The professionals’ beliefs about the possibilities to communicate and engage patients in their care can have a crucial impact on the framing of the meeting and thereby on patient’s possibilities to be heard and participate in the treatment and care process. It is possible to identify three ethical perspectives through history in the normative medical and psychiatric ethics literature. These three perspectives are paternalism (The Hippocratic Oath), autonomy (The International Code of Medical Ethics) and social inclusion (Universal Declaration of Human Rights and the Madrid and Kobe declarations). These three perspectives reflect a historical development of values in psychiatry, and can be seen as complementary to each other. One of the important differences is who has the right to make decisions; the doctor, the patient, or whether they should seek a joint decision. Psychiatry's cultural heritage has been paternalism, in both positive and negative forms, the others perspectives came with the democratization of society. The latest of these perspectives, social inclusion is a development specifically in psychiatry. Social inclusion can be defined as a process to improve the terms of participation in society; to enhance the opportunities for people who are disadvantaged to get access to resources, get their voice heard and rights respected. The care and treatment process should be characterized by participation of the patient. Social inclusion could become a cultural heritage of modern psychiatry. We will discuss social inclusion from a researcher and user perspectives focusing on four areas; interpersonal meetings, patient involvement in care, organizational conditions for care and coercive measures. We want to show examples of how staff and management is handling this shift of value perspective taking place and what opportunities and obstacles there are to implement a more inclusive care.