4/ Editorial introductions

There is supposed generally to have been a laudable move towards listening to clients, and this has ostensibly been supported by the present government. A patients' charter would be an impressive innovation if it achieved its aim of empowering users of mental health services in making their opinions heard and effecting the changes they want in care provision. The rhetoric of citizens' rights and the notion that the conservative government now wants to make a charter with psychiatric patients (among others), to give them what they want, belies the fact that mental health service users' opinions and preferences have been freely available for years. They have, however, been ignored, simply because they are not overly valued by those who have the power to make a difference. In chapter seventeen, Peter Campbell details the development and contribution of the user movement. He addresses the central ethical issues of power and its abuse, powerlessness and protest in peoples' experience of society and psychiatric treatment. Peter then explores how realistic the prospect of a user-led service is. He discusses the possibility of advocacy work and explores ways of facilitating self-advocacy by users of psychiatric services. Peter questions the nature of expertise on mental illness and mental health care. He argues that the special insight into the nature of madness accessible to service users puts them in a unique position of expertise. Such expertise remains largely untapped by psychiatric nurses and other mental health carers. Peter endorses the case for more collaboration between service users and providers as a moral, also a practical imperative, but questions whether powerful and to an extent hidden ideology will allow it.