In this chapter we discuss the way in which a well-established group of mental health service users is working to ensure that users are influential within local service systems and more widely. We start by reporting on the way in which activists describe the nature of the group, its objectives and ways of working, and then go on to consider how ‘officials’ in local health and social care agencies are responding to them.

Mental health service users have been organising themselves in this particular city since the mid-1980s. The city-wide organisation had its origins in user councils on hospital wards and developed in the first instance as a Patients’ Councils Support Group. The development was thus a ‘bottom-up’ initiative, firmly located in the day-to-day experiences of current service users who wanted to achieve more influence over the services they were receiving, and to play their part in service planning. The following description refers to the period 1994-95 when data were collected.

Constitution, structure and funding

The city-wide group is a company limited by guarantee, and a registered charity. It employs three part-time and two full-time paid workers – discriminating in favour of people who are or have been users of services. There are also 20-25 regular volunteers, mainly users, who often work practically full-time. The management committee has 15 members, at least half of whom have to be users, and is elected by the membership. Paid workers do not have voting rights on the management committee, but do attend meetings.

Mental health services in the city are organised into six sectors and the group has a representative in each of these sectors. The volunteers attend meetings in their sector, canvass opinion and report back to the ‘Interlink’ meeting, where representatives from the different sectors meet together monthly.

In addition to the sector groups there are resident-only meetings on wards and client-only meetings in day hospitals and day centres. These are supported by workers and volunteers and they receive administrative and organisational back up. All groups are represented on the city Patients’ User Council which also includes among its membership representatives from the Joint Specialist Planning Team, the local Trust; a link worker from one of the sector teams; the Relatives’ Support Group; users from the rehabilitation services; black and Asian groups; and the Chair of the city Patients’ Council Support Group.