Until 1999 mental health services in England enjoyed wide ranging freedoms to decide how to provide services, a form of “localism” that is now once again central to governmental thinking on public policy. The consequence was no overall pattern of service, variations in the standard of care, and dissatisfaction by service users and carers. This situation was transformed by the 1999 National Service Framework for Mental Health, which—typical of governmental policy at that time—set centrally agreed standards and required a particular model of care (including home treatment, assertive outreach, and early intervention teams) to be implemented consistently across England. Unusually for a national strategy, this framework was substantially put into practice,1 largely through strong and financially incentivised performance management methods.

The coalition government has now published its new long term mental health strategy for England.2 Its six main “shared objectives” are: more people will have good mental health; more people with mental health problems will recover; more people with mental health problems will have good physical health; more people will have a positive experience of care and support; fewer people …