Service user involvement in the planning and provision of mental health services has been growing over the last two decades, especially in countries and areas where institutional service provision has been changed to a community-orientated model of care. However, the material involvement of service users in mental health research is still in its infancy. The aim of this paper is to attempt to place these developments in a conceptual context, to summarise the ethics-based and evidence-based reasons why it has to be considered as necessary, and to illustrate some of the emerging evidence which shows the advantages to be gained from it. In particular the results of recent studies are briefly reported, showing that outcomes data rated by service users in some cases are more important than those rated by staff. The reduction in patient-rated unmet needs in the social domain was the strongest predictor of an increase in subjective quality of life. The importance of including service user preferences within the content of the research questions is exemplified by the results of a recent study that showed that joint crisis plans can significantly reduce the use of compulsory admission during crises and by a review that demonstrated that the use of an explicit service user perspective produced distinctive insights into the long-term effects of Electro-Convulsive Therapy (ECT).

Declaration of Interest: none.

Aims and methods — This article, written from a service user/survivor perspective, explores a hypothesis which seeks to offer a more systematic basis for the full and equal involvement of mental health service users/survivors in both the research process and research structures more generally. The hypothesis challenges traditional emphasis on positivist assumptions about the priority of values of ‘distance’, ‘neutrality’ and ‘objectivity’ (which it argues discriminate against service users and their experiential knowledge). It explores instead the idea that ‘the shorter the distance between direct experience and its interpretation, then the less likely resulting knowledge is to be inaccurate, unreliable and distorted. Results and conclusions — The proposal discusses ways in which such (objective and subjective) distance may be reduced, to improve the quality of research, to enable more equal involvement of service users and their direct experience and to make it possible for non-service user researchers to work alongside service users on more equal terms.

Declaration of Interest: Peter Beresford is Professor of Social Policy at Brunei University and Chair of Shaping Our Lives, the national independent user controlled organisation which receives its core funding from the UK Department of Health. No financial support from pharmaceutical or other commercial companies has been received by the author over the last two years. Funding has been gained from governmental and non-governmenatal funding agencies.

The involvement of mental health service users in service delivery is a new and growing phenomenon. Such involvement is complex, given the history of paternalism in the mental health system, the power differential between service providers and service users, and the very differing views each group holds on multiple issues. Unless such differences are addressed, there can be no meaningful involvement. Service user involvement needs to apply to all aspects of the service delivery system, including professional training, service design, delivery, evaluation, and research. User/survivors, and their organizations, have developed a body of experience and knowledge that needs to be recognized and respected. Unless there are multiple opportunities for ongoing and open dialogue on these many difficult issues, real user involvement will not occur.

Declaration of Interest: the author has received no financial support that presents a conflict of interest.

Aims — In this article the author – board-member of the European Network of (ex-) Users and Survivors of Psychiatry (ENUSP) -explains, what is needed to guarantee a minimal level of involvement of users and survivors of psychiatry into issues relating to psychiatric drugs. Methods – He reflects demands of their organisations, and compares these demands with the current involvement level. Considering the concrete circumstances in psychiatry, he reflects the risks and dangers of the administered drugs -especially the widely used neuroleptics –for example enhanced breast cancer risk in women, suicidal effects, receptor changes, tardive dyskinesia and other toxic reactions. Results – Considering the unique situation of psychiatric patients to receive treatment in general without informed consent and in a violent way or through bullying and threat, he argues for to provide their involvement in all aspects of psychiatric drug issues -especially registration and monitoring, for example by their involvement in creating and running a suicide register. And he argues for involvement in ethics committees, licensing processes and providing guidelines and decision making about effectiveness and reimbursement of costs. Conclusions – As first steps towards these aims he proposes independent and user-controlled research, independent and user-controlled education and independent and user-controlled information about the effects of psychiatric drugs.

Declaration of Interest: the Author did not receive any grants and financial support for the study; any forms of financing (included pharmaceutical company support and any honoraria for consultancies or interventions in the last two years); any other involvements that might be considered a conflict of interest in connection with the submitted article.

Aims – Best practice emphasises user involvement. This exploratory study addresses the views of teenage clients and their parents on service delivery in a specialist Child and Adolescent Mental Health Service (CAMHS) serving a population of 250,000. It aims to explore some of the complexities inherent in children's services when parents are integral to modes of treatment. Methods — Twenty-seven teenage clients from specialist CAMHS were recruited with their parents (n=30). All were white British, 11 boys and 16 girls, from a range of socioeconomic backgrounds. Focus groups were employed using a series of structured interactive technique to elicit information, preceded by home visits. Analysis of interview data followed standard approaches to qualitative data analysis. Descriptive statistics were generated from both home interview data and focus groups. Results – Three themes emerged: the core values implicated in establishing a therapeutic alliance; the style of therapy and mode of practice (i.e. its inclusiveness of different family members). Practice implications – Core therapeutic skills are of fundamental importance. Our paper supplements a model of organisational user involvement with a model of therapeutic user involvement for use in negotiating mode of practice. Conclusions – This exploratory study was a collaboration between service users, researchers and health professionals exploring three important themes of therapy and the complexities inherent in children's services. The process of eliciting views was therapeutic in itself leading to the formation of a parent-led self-help group. The design can be replicated in other specialist CAMHS to achieve attuned practice.

Declaration of Interest: none.

The Prenatal Determinants of Schizophrenia (PDS) study was designed to examine early antecedents to schizophrenia. Based in the Child Health and Development Study cohort assembled in 1959-1967, over 12,000 cohort members were followed in the PDS study for psychiatric disorders. Using the extensive data and biological samples prospectively collected beginning during pregnancy, PDS investigators have examined the influence of prenatal exposures on risk of schizophrenia in adulthood. Here we describe a few key findings from the PDS with respect to prenatal infection, nutrition, and toxic exposures.

Declaration of Interest: Supported by the Lieber Center for Schizophrenia Research, and the following grants: NIMH 1R01MH 63264-01A1 (A.S.B.), NIMH 1R01MH-60249 (A.S.B.), 1R01MH-60249-03S2 (A.S.B.), 1K02MH65422-01 (A.S.B.), aNARSAD Independent Investigator Award (A.S.B.).

Background — In order to minimise retrospective recall in developing estimates of the prevalence of mental dis-orders in the general population, we conducted a prospective study of a cohort of youth from Zurich, Switzerland. Method — A 20 year prospective study of a community-based cohort aged 19-20 from Zurich Switzerland. The sample was enriched by subjects scoring high on the Symptom Checklist 90 R (Derogatis, 1977). A semi-structured diagnostic interview was administered by clinically experienced psychologists and psychiatrists. The six interviews from 1979 to 1999 assessed diagnoses and sub-threshold manifestations of major diagnostic categories (with the exception of schizophrenia) for the past twelve months, depending on the current DSM versions (DSM-IH, DSM-HI R, DSM-IV). Additional information on symptoms and treatment were collected for the years between the interviews. The reported prevalence rates are weighted for stratified sampling and cumulate the one-year rates of the six interviews. Results — The cumulative weighted prevalence rates for any psychiatric disorder were 48.6% excluding, and 57.7% including tobacco dependence. In addition 29.2% and 21.8%, respectively manifested sub-diagnostic syndromes. Overall there were no significant gender differences. The corresponding treatment prevalence rates were 22.4% and 31.1%, respectively for the diagnostic subjects and 6.9% and 6.1 %, respectively for the sub-diagnostic groups. The total treatment prevalence rate was 37.2% of the population (males 30.0%, females 44.1%). Conclusions — Our findings reveal that psychiatric disorders are quite common in the general population. When the spectra of mental disorders are considered, nearly three quarters of the general population will have manifested at least one of the mental disorders across their lifetime. Limitations — The data are based on a relatively small sample; a single age cohort, and the study was conducted in Zurich, Switzerland. These study features may diminish the generalisability of the findings.

Declaration of Interest: this work was supported by Grant 3200-050881.97/1 of the Swiss National Science Foundation, and Research Scientist Development Awards (MH 46376 and DA00293) from the US National Institutes of Health (Dr. Merikangas).

Background — By the mid-1960s, the importance of socio-economic status for schizophrenia had been demonstrated in terms of differences between social-class groups in prevalence and incidence rates, illness course and outcome, and treatment experience. In the causation – selection debate, however, opinion had swung in favour of the selection hypothesis. Aims — To reassess evidence on the social-class distribution of schizophrenia in Britain, and to compare this body of research with population-based studies of schizophrenia risk in socially disadvantaged ethnic minorities. Method — Systematic review of medical and psychological data-bases. Results — Epidemiological research, while confirming the importance of premorbid social decline, has also provided support for the environmental ‘breeder’ hypothesis. High psychosis rates have been confirmed in ethnic minori-ties; in particular among Afro-Caribbean and other Black immigrants whose low social status cannot be accounted for by selective downward social drift or segregation. Conclusions — There are striking parallels, both in the epidemiology of schizophrenia and in social characteristics, between the lower-class indigenous groups highlighted by earlier psychiatric surveys and African-Caribbean populations in Britain's inner cities today. These similarities underline the need for a broader perspective in the search for environmental risk factors.

Declaration of Interest: none.