that fails to engage with imbalances of power and divergences of interest between users and providers of services (see, eg, Sashidharan, 1997; Stickley, 2006; Carr, 2007; Forbes and Lewis, 2012).

Alongside user involvement, the last UK government promulgated a human rights framework for health care (DH, 2007), which promoted the application of the human rights principles of dignity, equality, respect, fairness and autonomy as the value base for service provision, and promoting human rights is central to the current Coalition government's Mental Health Strategy (HMG and DH, 2011, p 1617). The application of this value base in public-sector services has also been promoted through the Equality and Human Rights Commission. This highlights the question of what the situation with user involvement described earlier means for the achievement of a human rights-based approach within mental health services.