Changing the system

Abstract

Within Chapter 5 we set out to examine evidence of the impact of user self-organisation and involvement in the planning and delivery of services on both service users themselves and the attitudes of individuals. In contrast, this chapter looks for evidence of influence on the structures and policies of the organisations that deliver mental health services. We described towards the end of Chapter 5 how, since the late 1980s, both legislation and policy guidance impacting upon mental health services have stressed the need for service user involvement in the planning and delivery of services. We also described how, even where legislation does not specifically require it, user involvement has become established as good practice. In themselves these developments would appear to indicate changes in the ideas of those managing and providing services and perhaps in the minds of the public who provide policy makers with a democratic mandate to make changes on their behalf. Nonetheless, we also alluded to the fears that both in Canada (Everett, 1998) and the USA (McLean, 1995) strategies encouraging increased user involvement had not necessarily produced real changes in mainstream mental health provision. Indeed, diverting the energy of the movement away from its oppositional role may have lessened the momentum for change it had generated.