The National Service Framework for Mental Health was published in 1999. It laid out a much welcomed list of standards of what health services were to be provided – in terms of mental health promotion, services in primary and secondary care, services for carers and for suicide prevention. It gave an expectation that all of these would be met within a ten year timeframe. Five years on, it is time to reflect on how far mental health services have risen to the challenge. The picture is mixed.