Anne O'Donnell and Lydia Sapouna, based in Scotland and Ireland, respectively, are activists and writers who have made long-standing contributions to the debate about mental health and recovery. In this dialogue they exchange analyses of the achievements and lessons to be learned from mental health activism that has resisted dominant narratives of mental illness and that has created innovative, collaborative and critical spaces for the exchange of ideas, experiences and enthusiasms. The dialogue seeks to evoke the distinctive styles of activism adopted in each context, the successes engendered and the kinds of dilemmas and tactical choices navigated. Ann and Lydia have initiated a process of reflection and exchange, and out of this they have constructed a dialogical piece that highlights key organizational issues for mental health activists and for community based social movements more generally.