National mental health director Professor Louis Appleby has ordered the NHS to take 'immediate action' to meet targets for zero suicides on acute psychiatric wards by the end of March 2002.

But mental health experts and managers have warned that bringing the number of suicides down from about 60 a year will require fundamental changes, which trusts may struggle to achieve.

Professor Appleby is targeting the commonest means of suicide on mental health wards - hanging from bed frames, and shower and curtain rails. 'Collapsible rails are readily available, so there is no reason for this to continue.

'It is a simple fact that there are far too many suicides on acute psychiatric wards, at least 60 a year, many of which are avoidable.'

Following the announcement last week, he wrote to all regional offices requesting that detailed action plans to improve ward safety be in place by the end of November.

Eastern regional office head of mental health Graham Shelton said the drive against inpatient suicide was 'absolutely necessary', and the timescale 'manageable'. Trusts had been given a 'clear message' that they should rush through improvements, which had been packaged with longer-term modernisation plans.

But Mr Shelton warned that Professor Appleby was only encouraging the service to make simple changes which would not by themselves eradicate suicide.

'He is asking very specifically about fixed points and curtain rails. But there are other factors - such poor ward environment and staffing levels - that can contribute to a person taking their own life.'

Chris Heginbotham, chief executive of Eastern regional specialised services commissioning, said anti-suicide action would have to be 'rolled out' to different settings, since 'relatively few patients kill themselves on wards'.

'The problem we had in my last patch (East and North Hertfordshire health authority, where he was chief executive until last month) was largely suicides among patients who were considered fit to go on home leave, or were allowed to leave the ward.The way to deal with that is to have very much better risk-management arrangements.'

Mr Heginbotham admitted he did not know whether wards in East and North Hertfordshire had collapsible rails: 'It's one of the things you somehow take for granted. It seems so simple you expect trusts to have done it.'

The Sainsbury Centre for Mental Health senior adviser Dr Andrew McCulloch said the high suicide rate among mental health inpatients was 'one symptom of a bigger quality problem on acute psychiatric wards. It goes beyond suicide.'

He said: 'In my view (zero suicides on wards) is unrealistic.'