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The U.S. mental health service delivery system consists of a broad array of inpatient and ambulatory services operated under governmental, corporate, nonprofit, and entrepreneurial auspices. Granted this complex mixture of control patterns, a primary question to be addressed by this paper is the degree to which this set of services can be conceptualized as a system at any level of social organization beyond a single control point for a subset of services. This paper will also explore the utility of systems formulations, including cybernetic processes, for addressing the question of whether mental health services can be controlled and directed to such a degree that they act in concert across different control points. Reference will be made to exogenous systems, such as public and private reimbursement programs, that may influence control processes. Some directions for future research will also be explored.

The mental health field is viewed by some as reluctant to tackle the problem of abuse. While ‘adult protection’ offers one way forward, the authors of this paper caution against over‐enthusiastic borrowing from this paradigm. Instead they argue that mental health services will only become intolerant of abuse when there is widespread acceptance of the role of power abuse in psychological distress and disturbance.

In the last decade we have witnessed much debate and activity around the provision of mental health services for people with learning disabilities in England. This article looks not only at current initiatives to improve mental health care from around England, but also places them within a policy context. Unfortunately there are areas that still fail to provide a basic care standard, some of which has been reported throughout the media from recent investigations. Where this is the case, we outline the responses and actions that have been put in place to address these issues.To maintain a momentum for positive change for the mental health care of people with learning disabilities, there now needs to be cooperation between services that traditionally have not worked together for the benefit of this client group. Before an equality of mental health service provision, in line with national standards, can be realised the traditional views and values of service providers and commissioners will need to be challenged and tuned to the needs of this group of people.

Service systems for people with learning disabilities in Scotland have developed in the context of the Scottish legal system and devolved policy for health. Scottish organisations are responding to the spectrum of mental health needs by working in partnership to improve quality. This article describes this system and the key organisations, and presents some findings of the National Overview Report of services undertaken by NHS Quality Improvement Scotland.

Young homeless people have mental health needs. Research and national policies have highlighted that accommodation providers need to offer holistic interventions to encourage this vulnerable group to break the cycle of homelessness. Currently no research literature documents how homeless shelters respond to mental health needs. This research was intended to address this research question.A postal questionnaire was sent to 132 managers of homeless shelters, achieving a response rate of 64.4%. Frequencies and descriptive statistics were calculated, and written data was analysed using content analysis. Mental health problems were highly prevalent, and homeless shelters responded in a variety of ways (use of GP services, internal services, referring to external services, in‐house outreach services, no service provision, etc). Only 27.1% of managers of homeless shelters reported that their services were sufficient to meet their young people's needs. These findings reflect the need for inclusion of mental health in homeless shelters' strategic objectives, and development of commissioning of local partnerships with health agencies.

The purpose of this paper is to obtain an insight into how mental health and alcohol services are responding to people presenting with alcohol and mental health problems, as a part of a wider North West Alcohol and Mental Health Project commissioned by Drink Wise North West and Alcohol Improvement Programme (Department of Health).

An electronic survey was sent to managers and clinical leads in mental health and alcohol services across the North West region of England.

The paper found a variation in definitions of dual diagnosis and that not all areas had a strategy in place. NHS mental health and alcohol services seemed to offer a wider range of treatment options; but, this reflects the more complex nature of the service users. Workforce issues were identified as an important issue. Barriers to accessing effective care included lack of agreements between local agencies, and solutions included greater partnership working.

This was a small sample of respondents, accessed opportunistically and, therefore, unlikely to be a true representation of all services in the North West of England.

Whilst limited in scope, this survey highlights that even after ten years of service development related to alcohol and mental health, there are still significant barriers to effective care and that more workforce development and multi‐agency collaboration is required.

Changes have occurred in the pattern of services for people with learning disabilities and mental illness and/or challenging behaviour over recent years, with the development of a variety of service models across the UK. In SE London, residential services are based predominantly on a supported housing model and the strong philosophical premise that people should not be excluded from a community residential service because they have complex physical, behavioural or mental health needs. Local services, therefore, are supporting individuals with a wide range of need. This paper describes the development of specialist mental health and challenging needs services in support of this model. The issues raised are outlined, together with a list for action and priorities to overcome the difficulties encountered, including the maintenance of an effective infrastructure.

Forensic mental health services play an important role in providing treatment and accommodation for people diverted from prison or the courts who require secure and specialist mental health treatment. There are more than 3,500 people in medium and high‐secure hospitals who have been directed there by the courts or prison system, and nearly 1,000 new admissions are received each year. Yet, the facts and figures relating to these services are patchy and not widely published. This paper builds on an earlier statistical briefing produced by the Sainsbury Centre for Mental Health in 2007, and seeks to provide an up‐to‐date and improved understanding of this area of service provision by presenting the most recent data and figures.

Green Light was developed to enable service providers to implement the National Service Framework for Mental Health (NSF MH), and asks how good your mental health services are for people with a learning disability. A multi‐agency user and carer project in Hampshire has evaluated and improved the quality of existing service provision for adults with learning disabilities who also have a mental health problem.