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Quality of care—be it at the level of the institution or the individual healthcare professional—is at the core of the modernisation of the NHS,¹ but nowhere is it more difficult to measure and assess than in the area of mental health. Unlike diabetes mellitus and, to some extent, coronary artery disease where there is good agreement on the absolute threshold for making the diagnosis and increasing consensus as to what processes constitute high quality care (e.g. retinal screening, use of aspirin), the definite diagnosis of a mental health problem and agreement on its optimum management is much less clear. This is particularly so for the large burden of mainly undifferentiated mental illness that presents in primary care. Although undifferentiated, it should not be assumed that the severity and accompanying functional impairment are not insubstantial. We are not, as some might assert, dealing with the “worried well”.

In secondary care, psychiatrists are better able to agree on the diagnosis, partly because they are more used to using internationally agreed classification systems. In addition, more research has been undertaken to examine both the process and content of care for patients …