Perinatal mental illness (PMI) represents a significant public health concern affecting considerable numbers of pregnant women and mothers of infants. Depression and anxiety are key issues; however accurate identification of PMI, suitable intervention and provision of adequate services are salient contemporary challenges. Coherence in the commissioning of PMI services, appropriate and contextually sensitive to the needs of the locality, remains a critical factor in the provision of high quality, integrated and seamless care. However, such coherence has had difficulty in finding traction, largely as a consequence of complex service and organisational structures and commissioning pathways. This paper discusses many of the issues that must be considered in the provision of high quality PMI services that are sensitive and appropriate for the needs of women and their families in the community. An exemplar of the development of a local service is discussed in detail.