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Citizen participation, public involvement, call it what you will, is a little like the United States. Even if you willfully ignore the existence of Native Americans, the USA is hardly the ‘new world’ it is sometimes still presented as, with a history of colonization nearly half a millennium long. Similarly, provisions for public participation extend in the UK, for example, to over half a century in land use planning, while requirements in health, social care and children’s services have been in place for almost a generation [8]. Yet there is still a tendency to treat issues of participation as though they were novel and special, rather than with the seriousness that they merit as the routine part of broader policy and political frameworks they are now meant to be. Such involvement became institutionalized as an acronym in the UK National Health Service, initially as PPI – public, patient involvement (also Patient and Public Involvement and Engagement (PPIE)) and, since 2017, as patient involvement PI. However, public involvement is also an international development, with equivalents in Europe and the US although it is far less developed in the Global South. In the UK it is most closely associated with health and care – extending to all their aspects – from policy, practice and learning, to evaluation, research and knowledge development, but it is also an expression of a wider interest in customer involvement in the public sector more generally and of the notion of the ‘public service consumer’ [21]. I have been involved in participatory developments since 1977 as writer, researcher, educator, activist and (long term mental health) service user. I have been privileged to be part of the emerging psychiatric system survivor and disabled people’s movements over that period, as well as being involved in UK government developments at a high level, and in voluntary organizations, user led and disabled people’s organisations (ULOs and DPULOs) and activities and also international schemes, as well as initiatives in other countries. This has offered me close-up insights into theory, policy and practice developments over this period as well as opportunities to be part of them. It has introduced me to many people involved in such activities as policymakers, educators, practitioners, service users and family carers [5]. This experience has highlighted for me a range of key issues in relation to PPI – public and service user involvement and it is these I want to explore here. While I am not suggesting that this list would be shared by all concerned with these issues, the fact that I have been directly involved with many people from different standpoints, both individually and collectively, gives me some confidence that this list is likely to have at least some wider relevance and resonance. The issues that have emerged for me about public and service user involvement over more than 40 years can perhaps be best summed up in terms of a series of relationships. Issues with these relationships have characterized them so far and if we want progressive change, then we are likely to need to review and change those relationships for the future. The relationships that I have found most striking are those of PPI and involvement with:

PPI Or User Involvement: Taking stock from a service user perspective in the twenty first century