Background: Since 1991, English mental health policy guidelines have been explicit in recommending inter-professional working, involvement of patients and carers, harmonisation between health and social services and targeting at people with severe mental illness. Aims: To explore the structure and operation of mental health services in practice and relate them to measurable data. Method: A survey of mental health trusts was conducted in 1997-1998. Responses were compared with a concurrent survey of social services departments. Some qualitative data were collected. Harmonisation and targeting scores were devised and tested for association. Results: The response rate was 79%. The frequency with which different professionals, patients and carers were involved in the care process is described. Reasons for this are discussed briefly. Levels of harmonisation and targeting were found to vary widely and to be positively associated. Conclusions: This survey portrays mental health services' practice in relation to Government policy. However, adherence to guidelines cannot be taken as a guarantee of service quality or efficiency. Declaration of interest: The research was funded by the Department of Health. The views expressed are the authors' alone and not those of the Department.