This paper presents findings from a national study into the Care Programme Approach funded by the Department of Health. The work examined the relationship between service user’s mental health issues, the services they received and the impact of both on carers. Background: Mental health services are required to take account of the needs of carers, yet little is known about how services affect carers. Aims: This paper explores the relationship between the user's mental health problems, the services received and the impact of caring on carers. Methods: Sixty-four carers were interviewed, measuring their experiences of care-giving, carer stress and the service user's level of impairment. A robust, composite measure of user severity was derived. Results: Carers were sometimes better judges than care co-ordinators of user impairment. Their experience reflected the independently rated severity of service users' problems. When carers were aware of care plans, they felt less negative about caring. Even in above-average mental health services, carers lacked information about: care plans, medication and complaints procedures. Conclusion: This evidence can be used in allocating resources such respite care, family therapy and CBT to carers. These findings have implications for how mental health services might improve their provision for carers, for instance, involvement in care planning may help carers to cope. Declaration of interest: This work received funding from the Department of Health. The views expressed here are those of the authors and not necessarily those of the Department of Health.