Simon Duffy talks to Brainwaves following his keynote speech “Being a true equal: Citizenship contribution and mutual support under a modern welfare state ”at the VICSERV Conference in May this year. Simon explored what it means to be a true equal and what this means for how we think about mental health and the organisation of support. The modern welfare state, particularly health and social care, has become a vast empire of services. But there are good reasons to think that this empire does not serve us well, and in particular that people with mental health problems are being held back by old ideas and old systems. But we will not make progress by trying to convert patients into consumers. Progress will only come from treating each other as citizens, recognising our gifts and our ability to contribute and support each other.