This paper reports a qualitative evaluation undertaken to investigate the perceived impact of the FACE quality assessment tool across a range of mental health settings and to identify factors critical to the successful implementation of quality assessment (QA) and quality improvement (QI) systems in mental health services. The 'FACE initiative' led to positive changes in service provision but there was some variation in its perceived effectiveness among settings. Support from management and senior medical staff, staff ownership of QA/QI initiatives and adequate resourcing were identified as key factors in ensuring the success of QA/QI in mental health. QA/QI techniques such as FACE can lead to improvements in the quality of care but further research is required to provide conclusive evidence about the effectiveness of these initiatives in improving patient outcomes.