Introduction

Engaging people who use mental health services in developing those services, a process generally known as ‘user involvement’, has developed over the years to become part of policy (DH, 1999, 2005; NIMHE, 2003). Involvement and participation initiatives came on the agenda of most mental health trusts. The National Institute for Mental Health in England (NIMHE) developed a programme and guidelines for user involvement Making a real difference (MARD), based on the recommendations from a report on strengthening user and carer involvement in NIMHE (HASCAS, 2005). MARD guidelines and tools for developing and evaluating involvement were expected to enable a systematic approach to user involvement and to fulfil the principles set out in the 2006 White Paper Our health, our care, our say (DH, 2006). The National Mental Health Development Unit, which had the responsibility for providing support for the implementation of mental health policy, took this work forward until its closure in March 2011.

The extensive policy changes following the new government in 2010 and the austerity measures that are affecting service delivery across the NHS and social care have made it difficult to be clear about the nature and extent of user involvement in mental health in the future. However, the new mental health strategy, No health without mental health (DH, 2011a), contains statements of the Coalition government's commitment to service users, including friends, families and carers, having a say in how services and policy are developed and delivered: ‘users of services will increasingly be able to take decisions about their own healthcare. They and their carers may wish to become involved in the planning and design of local services’ (DH, 2011a, p 30). Also, the Department of Health is currently funding the National Involvement Partnership, a collaboration between the National Survivor User Network, the Afiya Trust and the Social Perspectives Network. The National Involvement Partnership will develop involvement standards and monitor the impact of user involvement.

User involvement is not just about participating in policy-driven, organisational initiatives. It is also about involving oneself in peer groups, for personal support and/or political campaigning. It is generally seen as enabling and there seems to be a belief in its intrinsic value.