Critics say the new mental health strategy fails to tackle the staffing crisis or caseload size and is wrong on the 'public safety' issue. Laura Donnelly reports

The tabloids were ready and waiting for health secretary Frank Dobson to condemn care in the community and bring forth the government's mental health strategy.

The strategy had been on the tip of Mr Dobson's tongue for an awfully long time - it is hard to spot the differences between a draft copy leaked in April and the final version of Modernising Mental Health Services.

So when Mr Dobson last week told the Commons that 'community care has failed', The Mirror knew exactly what he meant, and reassured fearful readers that 'Evil Psychopaths Will Be Locked Up'.

So, farewell then, care in the community.

Except that despite the swathes of column inches waving it good riddance, the strategy's proposals consist largely of measures to strengthen and support community-based care.

Mental health groups, including Mind, Sane, and the National Schizophrenia Fellowship, welcome the emphasis on assertive outreach, improved training for nurses and primary care staff, 24-hour nursing teams and helplines.

Mind chief executive Judi Clements says£700m extra funding over the next three years will mean 'a substantial investment in services'.

Of the assertive outreach teams, she says: 'If they are well staffed, with a good level of training - then yes, they could be a great asset.'

But she is not alone in believing that teams may find themselves 'under- resourced and poorly trained' unless the government tackles low recruitment levels and low staff-to-patient ratios - issues on which the strategy gives little guidance.

Ms Clements says: 'There is a need for staff to have lower caseloads - and this is not something that is properly addressed in the strategy. At the moment we see community psychiatric nurses with caseloads of one to 57.'

The NHS Confederation and the Community Psychiatric Nurses Association are equally concerned about staff shortages. CPNA professional officer Brian Rogers describes recruitment plans as 'too modest'.

And Paul Corry of NSF cites 400 vacancies nationally for consultant psychiatrists as evidence of staffing problems 'from the top down'.

He adds: 'Our major concern is the money. We were hoping for something like£1.5bn over the next three years.' He says the costs of setting up new outreach teams and providing new drugs such as clozapine could 'wipe out most of the government's budget'.

Mr Corry is among many criticising both the 'public safety spin' placed on the new strategy and the government's criticism of community care policies.

Ms Clements and shadow health secretary Ann Widdecombe see Mr Dobson's comments as an 'insult to dedicated staff'.

And King's College centre for mental health services development director Edward Peck believes the spin is not only 'profoundly unhelpful to staff' but distracts attention from the policy's 'real weaknesses'.

Of these, he cites the government's failure to address the problems of patients with a 'dual diagnosis' as 'the most serious cause for concern'.

Dr Peck warns: 'One of the major problems is substance abuse - and those with a dual diagnosis of mental illness and substance abuse are more likely be violent than those who are just mentally ill.

'Over half of those people coming in to mental health services have a dual diagnosis.'

Despite the long wait for the strategy, the Department of Health failed to consult with substance abuse charities, says Dr Peck.

Future legal changes to allow compulsory treatment in the community and the detention of people with personality disorders are the cause of greatest alarm among mental health professionals.

Sane is one of the few mental health groups to welcome the plans as 'redressing the balance'.

The Royal College of Nursing says compulsory treatment orders are 'counter- productive' - 'driving patients underground and further out of contact with services' and leaving nurses with 'the unenviable task of policing the policy'.

CPNA 'remains to be convinced' of the benefits of compulsion, and the King's Fund is concerned about 'human rights implications'.

NSF is to consult its 13,000 members on compulsory treatment orders, which Mind has opposed from the outset.

The controversy highlights a gulf between the government's statements stressing that service users should 'play an active part' in care processes - and its dogged determination to introduce compulsory treatment orders.

That debate peaked at Mind's annual conference last month, when a speech by junior health minister John Hutton met anger from delegates.

Two service users resigned from sub-groups of the government's external reference group on the national service framework for mental health.

Since last week's announcement a third service user - UK Advocacy Network co-chair Ethna Kilduff - has 'suspended' UKAN's involvement in the work.

Service user groups also claim that plans to appoint two service users to the government's mental health act review group were recently ditched following their premature disclosure by a mental health charity.

The DoH denies the claims, saying the appointments had not been made and were never planned.

But HSJ sources blame a 'charged' and 'sensitive' atmosphere surrounding policy making for the apparent u-turn.

The review group's other attempts at involving service users have been equally peremptory.

Chair Professor Genevra Richardson launched a consultation last month by warning service users of the review's 'particularly tight remit' and the need for 'careful consideration' of laws regarding compliance.

She also admitted that the group was working to a 'very short time-scale' - with a deadline of 8 January for comments.

Matt Muijen, director of the Sainsbury Centre for Mental Health, warns against 'rushing' legislation to meet 'pressures set by a government agenda'.

He says: 'It would be dangerous to be too simplistic. If it is done fast it could be done very badly - and this legislation could be with us for the next 30 years.' See Politics, page 19.