Background: High-quality health services include both safe care as well as involving service users in treatment and decision-making.

Material: The aim was to explore how mental health service users perceive the relationship between safe care on the one hand and increased influence and decision-making on the other. This was a qualitative study of 15 User Interviewing User evaluation reports, including 417 service users.

Discussion: Safe and predictable care was essential in poor illness phases, while increased influence and independence were more important in better phases.

Conclusions: High-quality services are flexible enough to adjust to users’ varying symptoms and needs.