1) The NHS is facing £20 billion in budget cuts over the next 5 years which will impact mental health services. 2) To survive, individual clinicians and services must review what they do to ensure it aligns with strategic goals, demonstrate quality outcomes, and find more cost effective ways of working. 3) At a service level, mental health trusts should concentrate on core services, develop care pathways, workforce skills, and collaborate with other providers to use resources efficiently. Regional and national involvement can also help influence local decisions.