- Mental health policy in the United States and Britain has been moving in a similar direction for several decades, from institution to community based services. In both countries there is a pressing need to speed the pace of service development in the community, and also awareness is growing that service provision must become much more responsive to what users, carers and ethnic minorities consider most important. Part 1 of this report describes common concerns of the US and Britain in making a transition in mental health systems; part 2 describes a 15 year effort by the US National Institute of Mental Health to improve community based services nationwide, the Community Support Programme. Part 3 examines the situation in Britain in the 1990s. It then draws upon US experience to examine six critical issues that must be effectively and continuously addressed at all levels to ensure better future for people with mental health problems.