A focus on health outcomes started in 1992 with the government strategy “Health of the Nation” (Department of Health, 1992a), which built on the earlier WHO document, “Health for All by the Year 2000”. Mental illness was included as a key part of this strategy, which set targets to reduce morbidity and mortality due to mental illness, and was followed by implementation strategies in the Mental Illness Key Area Handbooks (Department of Health, 1993, Department of Health, 1994, see also Jenkins, 1994). “ Building Bridges” (Department of Health, 1995) set out the vision for inter-sector liaison around mental health and “The Spectrum of Care” (Department of Health, 1996) set out the range of services and interventions envisaged as part of local services for mentally ill people. The Quality Outcomes Framework (QoF) was introduced in 2004 alongside PbR, as a performance management and incentive payment scheme for General Practitioners (GPs) in England, and includes mental health care indicators (see section 5.2).