Mental health social work is at an impasse. On the one hand, the emphasis in recent policy documents on the social roots of much mental distress,and in the recovery approaches popular with service users seems to indicate an important role for a holistic social work practice. On the other hand, social workers have often been excluded from these initiatives and the dominant approach within mental health continues to be a medical one, albeit supplemented by short-term psychological interventions. Here, Jeremy Weinstein draws on case studies and his own experience as a mental health social worker, to develop a model of practice that draws on notions of alienation, anti-discriminatory practice and the need for both workers and service users to find 'room to breathe' in an environment shaped by managerialism and marketisation.