This paper describes major reforms to mental health services in the UK over the past 50 years and analyses the significant reforms of the 1980s and 1990s. These involved moves towards a balanced, mixed community/institutional provision of services set within a range of significant reforms to the National Health Service. The major intended and unintended outcomes of the reforms are reported. A major aim of the paper is then to describe an alternative refinement to service provision. The alternative approach, known as ‘stepped care’ is described in the context of depression services in the North West of England, where it is currently being implemented to improve and simplify services. In particular, the paper describes the use of system dynamics modelling to overcome anticipated problems with stepped care, such as communication of benefits and resource reallocation. The modelling process provides an example of archetypal thinking in action to pre-empt and counter unintended consequences in parallel with the main reforms.