There has recently been a re-emergence of interest in non-reductive historical materialist modes for analysing social movements. A precursor of this is found in the work of mental health activist and Marxist theorist Peter Sedgwick. We contend that Sedgwick's work retains utility for theorising radical mental health movements in the twenty-first century, though we argue his framework needs extension in light of intervening debates regarding the interaction of material (distributive) and post-material (recognition) concerns. Having established this we will turn to an overview of recent neoliberal work, welfare and mental health policy reforms as a basis for consideration of strategic implications and challenges for resistance and coalition building amongst survivor and worker activists. We will propose a contemporary Sedgwickian strategy that identifies transitional organizing goals combining concrete material demands with imaginative, prefigurative means oriented towards ruptural change. In conclusion we argue that tools for promoting this strategy such as the Social Work Action Network's (SWAN) Mental Health Charter may assist in binding together diverse constituencies to strengthen alliances of resistance and deepen a politics of solidarity.