Seen But Not Heard: Can ‘User Involvement’ Become More than Empty Rhetoric?

Within mental health services, as in other areas of life, ‘professionalism’ is deeprooted. ‘There is a pervasive societal belief that trained professionals are the only people who know how to provide proper assistance. This attitude exists whether our television needs to be fixed or we need help dealing with personal issues. We have grown accustomed to turning to professionals for help because we assume they have special expertise’.1 However, amongst mental health service users/survivors, recognition of the shortcomings of such professionalism is increasingly widespread: more and more people who experience mental distress and disability are turning to sources of expertise other than professionals.2, 3 ‘Ex-patients...are beginning to turn to each other rather than to mental health professionals for emotional and instrumental support. They are finding that often people with experiential knowledge (i.e., having learned through personal experience) are more able to understand their needs than are professionals who have learned through education and training. Moreover, they are finding the support and help they can give each other to be as valuable — or sometimes more valuable — than the interventions of trained professionals’.1 Such trends can be seen in a variety of self-help and user run services.4 This paper is based on the premise that mainstream mental health services cannot survive without the expertise of those who have themselves experienced mental health problems. ‘User involvement’ is not some act of altruism on the part of mental health workers and service providers, neither is it an ‘optional extra’: the ‘icing on the cake’. If services are not to become irrelevant to those who experience mental distress and disability, then people who have experienced these things must be the critical ingredient of the cake itself.