What events in the 1990s will be considered significant when the history of mental healthcare is written? It is hard to tell because of so many false dawns. Responses to crises have often been little more than superficial public relations jobs coupled with a new tranche of guidance - some of it useful, some of it less so.

The false dawn has become so much the norm in mental health that it has produced an army of cynics. This has created precisely the right conditions in which to miss those once-in-a-decade opportunities which really do matter. One of these moments may be with us now. We must use it or lose it.

It takes some digging beneath the publicity to discover what may really be happening. Ministers are apparently suggesting another policy reversal and telling us that the mantra 'community care good, hospital care bad' has gone forever. There are leaks to the BBC, allegedly straight from Number Ten, testing the idea that community care will be abolished, and stating that safe places will be offered instead. Oh yes, and hidden in the small print is a suggestion that money many be on offer, something like pounds500m over 10 years for health, and another lot for social

services.

Such a figure is undeniably momentous, and we had better wake up to this. It is roughly equal to what the Sainsbury Centre and other mental health organisations such as the National Schizophrenia Fellowship, the Mental Health Foundation and Mind estimate to be the minimum needed to develop adequate mental healthcare nationally. It is a once-in-a-generation opportunity to make a difference. If we blow it, there may not be another chance. Yet it can be wasted: the fastest way is to follow some current suggestions.

The political emphasis on safe 24-hour places is understandable, inspired by yet more appalling incidents associated in the public mind with the continuing calls for more hospital beds. Logic says we had better go back to the time when we locked up the individuals who posed an unacceptable risk. Of course, it is argued, care must be humane this time, and then everybody will be happy.

Ignoring the problems of definition and identification, probably about 5,000 people in the community have serious behavioural problems, and we can provide 24-hour nursed care for pounds40,000 each annually. That is a cool pounds200m a year indefinitely. Hospitals have occupancy rates of up to 130 per cent; so we also need an increase of, let's say, 20 per cent in bed numbers - 8,000 beds, costing about pounds300m. That's the money gone. For those who think these numbers are an exaggeration, remember we have 25,000 fewer beds than 10 years ago.

Mental healthcare must be tightened up. Unfortunately, the populist scenarios are based on simplistic beliefs such as the predictability of risk, the supposedly higher intrinsic risk of community care and the safety of institutional care. They ignore facts and evidence.

We know that rates for homicides committed by mentally ill people have not increased, and have gone down as a proportion of all homicides. We know from the many inquiries that incidents are related to poor co-ordination of care and unclear responsibilities, often while people are still inpatients or living in residential care.

We also know that 24-hour nursed care is not popular with its target population, mostly young men, who want their independence. If admitted, they would simply walk out of nursing homes or hospitals, just as they do now, and would withdraw from care, just like now. Horrifying incidents would occur - probably with the same frequency as they have always happened - and continue to receive high-profile publicity, and the next government will condemn the policy as a failure.

The Mental Health Act would be blamed, and draconian measures would be introduced to lock people up to compensate for poor care. More beds would also be demanded, and more resources. Some people would escape, more incidents would occur.

There is an alternative that could break the cycle. We could use the money to create the services which address the priorities of service users and the public alike. Sometimes it is forgotten that service users are not from a different planet, but have aspirations identical to the rest of us. These do not include isolation, sleeping on the street or spending the rest of their lives in Broadmoor. They want emergency services available 24 hours a day and continuity of care, but especially a decent place to live, meaningful occupation and some money to spend. It could be called social inclusion.

We know that crisis teams can achieve early intervention. Assertive outreach services are able to keep in contact with the most challenging people. Obviously, they need backing up with hospital care and a range of occupational and residential provision. Most of the people we need to target live in the inner cities, where we should spend the growth money. Service profiles need to be formulated across all agencies, and a system of care should be implemented as an inter-agency mental health action programme.

If we are very lucky and the rumours are right - whatever the rhetoric - ministers have made a historic decision which earns respect. It would mean that funding plans are realistic to achieve the objectives that have so far been illusory. At last sufferers, whether patients, staff or society, may experience some relief from the neglect of care and the onslaught of public opinion. If the rumours are wrong, or if the money is directed exclusively to a capital-led strategy - more beds or bust - the consequences for the next generation do not bear much thinking about.

Dr Matt Muijen is director of the Sainsbury Centre for Mental Health.

'We could create services which address the priorities of service users and the public alike. Sometimes it is forgotten that service users have aspirations identical to the rest of us. These do not include isolation, sleeping on the street or spending the rest of their lives in Broadmoor'