In the twentieth century, as some societies moved from manufacturing to service, in the developed world the self help movement and the human rights movement parented the mental patient movement. This new movement inherited the self-help principles of volunteering, mutuality, valuing the experiential, and deflating professional privilege, along with the civil rights focus of other disability rights, gay rights, and women's movement groups and was nurtured by the politics of empowerment in an increasingly self-help oriented society.

In the 60's, the mental patient movement challenged psychiatry's hold on explaining behavior but remained separatist. By the 80's, diagnosed people were changing the mental health system from within. Some groups maintained a strong anti_psychiatry ideology; society was urged to increase social acceptance of human diversity. Some groups developed institutional collaborations or at least interactions - partnerships.

Either way, there is a shared user value base of self_determination, dignity, hope, reciprocity, witnessing, spirituality, diversity, ... and personal competence is connected with a desire for and a willingness to take public action.

But in the United States, we have no national consumer organization. There are at least five federally funded bodies  that sometimes serve as substitutes. The family voice is well-funded and very strong, often presenting loved ones as objects of pity, as public safety hazards unless medicated. Consumers can act when the danger is sufficient. The threat of increasing unconsented interventions in New York and California mobilized many, but unsuccessfully. Progressives fear the United States is moving away from democracy in our political, social, and health practices.

In California, for twenty years we have had a now state-funded client network which joins with other social justice and provider organizations to advocate for housing and choice. However, the network has been slow to develop across the state and it’s recognition in the capitol is not matched at the local level.

Here in Santa Cruz, we have a county-funded peer-run drop-in which is vibrant, providing support and personal enrichment and sometimes advocating around county budget issues.

There are other groups and other voices, a patchwork that is often fringe and that generally doesn’t ally with each other or with the cross-disability or social justice community.

The World Health Organization stated in 1978 at Alma-Ata that health is holistic, biopsychosocial, and I would add spiritual, and that "the people have the right and duty to participate individually and collectively in the planning and implementation (organization, operation and control, and I would add evaluation,) of their health care," and that a target is a "socially and economically productive life."

Mental health has been failing on all counts - though users and survivors are beginning to be included, that inclusion is not yet meaningful and effective. Partly because there is a pervasive assumption of our disorder; a cloaked process, a lack of transparency about how the system works; and an unwillingness to shift to a more-than-medical understanding.