When we first got together to discuss this article, we soon found ourselves sharing our thoughts and stories. As we did so, it became apparent that we had a joint view of some paradigmatic shifts that have occurred, which we explain here as specific gradients of change. One of these we have explored in the article From Labelling to Listening. For this article we will outline some of the other changes we have observed.

One such shift has been in the increasing involvement of people who use mental health services. We understand this as a move from tokenism to inclusion. Looking back two decades, service user involvement was quite a peripheral thing. At best, people were consulted but not fully involved. Back then, the idea of having peer support workers, people with lived experience of mental health challenges employed on the basis of having that experience, would have been a radical one. Now these roles are commonplace with an expectation that service users are included both in shaping and delivery of services.

Another shift is the development of the recovery movement from the being focussed on rehabilitation to education. Over this time, there has been the development of recovery colleges and a shift away from service-led interventions such as day centres. Mental health wards have also transformed over the last twenty years, seemingly driven by the imperative that these should be places that people are not expected to stay long.

Due to this continued move to community-based services, the large, long-stay hospitals are now a very distant memory. This can be seen as part of long process of change from incarceration to community. This has given many people the freedom both to live their lives and make mistakes in the way we all need to do.

However, in our discussion, we also reflected on the increase in compulsory community treatment orders. These legal measures ensure that people keep to certain conditions such as attending for mental health treatment. Those who find themselves in this situation in mental health services may well be reminded of the lyric from Hotel California which aptly states you can “check out” but never truly leave (Frey, Henley and Felder, 1977).

Away from hospitals and mental health services, there has also been the growing role of social media in highlighting prominent issues relating to mental health. We discussed the positives and negatives of this. In many ways this has helped break down barriers as people openly share their experiences of mental health challenges. 

However, in other ways we wondered if this has resulted in an overexposure for some people. This can be understood as a move from privacy to visibility. There are many benefits of this for reducing stigma, but is there potentially a personal cost for people who share this content and, perhaps, also for those who engage with it?

Social media did not have a significant presence twenty years ago. There was a need to find alternative ways for people to share their experiences of mental health and its services to a wider audience.

One of us was reminded of the first course we tutored at The Open University, which contained a dramatization by service users. This groundbreaking production, entitled, A Quiet Night on Roundhay Wing, captured an insiders' perspective on the practices that dominated and defined people’s experience at the time. This reflected a view that mental health services are something to be survived rather than to benefit from. 

This is not to say that things are now where they need to be. Conditions on wards are more clinical, but not necessarily more therapeutic. There are good intentions to reduce restrictive practice and compulsory treatment, but they still cast a long shadow. People are more open about their mental health challenges, but also many people are seemingly still struggling to get the help they need. The last twenty years has given us an indication of the direction we need to travel, but there is a still long way to go.