Patients are at the core of therapeutic encounters, yet often in psychiatric settings in particular they feel ignored. However, over the past few decades this has started to change, albeit far too slowly.

It is now a central plank of government policy that the NHS should be patient-driven, that there should be a high level of patient and public involvement in health services and that there should be a rapid expansion of choice. This represents a cultural shift and a rebalancing of power relations between patients and doctors. The Department of Health recognises that this is not easy, as doctors may not wish to hand over power to patients (Department of Health & Farrell, 2004). A further part of this cultural shift comes in the wake of the Francis inquiry into the failings of Mid Staffordshire NHS Foundation Trust. The report highlights the importance of the patient experience as of equal status to clinical outcomes (Francis, 2010).

In this context, there is a crucial dilemma for psychiatrists. The culture shift described above is supposed to be transferable to all medical disciplines and the mental health user movement has long struggled to bring this about in the psychiatric domain. It has to be said that there have been some successes here. The dilemma is that psychiatrists have the power to take all choice and control away from psychiatric patients by use of the Mental Health Act 1983. The 2007 amendments to the Act make the grounds for compulsory treatment wider and extended powers to compulsion in the community. Many psychiatrists were opposed to this, but it shows that government policy is pulling in two directions at once – more choice and involvement on the one hand and more control and coercion on the other.

In this chapter I will look at the mental health user movement, what it has achieved and what it has still to achieve. I will then look at research which has tried to determine what users want and do not want in terms of services, especially from psychiatrists. Much of this research has been userled or carried out in collaboration with service user researchers.