hence there is a need to develop indicators of population mental health that also reflect mildtomoderate mental illness a number of factors are responsible for this lag including the complex nature of mental health problems high rates of comorbidity and lack of agreement on suitable measures stakeholder in particular clinicians patients and families involvement and the integration of quality and outcome measurement into key processes of care are integral to ensuring mental health is at the forefront of highquality services that are efficient and deliver value for money to understand mental health system performance at an international level better measures of the quality and outcomes of mental health care are needed