the development of treatment of patients with mental illness in the history of psychiatry on the one hand meant progress in the restoration of dignity to people who previously had been demonized, on the other it brought the danger of making patients into objects of medical attention. Progress can bring a loss of personhood. An integrated approach to both medical and psychological treatmentemphasizes the subjective initiative and decision-making by patients. In this regard, the shift from user participation to user leadership signals a radical challenge to the functionalist regimes of treatment that were promoted in the name of progress. However, in the current political climate of Neoliberalism user initiatives can again be instrumentalised to economise on public resources and this needs to be monitored carefully by user movements.