Exploring the concept of user involvement in mental health through a participation continuum

Although recent years have seen an increased emphasis on involving service users in decisions about their care, there has been limited exploration of the theories and ideologies underpinning the concept. This paper identifies two approaches to user involvement, each with implications for the extent to which users can be involved in decisions about their care. The approaches are linked through a 'participation continuum' which is a framework through which the concept of user involvement can be explored, and against which practice can be assessed. The framework must be seen within the contest of constraints to user involvement. A more realistic assessment of the extent to which users can be involved in decisions can then be made and the risks of raising unrealistic expectations avoided.