Mental health services are intended to provide the means to deliver interventions and care to people experiencing mental health problems. This can only be achieved if the staff and resources to provide interventions and care are available. Unfortunately, the current design and resourcing of services can seriously interfere with this happening. Services have evolved over centuries, and many practices are determined by convention and limited by resources, particularly availability of staff in sufficient numbers and with appropriate skills. Mental Health Service provision, commissioning and funding in the NHS, and the evidence base are rapidly developing. Community mental health services, early intervention, assertive outreach, inpatient, outpatient, intensive care units and home treatment teams form key components, but clinical and patient-rated outcomes are still too infrequently measured to guide service development. The complexity of these services and their interfaces with primary care and specialist mental health teams are discussed in this chapter.

Financial arguments have been influential in the development of mental health services over the ages, from the establishment of asylums through to their demise and replacement with other forms of care. In 1960, gross domestic product (GDP) in the UK was £26.1 billion and by 2010 was £1.6 trillion. Adjusting for inflation gives an increase of some 336 per cent over this period. In 1960/1, the amount of GDP accounted for by health spending was 3.1 per cent and this had increased to 7.5 per cent by 2009/10. Given that in other areas productivity gains can be achieved though technological advancements, products in these areas are prone to become cheaper in real terms. More labour-intensive sectors (health but also education) do not experience such productivity gains and so, as an economy develops, we should expect and even welcome a greater proportion of spending going on those areas. Health economic studies carried out in London and published between 1999 and 2009 suggest that, while home treatment teams for people in acute mental health crises and early intervention teams may save money, assertive outreach teams for difficult-to-engage patients may not.