Mental health services have a high policy priority with new plans and guidance afoot. Morale amongst mental health service providers in both specialist and generalist settings is low, with staff recruitment and retention dwindling. The prevalence of identified and diagnosed mental health problems is increasing, and is much greater in disadvantaged settings. Material and social deprivation, financial hardship, and widening discrepancies in relative wealth are associated with, and probably contribute to, a greater prevalence of mental ill health in the inner city. The importance of developing a whole system approach, and the related acceptance of the needs and contribution of primary care were openly acknowledged and to a certain extent promoted at a senior level. In May 2000 a whole system event involved 150 people meeting together to focus on problems and successes of the existing system and to define the changes and actions required.