BACKGROUND: Mental health problems are under recognised and under treated in people with multiple sclerosis (MS). METHOD: A nurse-led project linking MS and mental health services was evaluated. Data on all referrals and management from 2006 to 2008 were collected prospectively. RESULTS: 127 referrals were received. 82% had depression, 53% had anxiety (45% both). 42% were offered case management; 52% received Cognitive Behaviour Therapy (CBT), 55% required initiation or alteration of psychiatric medications and 19% were referred to secondary care; 16% had made suicidal plans. Significant improvements in depression at 6months occurred, but not anxiety or fatigue. CLINICAL IMPLICATIONS: This service provides a model of mental health provision for patients with long term neurological conditions, in particular MS.