The shift from passive recipient to active participant among people who experience mental distress and have contact with mental health services has been a dramatic one over the last 20 years in Britain. A key phrase, often heard in describing processes inextricably linked to that shift, is ‘user involvement’. This article attempts to give an overview of what user involvement actually means in relation to the current mental health system in Britain, and people’s experience of having contact with that system. In doing so, a number of unresolved issues are identified, particularly relating to the question of how much can it actually achieve and for whom? Somewhat like a line out of the satirical school history book, 1066 and All That, user involvement is generally considered to be a Good Thing. Born out of a general rise in consumerism and an increasing confidence and ability among people in receipt of mental health services to vocalise their dissatisfaction with those services and their desire and ideas for improving the mental health system, and an apparent willingness on the part of government, as well as many people working in the mental health system, to enable people using the services to have a much more active role in determining how the system works, user involvement has been growing dramatically since the old Victorian asylums began gradually to give way to the policy of community care in the 1980s. This also reflects a wider trend; in 2003 the government established the Commission for Patient and Public Involvement in Health to ensure that the public is involved in decision making about health and the provision of health services across both physical and mental health needs. The Department of Health is also currently undertaking a national consultation aimed at patients and service users on choice, responsiveness and equity in the NHS and in social care – one of the key themes is mental health (Department of Health, 2003). Inextricably linked with user involvement in the mental health field is the concept of ‘empowerment’, reflecting the belief that genuine, meaningful involvement would, both as a process and in its outcomes, bring about positive change and improvement for service users, both individually and collectively, as well as for the mental health system itself. Yet underneath the glib assertion of user involvement being a Good Thing, and the somewhat broad definition of it that has just been given, both the concept and the reality are significantly more complex. The terminology alone can complicate things; many people who have had contact with mental health services as well as many who provide services are not comfortable with the term ‘user’ for a number of reasons. ‘Survivor’, ‘consumer’, ‘client’ and ‘patient’ are still preferred by many, denoting how they choose to define themselves, or the person, in relation to their mental health and/or the mental health system*. The processes and the objectives of involvement mean that it is not straightforward. Examination of these in more detail gives a good sense of the complex and diverse array of activities that can be included, and also where potential or actual difficulties with user involvement may lie. Certainly since the advent of community care policies in the 1980s and the development of the Care Programme Approach (CPA) there has been considerable emphasis placed on ensuring that individual users are fully involved in the planning, delivery and review of the care and treatment they receive. Describing the CPA assessment process, Department of Health guidance states that it ‘will involve the user and the carer, where appropriate, as central participants in the process’ (Department of Health, 1999a). Phrases such as ‘user-centred’, ‘client-