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Spending on mental health accounts for around ten per cent of the overall health budget and so the mental health sector has a key role in responding to this challenge. The King’s Fund and Centre for Mental Health, with the support of the Royal College of Psychiatrists and the NHS Confederation’s Mental Health Network, have worked together to explore how mental health services could be delivered in a different and more cost-effective way. The consensus from their work, including an expert seminar and a review of evidence, is that there is scope for mental health services not only to improve their own productivity but also to support productivity improvements in other parts of the NHS. Mental health and the productivity challenge: Improving quality and value for money focuses on four main areas: immediate priorities for improving productivity in existing mental health services, what mental health services can offer to improve productivity in the NHS as a whole, the economic benefits beyond the NHS of improved mental health care, the longer-term challenge of building a preventive and empowering mental health system. The report suggests that there are real opportunities to change the way mental health services are delivered in order to achieve more within existing budgets.  Of the improvement areas highlighted in the report, we consider that the following are the most promising targets for immediate attention: reducing unnecessary bed use in acute and secure psychiatric wards, establishing systems to review the use of highly expensive out-of-area treatments, improving workforce productivity, strengthening the interface between mental and physical health care, particularly for older people and people with long-term conditions. 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Commissioning was intended to drive improvements in the quality, accessibility and cost-effectiveness of services, but has so far largely failed to achieve these objectives. The world class commissioning programme was introduced in 2007 to raise standards in commissioning. To meet this challenge, NHS commissioners have increasingly looked to external organisations, particularly those in the independent sector, for support. Building high-quality commissioning examines how external support is being used by primary care trusts and strategic health authorities and whether it is helping them to develop more effective commissioning. Our research shows that the use of external support is now standard practice in the NHS. There was evidence that in many cases external organisations had succeeded in improving commissioning processes and could provide support in key areas such as data analysis and commercial skills. However, it was also clear that external support is not always used effectively. This report provides guidance for commissioners, policy-makers and providers of support on how to avoid those pitfalls and ensure best value from external support. The recommendations made will be relevant to GP commissioning consortia as well as to PCTs. The coalition government’s intention to transfer commissioning responsibilities from PCTs to GP consortia may increase the need for external support in the future. 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