This chapter explores affective disorders from the perspective of the service user and the carer. It examines the policy and practice guidance driving the broader agenda of public participation, service user and carer involvement in shaping health service delivery. The chapter shows that elder abuse is a major but generally unreported problem. Women are over-represented in studies of depression and the prevalence rate of depression among abused women is 47.6%. The 'cycle of depression' for carers or older adults may be linked to physical illness, mental illness or the onset of old age. The chapter also examines the critical issues of choice and control in the care and treatment of older adults. Older adults need holistic joined-up services meeting all health and social care needs and reflecting the need to retain their social inclusion. Decisions about care and treatment are taken by professionals and when ill, older adults experience a loss of control and power.