User-focused monitoring (UFM) is an emerging method for user involvement and quality development in the Swedish mental health sector. It involves people with lived experience conducting a systematized evaluation of a mental health service or support programme. The aim of this study is to analyse motives and central concerns when initiating a UFM project. Five UFM projects in Sweden were sampled, 16 semi-structured interviews were performed with user monitors and commissioners and analysed using conventional content analysis. Our results showcase a range of motives for conducting UFM, illustrate the centrality of trust in the relationships of the UFM practice and the varying degrees of user autonomy in UFM projects. We further discuss our results in relation to epistemic trust and organizational learning theories. Accountability processes are discussed as important for securing continuous trust between the stakeholders. Furthermore, trust is required for UFM being applied to engage in continuous learning and review of organizational norms and goals together with service users.